Evidence map›Paper›PMID 35115322›Full record

ArticleBMJ open quality2022

Introducing NICE guidelines for intravenous fluid therapy into a district general hospital.

Marcia McDougall, Bruce Guthrie, Arthur Doyle, Alan Timmins, Meghan Bateson, Emily Ridley, Gordon Drummond, Thenmalar Vadiveloo

Registry-linked trialOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open quality, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05964283 (Physician Knowledge Level of Intravenous Fluid Therapy in Hospitals), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.3field-weighted citation impact, top 22% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05964283 completednot on this mapstarted 2023, after this paper: background citation

Physician Knowledge Level of Intravenous Fluid Therapy in Hospitals: A Cross-Sectional Study

TypeobservationalSponsorIndonesia UniversityRan2023 to 2024Enrolled372ConditionsKnowledge Level, Intravenous Fluid TherapyArmsQuestionnaire
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

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  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 1 country.

Marcia McDougallDepartment of Anaesthesia, Victoria Hospital, Kirkcaldy, UK.
Bruce GuthrieUniversity of Edinburgh, Community Health Sciences, Edinburgh, Midlothian, UK.ORCID 0000-0003-4191-4880
Arthur DoyleRenal Unit, Queen Elizabeth University Hospital, Glasgow, UK.
Alan TimminsPharmacy Department, Victoria Hospital, Kirkcaldy, UK.
Meghan BatesonInstitute of Healthcare Policy and Practice, University of the West of Scotland, Blantyre, South Lanarkshire, UK.
Emily RidleyAnaesthesia, Victoria Hospital, Kirkcaldy, UK.
Gordon DrummondEdinburgh Medical School, The University of Edinburgh, Edinburgh, UK g.b.drummond@ed.ac.uk.ORCID 0000-0002-7038-1887
Thenmalar VadivelooHealth Services Research Unit, School of Medical Sciences, University of Aberdeen, Aberdeen, UK.
Victoria Hospital · GBUniversity of Edinburgh · GBQueen Elizabeth University Hospital · GBUniversity of Aberdeen · GBUniversity of the West of Scotland · GB

Funding

Chief Scientist Office HSRU1
6 · The paper itself

Abstract

backgroundNational Institute for Health and Care Excellence (NICE) guidelines on intravenous fluid prescribing for adults in hospital, issued in 2013, advised less use of 0.9% sodium chloride than current practice, provided a logical system for prescribing and suggested further study of electrolyte abnormalities.

aimsTo describe the steps taken to establish and monitor guideline introduction and to assess effects on clinical biochemistry results, in a general hospital setting.

methodsWe used established principles of change to modify education, teaching, record keeping and audit throughout the hospital, changed the availability of intravenous fluid preparations in the wards and monitored the use of intravenous fluids. We anonymously linked local clinical chemistry records to nationally available patient records (NHS Scotland SMR01). We chose specified medical emergencies, and major emergency and elective general and orthopaedic surgery, where management would require intravenous fluids, for a two-phase cross-sectional study between 2007 and 2017, spanning the change in prescribing. Primary outcomes were abnormal bicarbonate, sodium, potassium and incidence of acute kidney injury (AKI), and secondary outcomes were mortality and length of stay.

resultsOver the study period, sodium chloride 0.9% use decreased by 75%, and overall intravenous fluid use decreased from 0.65 to 0.40 L/occupied bed day. The incidence of acidosis decreased from 7.4% to 4.8% of all admissions (difference -2.7%, 95% CI -2.1 to -3.0). No important changes in other electrolytes were noted; in particular, plasma sodium values showed no adverse effects. Stage 1 AKI increased from 6.7% to 9.0% (difference 2.3%, 95% CI 1.6 to 3.0), but other causes for this cannot be excluded. Mortality and length of stay showed no adverse effects. CONCLUSIONS AND IMPLICATIONS: Effective implementation of the guidelines required substantial time, effort and resource. NICE suggestions of fluid types for maintenance appear appropriate, but prescribed volumes continue to require careful clinical judgement.

Indexed as

Acute Kidney InjurySodium ChlorideAdultCross-Sectional StudiesFemaleFluid TherapyHospitals, GeneralHumansMaleSodium Chlorideclinical practice guidelineshealth professions educationquality improvement

Identifiers

PMID35115322
PMCPMC8814811
OpenAlexW4210698199

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.