ArticleBMJ open quality2017
Optimisation of intravenous fluid prescribing: framework for changing practice through education and audits.
Article in BMJ open quality, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 11 citations in OpenAlex.
- Knowledge, Attitudes, and Practices Regarding Intravenous Fluids Among Physicians in the West Bank of Palestine: A Cross-Sectional Study.Health science reports · 2026Article
- Sink or swim: Making sense of the NICE intravenous fluid guidelines as a Foundation Year Doctor.Clinical medicine (London, England) · 2026Article
- Physician awareness of fluid volume administered with intravenous antibiotics: a structured interview-based study.Clinical and experimental emergency medicine · 2025Article
- Article
- Are Further Interventions Needed to Prevent and Manage Hospital-Acquired Hyponatraemia? A Nationwide Cross-Sectional Survey of IV Fluid Prescribing Practices.Journal of clinical medicine · 2020Article
- Fluency training in medical education: Improving competence in IV fluid therapy knowledge and skills.MedEdPublish (2016) · 2019Article
Corrections and comments
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Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIntravenous fluids are one of the most commonly prescribed drugs in the hospital setting and yet the practice continues to fall short of National Institute for Health and Care Excellence (NICE) guidelines, with significant gaps in staff knowledge exposing patients to heightened morbidity and mortality.
aimFollowing the 2013 publishing of updated NICE guidelines on intravenous fluid prescribing, an intravenous fluid team was formed within the Royal Liverpool University Hospital (RLUH). Their role has been (and continues to be) to overhaul the culture of suboptimal intravenous fluid prescribing within the hospital and, ultimately, to improve patient outcomes. A framework to engender this change has been developed and is offered as an example to other Trusts within which improvement of guideline-compliant intravenous fluid prescribing remains stagnant.
methodThere have been three principal stages of the project to this point which are best demonstrated in a chronological manner. The period of 2010-2014 allowed for assessment of the issue of intravenous fluid prescribing and analysis of its causes through serial audits and a staff-wide survey. From 2015, there has been implementation of several measures (educative, managerial, administrative and technological) within the hospital to foster reproducible and positive change with regards to intravenous fluid prescribing. Finally, between 2016 and 2017, three cycles of a rolling audit based on NICE guidelines have been completed to allow measurement of improvement in intravenous fluid prescribing practice.
conclusionResults have demonstrated a significant improvement in the appropriateness of the intravenous maintenance and replacement fluids prescribed in the hospital since the March 2016 audit. Moreover, a 29-fold increase has been observed in the use of 4% dextrose/0.18% sodium chloride as maintenance fluid (gold standard as per NICE guidelines) since the staff-wide survey of 2015. Despite progress however, adherence to NICE guidelines remains below the recommended 100% and therefore further work remains to be done.
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