Appropriateness of intravenous fluid prescriptions
Abstract:
Background: Inappropriate use of intravenous (IV) fluids results in fluid overload, electrolyte disturbances, and increased costs.
Aim: To describe IV fluid prescribing and its appropriateness in hospitalised patients.
Method: A point prevalence study was conducted at two sites (academic and general) of a tertiary care hospital in Belgium. All inpatients (except those in the operating theatre) and all IV fluids prescribed during a 24-h period were analysed. Data collected included type, rate and volume administered. Each IV fluid was classified by indication (i.e., resuscitation/replacement, maintenance, catheter patency management, drug administration). Appropriateness was assessed using predefined criteria and validation by attending clinicians.
Results: IV fluids were administered to 60% (297) of patients, with a median of 3 [IQR 0.5-6] IV fluid bags per patient and a median daily volume of 1000 ml [IQR 100-1550]. Amongst the 1162 IV fluid prescribed bags, 61.2% (712) were for drug administration, 22.1% (257) for catheter patency, 9.7% (112) for maintenance and 7.1% (82) for replacement/resuscitation. Inappropriate use was found for 56.9% (169) of patients with an IV fluid, representing a median volume of 300 ml per patient [IQR 10-500], and median costs of 4.60 € per patient [IQR 0.4-6.7].
Conclusion: Inappropriate IV fluid use is frequent in hospitalised patients, and results in significant costs. Optimisation strategies are needed.
Reference:
Sneyers B, Nyssen C, Bulpa P, Michaux I, Lacrosse D, Dubois PE, Rotens T, Spinewine A. Appropriateness of intravenous fluid prescriptions in hospitalised patients: a point prevalence study. Int J Clin Pharm. 2024 Nov 11. doi: 10.1007/s11096-024-01816-9. Epub ahead of print. PMID: 39527169.