Abstract
Introduction
Dehydration is the most common fluid and electrolyte imbalance in older adults; hospitalised older adults with markers of dehydration have mortality rates of 45% (Hodgkinson B et al, 2003). The current method of measuring fluid intake on wards is to record this hourly on fluid balance charts however this is often poorly documented (Jeyapala S et al, 2015). We wished to improve the accuracy of recording the oral fluid intake of older adults by introducing a simplified bedside chart which could identify those at risk of dehydration.
Methods
Using PDSA methodology, a team of doctors directly observed and recorded the oral fluid intake of patients in a 6-bed bay on an older persons’ ward for 8 continuous hours. The collected data was compared to that recorded on pre-existing fluid balance charts. A new bedside fluid intake chart was then introduced; this laminated chart included example volumes of common drink receptacles and used ‘ticks’ to record each time fluid was consumed. A repeat PDSA cycle was performed with a second observation day. Guided interview qualitative methodology was used to obtain feedback from nursing staff.
Results
The mean difference in observed fluid intake versus charted fluid intake prior to intervention was 287.50ml (SD = 152.27, n = 6) and 95ml post intervention (SD = 94.21, n = 5). Analysis with an unpaired two sample t-test demonstrated a significant difference (p = 0.0367). Qualitative feedback from nursing staff reported it to be easier to use and more likely to be correctly completed.
Conclusion
The redesigned fluid intake chart led to statistically significant improvements in the accuracy of recording fluid intake. A further PDSA cycle across a whole ward will inform feasibility on a larger scale of early identification of dehydration. The tool may also allow assessment of the effectiveness of hydration aids.