Dr. Marcia McDougall is Fluid Lead for NHS Fife and consultant in Anaesthetics and Intensive Care at the Victoria Hospital, Kirkcaldy, Fife, Scotland.
Marcia became interested in fluid prescribing after hearing Professor Dileep Lobo speak about the subject in 2008. He focused on the harm that may be caused, particularly to the elderly, by poor prescribing practice, usually secondary to inadequate education for prescribers. Marcia led the introduction of NHS Fife Guidelines for Intravenous Fluid and Electrolyte Prescription in May 2012, based on the GIFTASUP Guidelines and later the NICE Guidelines for Intravenous Fluid Therapy in Adults in Hospital. She is clinical lead for the Scottish National Intravenous Fluid Improvement Programme. NHS Fife employed Scotland’s first Quality Improvement Nurse for Fluid Management in 2013; now most hospitals in Scotland employ a dedicated member of staff to develop fluid stewardship, funded initially by the Scottish Government. Along with colleagues from the Fife fluid team, Marcia recently published a paper detailing the biochemical effects of the changes in fluid use in NHS Fife. This showed that use of the guidelines is safe, sustainable and economical, but considerable effort is required to maintain appropriate education. https://bmjopenquality.bmj.com/content/11/1/e001636.full