Physician awareness of fluid volume administered with intravenous antibiotics - a structured interview-based study.

Abstract

Objective: Fluids administered as drug diluents with intravenous (IV) medicine constitute a substantial fraction of fluids in inpatients. Are physicians aware of fluid volumes administered with IV antibiotics for patients with suspected infections? Does addressing this lead to adjustments in 24-hour fluid administration/antibiotics?

Methods: This cross-sectional interview-based study was conducted in three emergency departments. Physicians were interviewed after prescribing around-the-clock IV antibiotics for ³24 hours to patients with suspected infection. A structured interview guide assessed the physicians' awareness, considerations, and practices when prescribing IV antibiotics. The 24-hour antibiotic fluid volume was calculated.

Results: We interviewed 100 physicians. The 24-hour fluid volume administered with IV antibiotics was 400mL (interquartile range: 300-400). Totally, 53% of physicians (n=53) were unaware of the fluid volume administered with IV antibiotics. 76% (n=76) did not account for the antibiotic fluid volume in the 24-hour fluid administration. 96% (n=96) indicated that they would not adjust prescribed fluids after receiving information about 24-hour antibiotic fluid volume administered for their specific patient; no comorbidities associated with fluid intolerance was primary reason for not adjusting prescribed fluids/antibiotics. 79% (n=79) opted for visibility of fluid volumes administered with IV antibiotics in the medical record.

Conclusion: The majority of physicians were unaware of fluid volumes administered as a drug diluent with IV antibiotics. The majority chose not to make post-prescribing adjustments to their planned fluid administration; they regarded their patient as fluid tolerable. The physicians opted for visibility of fluid volumes administered as diluents during the prescribing process.