Problems with solutions: drowning in the brine of an inadequate knowledge base

Background & aims:We undertook a telephone questionnaire to determine curre nt fluid prescribing practices and relevant knowledge among surgical prereg istration house officers (PRHOs) and senior house officers (SHOs) working i n 25 British hospitals. Methods, One hundred PRHOs were surveyed within 10 days of starting their f irst job (Group A). Fifty other PRHOs were surveyed 6-8 weeks after startin g their first job(Group B) along with 50 surgical SHOs (Group C). Outcome m easures included responsibility for prescribing, knowledge of the compositi on of common intravenous fluids and the principles governing their use. Results: PRHOs were responsible for prescribing in 89% of instances. Only 5 6% of respondents stated that fluid balance charts were checked on morning ward rounds. Less than half were aware of the sodium content of 0.9% saline or the daily sodium requirement. Although potassium supplements were usual ly correct, 25% of respondents prescribed two or more litres of 0.9% saline per day, which is far in excess of normal requirements. Although SHOs were more confident (P<0.0001), there was no significant difference between the three groups for most responses. Conclusions: Inadequate knowledge and suboptimal prescribing of fluid and e lectrolytes is common. Undergraduate and postgraduate training in this basi c patient management skill needs improvement, with particular emphasis on t he practical aspects. (C) 2000 Harcourt Publishers Ltd.