RESUMEN
Aims: Intravenous fluid prescriptions are common in hospitals and most are written by junior doctors. Despite the frequency in which clinicians prescribe IV fluids, the burden from mortality and morbidity related to IV fluids is huge with an estimate that 1 in 5 patients are harmed by inappropriately prescribed fluids. We wished to identify the deficiencies in foundation year 1 doctors’ (FY1s, first year of clinical practice after graduation) knowledge and practice of IV fluid prescribing and to identify barriers to good prescribing practice that they had encountered on the wards. FY1s are in their first year of internship after graduating from medical school and this UK experience may be mirrored across the world. Study Design: A prospective, mixed methods study was carried out, using questionnaires, educational interventions and post-interventional evaluation. Place and Duration of Study: Royal Liverpool & Broadgreen University Hospitals NHS Trust, Prescott Street, Liverpool, UK. The study took place over 2015. Methodology: A 53 point questionnaire was designed and used to sample data. An educational intervention was designed after a gap analysis and post-intervention sampling to assess the efficacy of the interventions was also carried out. Results: Significant deficiencies were revealed in the ability to prescribe maintenance fluids. 33% of doctors (n = 8) had not read any guidance about IV fluid prescribing. 42% (n = 10) of participants adhered to fluid prescribing guidance. 17% (n=4) doctors stated that they did not know the contents of fluid bags they prescribed. Only 25% (n = 6) of first year residents indicated that they adhered to weight based prescribing and 4% and 16% felt they at times prescribed too much sodium or water, or too little potassium, for maintenance. Most residents (92%, n=22) reported checking patient’s latest urea and electrolyte values prior to prescribing IV fluids and 54% (n=13) indicated that they reviewed the patient clinically prior to prescribing fluids, However, 67% (n = 16) reported not documenting IV fluid therapy and fluid status in the case notes. The analysis of the narrative data showed system barriers, such as nurses not weighing patent weight, as contributing to the deficiencies in prescribing correctly. The intervention was successful in reversing the deficiencies to a large extent. However cultural and system barriers were also identified. Conclusion: Cultural and system barriers are significant in any learning and need to be taken into account when designing healthcare improvements.
RESUMEN
Introduction：There are large Pacific island communities in western and south-western Sydney, New South Wales, Australia. In 2011 and 2012, measles outbreaks disproportionally affected children and youth within these communities. The objectives of this study were to explore barriers to immunization in a Pacific island community from the perspectives of community members and health professionals and to conduct a pilot programme whereby immunization catch-up clinics were held in a Samoan church in western Sydney.Methods：Interviews were conducted with Pacific island community members (n = 12) and health professionals connected with the Pacific island community (n = 7) in 2013. A partnership with a local Samoan church was established to provide an accessible venue for immunization catch-up clinics.Results：Among the community members there were high levels of belief in the importance of immunization and a positive view regarding the protection offered by immunization. A key barrier reported by community members was being busy and therefore having limited time to get children immunized. The important role of the church within the community was emphasized in the interviews, and as a result, two immunization catch-up clinics were held in a Samoan church in western Sydney. The age range of attendees was 7–33 years. A total of 31 measles, mumps and rubella doses and 19 meningococcal C doses were given during the two clinics.Discussion：The outcomes of the interviews and the subsequent clinics highlighted the potential of churches as a venue for providing public health interventions such as catch-up immunization.