Pharmacist intervention to enhance postoperative fluid prescribing practice in an Iraqi hospital through implementation of NICE guideline

Keywords: Fluid Therapy, Body Weight, Electrolytes, Guideline Adherence, Professional Practice, Pharmacy Service, Hospital, Pharmacists, Prospective Studies, Iraq

Abstract

Objective: The objectives of this study were to evaluate the current practice of postoperative fluid prescribing and assess the effectiveness of pharmacist-led intervention in the implementation of the National Institute of Health and Care Excellence (NICE) fluid therapy guideline in an Iraqi hospital.

Methods: The prospective interventional study was conducted at AL-Hilla Teaching Hospital, Babylon, Iraq between November 2017 and July 2018. The study included two phases: The pre-intervention phase with 84 patients and the post-intervention phase with 112 patients. A pharmacist provided training and educational sessions for the hospital physicians and pharmacists about the NICE guideline of fluid therapy. The researcher calculated the amount of given post-operative fluids and compared to the NICE guideline and also measured the patients’ body weight, serum Na, K and creatinine pre-and post-operatively.

Results: The pre-intervention phase showed no correlation between the amounts of prescribed fluids and body weight which caused increases in patients’ body weight. In pre-intervention phase, 6% of patients experienced hyponatremia, 19% had hypernatremia and 7.1% had hypokalemia. In the post-intervention phase, abnormal level of electrolytes and patient weight gain decreased significantly. Additionally, the intervention led to a strong correlation between body weight and amount of prescribed fluids in addition to lowering the incidence of electrolyte disturbances.           

Conclusions: A high proportion of patients in the pre-intervention phase experienced fluid overload, weight gain and electrolyte disturbances when fluid therapy was not prescribed in accordance with the NICE guidelines. The pharmacist-led intervention increased the surgeon awareness of the proper use of the NICE guideline which decreased the incidence of fluid-related complications and the inconsistency of fluid prescribing. Pharmacists can play a critical role to enhance post-operative fluid prescribing and minimize fluid-induced complications.

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Published
2019-08-29
How to Cite
1.
Abbood SK, Assad HC, Al Jumaili AA. Pharmacist intervention to enhance postoperative fluid prescribing practice in an Iraqi hospital through implementation of NICE guideline. Pharm Pract (Granada) [Internet]. 2019Aug.29 [cited 2019Nov.22];17(3):1552. Available from: https://pharmacypractice.org/journal/index.php/pp/article/view/1552
Section
Original Research