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08-11-2017 | Review Article | Uitgave 6/2017 Open Access

Perspectives on Medical Education 6/2017

Learning to prescribe intravenous fluids: A scoping review

Tijdschrift:
Perspectives on Medical Education > Uitgave 6/2017
Auteurs:
Richard F. R. McCrory, Gerard Joseph Gormley, Alexander Peter Maxwell, Tim Dornan
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s40037-017-0386-5) contains supplementary material, which is available to authorized users.

Abstract

Introduction

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.

Methods

We 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.

Results

Most 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.

Conclusions

Our 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.
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