title: Improving surgical intravenous fluid management: a controlled educational study.
abstract: BACKGROUND
  This study aims to measure whether the introduction of a multifaceted, evidence-based, educational intervention will improve both intravenous (i.v.) fluids prescribed by doctors and administrated by nurses.
  
  
  METHODS
  A daily baseline audit of i.v. fluid prescription and administration for colorectal inpatients was carried out at two Auckland teaching hospitals over 4 weeks. The educational intervention was then administered at hospital 1, while at hospital 2 nurses and junior doctors were merely informed of the audit. The educational intervention included a lecture, multiple posters around the wards and pocket i.v. fluid protocols for junior doctors. Data collection continued for a further 4 weeks at both sites.
  
  
  RESULTS
  The study included 513 days of i.v. fluids received by 109 patients at the two sites. At hospital 1 following the intervention, there was an improvement in the number of correct prescriptions of maintenance i.v. fluids from 21% to 62% (P < 0.001). There were also improvements in the number of patients who received correct administration of i.v. maintenance fluids from 26% to 57% (P < 0.001), gastric loss i.v. replacement from 61% to 93% (P < 0.001) and bowel loss i.v. replacement fluids from 59% to 85% (P = 0.004). None of these measures improved at hospital 2.
  
  
  CONCLUSIONS
  At baseline, both prescription and administration of i.v. fluids were poor. A multifaceted educational intervention, involving teaching sessions with handouts, pocket-sized cards and posters visible on the wards, has brought improvements to both the prescription and administration of i.v. fluids in patients managed by colorectal surgeons.
authors.affiliation: Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Vaishnaavi
authors.initials: V
authors.lastname: Gnanasampanthan
authors.forename: Lauren
authors.initials: L
authors.lastname: Porten
authors.forename: Ian
authors.initials: I
authors.lastname: Bissett
mesh_terms: D004502:Education, Medical, Continuing / Q000379:methods*; D004509:Education, Nursing, Continuing / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D005440:Fluid Therapy / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007262:Infusions, Intravenous / Q000592:standards*; D008297:Male; D008485:Medical Audit; D009520:New Zealand; D017410:Practice Guidelines as Topic; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D058996:Quality Improvement; D016037:Single-Blind Method
keywords: fluid management; intravenous; protocol