Surgical Fluid Prescribing: When Are the Last Orders?

Introduction Inappropriate fluid prescriptions result in excess morbidity and mortality in surgical patients. The majority of prescriptions are done by foundation year one doctors (FY1s) despite repeated evidence of poor knowledge and prescription habits among them when it comes to prescribing fluids. Materials and methods This was a retrospective observational study conducted at a 798-bed district general teaching hospital. Data for one year from an out-of-hours (OOHs) electronic task record system was extracted. An analysis was performed on all surgical ‘Fluid Reviews’ jobs recorded in the period from August 1, 2018, to August 7, 2019. Results During the 371-day study period, 1,283 requests for fluid reviews were made. Of these, 1,228 (95.7%) were assigned to the FY1 and 1,185 (92.3%) were requested by nurses. There was a mean of 3.5 ±2.1 requests per day. A bimodal distribution of requests was noted with peaks at 1900 and 2400. There was no discernible variation between different days of the week. Conclusion Fluid reviews were most frequently requested by nursing staff at times that coincide with their handover and the commencement of a new fluid chart at midnight. Reducing the number of inappropriate requests for fluid reviews may reduce the opportunity for inappropriate fluid prescribing. Improvements could be achieved through interventions in the ward rounds and by encouraging a multidisciplinary approach to education on fluid prescribing. Reducing the number of fluid prescriptions OOHs promotes continuity of care and education through patient follow-ups.