Impact of a Treatment Guide on Intravenous Fluids in Minimising the Risk of Hospital-Acquired Hyponatraemia in Denmark
Sindahl, Per; Overgaard-Steensen, Christian; Wallach-Kildemoes, Helle; De Bruin, Marie Louise; Kemp, Kaare; Gardarsdottir, Helga
(2023) Journal of Clinical Medicine, volume 12, issue 15
(Article)
Abstract
Hypotonic intravenous (IV) fluids are associated with an increased risk of hospital-acquired hyponatraemia, eventually leading to brain injury and death. We evaluated the effectiveness of a treatment guide to improve prescribing practices of IV fluids. We conducted a before-and-after cross-sectional survey among physicians working at Danish emergency departments. The primary
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outcome was prescribing practices of IV fluids. Participants were asked which IV fluid they would select in four clinical scenarios. We applied multivariate logistic regression models to estimate the odds ratio of selecting hypotonic fluids. Secondary outcomes included knowledge about IV fluids and hyponatraemia, and the receipt, reading, and usefulness of the treatment guide. After the intervention, about a third (47/154) reported that they would use hypotonic fluids in patients with increased intracranial pressure, and a quarter (39/154) would use hypotonic maintenance fluids in children, both of which are against guideline recommendations. A total of 46% selected the correct fluid, a 3% hypertonic saline solution for a patient with hyponatraemia and severe neurological symptoms. None of the knowledge questions met the predefined criteria of success of 80% correct answers. Of the respondents, 22% had received the treatment guide. Since the implementation failed, we recommend improving distribution by applying methods from implementation science.
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Keywords: drug regulation, fluid therapy, hyponatraemia, intravenous fluids, medication errors, patient safety, pharmacovigilance, prescribing practice, risk minimisation, General Medicine
ISSN: 2077-0383
Publisher: MDPI AG
Note: Funding Information: The authors declare no conflict of interest. At the time of the project, M.L.D.B. was employed by the Copenhagen Centre for Regulatory Sciences (CORS). CORS is a cross-faculty university-anchored institution involving various public (the Danish Medicines Agency, Copenhagen University) and private stakeholders (Novo Nordisk, Lundbeck, Ferring Pharmaceuticals, LEO Pharma) as well as patient organisations (Rare Diseases Denmark). The centre is purely devoted to the scientific aspects of the regulatory field and has a patient-oriented focus, and the research is not a company-specific product or directly company related. In the last five years, CORS has received funding from Novo Nordisk, Lundbeck, Ferring Pharmaceuticals and LEO Pharma for projects not related to this study. Currently, M.L.D.B. and H.G. are employed by Utrecht University and conduct research under the umbrella of the Utrecht-WHO Collaborating Centre for Pharmaceutical Policy and Regulation. This Centre receives no direct funding or donations from private parties, including the pharma industry. Research funding from public–private partnerships, e.g., IMI, the Escher Project ( http://escher.lygature.org/ , accessed on 8 September 2022), is accepted under the condition that no company-specific product or company-related study is conducted. The Centre has received unrestricted research funding from public sources, e.g., the World Health Organisation (WHO), the Netherlands Organisation for Health Research and Development (ZonMW), the Dutch National Health Care Institute (ZIN), EC Horizon 2020, the Dutch Medicines Evaluation Board (MEB) and the Dutch Ministry of Health. None of the abovementioned companies had any involvement in the current study. Publisher Copyright: © 2023 by the authors.
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