Abstract
IntroductionPrescribing intravenous (IV) fluid therapy is a core skill expected of qualified doctors at the point of graduation, but medical graduates often feel ill-equipped to perform this task. This lack of preparedness contributes to treatment-related patient harm. This scoping review maps the current state of published evidence about how junior doctors prescribe IV fluid therapy and learn how to do it.MethodsWe searched five electronic databases and grey literature from 1994 until June 2016 for articles describing any aspect of IV fluid prescribing practice or its education. A total of 63 articles were selected for analysis. Using the WHO Guide to Good Prescribing to categorize the extracted findings, our review focuses on prescribing IV fluids in adult generalist settings.ResultsMost articles studied IV fluid prescribing from the perspective of the doctor. Junior clinicians struggled to conceptualize IV fluid prescribing as a ‘whole task’ in authentic work settings and lacked support. Educational interventions to improve IV fluid prescribing often focused on enhancing prescriber knowledge about fluid and electrolyte balance rather than execution of the prescribing task.ConclusionsOur understanding of IV fluid prescribing as a holistic integrated skill is patchy, as is its performance. Current IV fluid prescribing education appears insufficient to foster safe and effective practice. For education to achieve the ultimate goal of safer prescribing in workplaces, we need a clearer understanding of how healthcare professionals prescribe IV fluids in real world practice.Electronic supplementary materialThe online version of this article (10.1007/s40037-017-0386-5) contains supplementary material, which is available to authorized users.
Highlights
Prescribing intravenous (IV) fluid therapy is a core skill expected of qualified doctors at the point of graduation, but medical graduates often feel ill-equipped to perform this task
Novice clinicians are responsible for most prescribing of intravenous (IV) fluids in hospital settings
Understanding how doctors prescribe IV fluids and learn how to do it will aid the preparation of learners, but the extent of evidence describing such practices is not known. This exploratory literature synthesis describes the activities doctors employ while prescribing IV fluids, summarizes the nature of educational initiatives implemented to improve fluid prescription quality and proposes topics for future educational research and development
Summary
Prescribing intravenous (IV) fluid therapy is a core skill expected of qualified doctors at the point of graduation, but medical graduates often feel ill-equipped to perform this task. This lack of preparedness contributes to treatment-related patient harm. This scoping review maps the current state of published evidence about how junior doctors prescribe IV fluid therapy and learn how to do it. Preparing new graduates to prescribe IV fluids is, of urgent concern to patients, practitioners, educators and those responsible for patient safety
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