A Clinical Audit on Appropriateness of Intravenous Fluid Prescribing Practices in Hospitalized Adult Inpatients: Evaluating Compliance with National Guidelines

Background: Intravenous (IV) fluid therapy is a routine yet critical aspect of inpatient care, essential for maintaining fluid and electrolyte balance. However, inappropriate prescribing can result in significant morbidity. Aim: To assess appropriateness of IV fluid prescribing practices among adult inpatients at Lady Reading Hospital, Peshawar & evaluate compliance with NICE CG174 guidelines. Methods: A retrospective audit was conducted over six months (January–June 2024). Data were collected from 200 randomly selected patient records across general medicine, surgery, and orthopedics departments. A structured tool based on NICE guidelines was used to evaluate key parameters such as initial fluid assessment, documentation, reassessment, and fluid type. Data were analyzed using SPSS version 25. Results: Only 48% of IV fluid prescriptions were fully compliant with NICE guidelines; 35% were partially compliant, and 17% were non-compliant. Documentation of initial assessment occurred in 70% of cases, while ongoing reassessment was documented in just 49%. General Medicine showed the highest compliance (55%), and Orthopedics the lowest (38%). Normal Saline was the most frequently prescribed fluid (65%). Conclusion: The audit reveals suboptimal adherence to national guidelines, with notable interdepartmental variation. Targeted interventions, including staff training and standardized protocols, are recommended to enhance safe and effective fluid prescribing practices. Keywords: Intravenous fluid therapy, clinical audit, prescribing practices, guideline compliance