2025 Southeastern Residency Conference

TITLE: Impact of Maintenance Intravenous Fluid Prescribing in Hospitalized Patients at a Large Community Hospital During a National Shortage


AUTHORS: Sheniesa N Whitton, Susan E Smith, Sarah L Cassell, W Anthony Hawkins


OBJECTIVE: Evaluate the changes in prescribing practices related to maintenance intravenous fluids (mIVF) during a national shortage


SELF-ASSESSMENT QUESTION: Based on the point prevalence study, how did prescribing practices change during the IVF shortage?
a.MDs were more likely to prescribe IVF
b.IVF were administered with stop dates
c.IVF were ordered with a documented indication
d.All of the above


BACKGROUND: IVF are among the most prescribed therapies in hospitalized patients. Despite their widespread use, inappropriate prescribing of mIVF remains a concern due to its association with adverse outcomes, including fluid overload, electrolyte imbalances, and increased need for invasive interventions.
IVF therapy has evolved into distinct categories, including mIVF, which is administered to meet daily fluid and electrolyte requirements when oral intake is inadequate. However, data on mIVF prescribing patterns in hospitalized patients, particularly during national shortages, remain limited. The study aims to evaluate the impact of mIVF prescribing both before and during a national shortage.


METHODS: This IRB approved, point prevalence study included all hospitalized adult admitted on November 10, 2023 (before the shortage) and October 10, 2024 (during the shortage). Patients were excluded if they received IVF in the intensive care units (ICU) and emergency department (ED). The prevalence of mIVF was calculated by dividing the number of patients receiving IVF < 333 ml/hr by the total number of patients admitted on the dates of interest. The research team defined IVF as a type of crystalloid that does not contain protein and not used as diluent for medications and mIVF as any fluid running at a rate of < 333 mL/hr. Descriptive statistics were used and chi-square and Mann Whitney was used to determine p-value. P- value of < 0.05 suggest statistical significance.


RESULTS: The prevalence of mIVF use was 31.6% during the shortage compared to 30.7% before the shortage, indicating that overall mIVF use remained relatively stable, with a slight increase of less than 1%. Patients during the shortage were significantly more likely to have an indication documented for IVF administration compared to those before the shortage (60.7% vs. 46.3%, p = 0.011). The proportion of patients with a documented stop date for IVF orders was similar across both time points (58.5% vs. 55.9%, p = 0.661). Normal saline remained the most commonly used IVF during both time points (48.9% vs. 48.5%, p = 0.953), followed by lactated Ringer’s (36.3% vs. 44.9%, p = 0.152). The use of half normal saline was significantly more common during the shortage (5.2% vs. 0.7%, p = 0.030). Regarding prescriber type, MDs were the most frequent prescribers of IVF both during and before the shortage (83% vs. 76.5%), followed by nurse practitioners (6.7% vs. 12.5%) and DOs (6.7% vs. 1.5%). The distribution of prescriber types differed significantly between time points (p = 0.009). Most patients receiving IVF were also on a diet, with no significant difference between the two dates (87.4% vs. 88.2%, p = 0.587). The proportion of patients receiving diuretics was lower during the shortage (72.7% vs. 87.5%, p = 0.768), though this was not statistically significant. Loop diuretics were the most commonly used in both groups (4.4% vs. 5.1%, p = 0.364).


CONCLUSION: The overall prevalence of mIVF use remained consistent across both time points, with a slight, non-significant increase during the IVF shortage. This suggests an increased awareness and implementation of fluid stewardship practices. These trends, observed in a large community hospital, highlight the potential impact of supply challenges on clinical behavior and documentation practices.