Fluid Chart Research Articles

Improving the Quality of Old Age Inpatient Ward Rounds During COVID-19 in NHS Lanarkshire, Scotland

AimsTo provide a structured Multidisciplinary team (MDT) checklist to improve the quality of ward rounds in Ward 3, Wishaw General hospital. Ward rounds normally involved patient and electronic documentation review during MDT. Feedback from medical and nursing staff indicated inconsistencies in finding up to date Do not resuscitate cardiopulmonary resuscitation (DNACPR)forms/Treatment escalation plans, treatment forms, care plans, thromboembolism prophylaxis during ward rounds. Discussions about who will update the family, make social work referrals needed clear documentation in order to follow up efficiently post MDT. Food, fluid, and weight charts although done regularly there was no single place to keep them together. These charts to be kept in a separate folder for finding easily during ward rounds. The Royal College of Psychiatrists sets standards that managers and practitioners have agreed standards for ward rounds. Structured ward rounds and check lists have shown to prevent omissions in care and improve patient safety.MethodsDiscussions with Ward 3 team, nursing colleagues and ward Quality improvement group were held. A Standard MDT Quality improvement Checklist was devised and used as a Pilot in W3, WGH.This was first introduced in August 2021. Plan, do, study, act (PDSA) cycle was carried out.Plan: Trial MDT checklist at Ward 3 ward RoundDo: Use Initially for two Consultant ward roundsStudy: Ask all MDT staff members for feedback on the formAct: Reformat the checklist for the following ward rounds and distribute among all consultants.Repeated Revisions of MDT checklist done after feedback from ward staff and final version devised and results audited in Nov 2021 and Jan 2022.Food, Fluid, and weight charts were put in separate folders.ResultsBefore MDT Checklist nil up to date MDT checklist information available, 10% individual food and fluid charts and 0% folders.After MDT checklist in November 2021, 73% increase in up-to-date checklist items, 100% increase in finding charts in folders.In January 2022 decrease to 44% of up-to-date MDT checklist items, 100% food and fluid charts in folders.ConclusionMDT Checklist provided robust structure to our Ward rounds along with the regular electronic record and has been incorporated in our shared drive. The results in January for up-to-date checklist were down because of staff sickness due to new Omicron variant and less people available to keep documentation up-to-date.

Management of urinary incontinence in athletic women: the POsITIve feasibility study

ObjectivesTo investigate the feasibility and acceptability of conducting a future trial of physiotherapy to manage urinary incontinence (UI) in athletic women. DesignFeasibility study with nested qualitative interviews. SettingCommunity clinics: university and private. ParticipantsAdult women who i) lived locally, ii) provided informed consent iii) self-reported UI iv) exercised at high/moderate intensity for over 150 minutes and over three times a week. InterventionsUp to seven sessions of tailored physiotherapy delivered over 6-months. Despite some variation in prescription and progression, all programmes included elements of pelvic floor muscle training undertaken in clinic and at home. Main outcome measuresRecruitment, eligibility of those screened, consent, data completion and attendance rates: assessed to determine feasibility of progression to a definitive trial. The acceptability of specific outcome measures, the intervention and of randomisation within a future trial was also examined. ResultsDirect recruitment of athletic women from sporting venues was feasible and acceptable. Most women not only consented to an intimate examination as part of the assessment, but described this as an important part of the intervention. Attendance rates and data completion was generally high but the return of 3-day fluid charts was poor: this was also reflected in comments by participants that these were difficult to incorporate into daily life. The addition of a smartphone app to aid motivation and monitoring was welcomed but further education in its use may enhance compliance. ConclusionsDirect recruitment from sporting venues was acceptable and feasible. Women valued assessment and treatment for UI. Clinical Trial Registration NumberNCT03986411.

129 Compliance with The ERAS Protocol Amongst Colorectal Surgery Junior Doctors at Gloucester Royal Hospital

Abstract Background Enhanced recovery after surgery (ERAS) is an evidence-based protocol aiming to expedite recovery following elective surgical procedures. ERAS has shown to reduce the length of hospital stay, complications, readmissions, and costs. The junior doctor’s role in ERAS centres around admission, preoperative nutritional care, and ERAS compliance. This audit aimed to review prescribing of perioperative nutritional drinks (NutriciaPreop© and Fortisips) and intravenous fluids for patients undergoing elective colorectal surgery at Gloucester Royal Hospital. Method An 80% standard was set for this audit. A full audit cycle was completed. Drug and intravenous fluid charts were analysed for correct prescribing of NutriciaPreop© and intravenous fluids pre-operatively, and peri operative Fortisips. Improvement measures included ward posters and education to incoming junior doctors. Results Initial data collection showed that 70% of patients received a correct intravenous fluid prescription pre-operatively. 24% of patients were prescribed NutriciaPreop© and 18% were prescribed Fortisips. During re-auditing intravenous fluids were correctly prescribed in 80% of patients, NutriciaPreop© in 67% of patients and Fortisips in 60%. Conclusions This audit emphasises the importance of good quality inductions for junior doctors and how simple measures improve prescribing of essential peri-operative nutrition. Additionally, the value of multidisciplinary team involvement in junior doctor training has been highlighted.

5 Quality Improvement Project (QIP): A Teamwork Approach to Optimise Fluid Intake in Older Inpatients #ButFirstADrink

Abstract The shortfalls of hydration management have been widely exposed since the Frances report in 2013. Age-related changes create challenges for people to drink adequate fluid amounts (Nazarko, 2018), making dehydration prevention in older people an ongoing public health priority (NICE, 2016). Hydration needs of older people are complex and may not be fully understood. A proactive MDT approach to facilitate regular drinking opportunities seems an achievable solution to increase hydration awareness, knowledge and daily fluid intake in older inpatients. A QI methodology was used, including stakeholder engagement and PDSA learning cycles to influence, engage and educate staff on hydration management. Outcome measures: Fluid intake (ml/day), number of drinks/days based on fluid balance chart recordings. Interventions: Sharing the #ButFirstADrink social media hydration movement, which includes educational posters, flyers and a YouTube video. Face to face drop-in education sessions were implemented using local hydration education resources from Age UK Salford and GM nutrition and hydration programme as teaching tools. SPC charts were used to show a time-series data. In 15 weeks, 461/525 fluid charts were reviewed from 169 patients. Mean age was 84 years and 68% females. Average daily fluid intake increased by 25% (exceeding aim) indicating 176mls more fluid was offered on average/day. Mean number of drinks/days increased from 4.6 to 6 post interventions. Knowledge and attitude improved in some areas; however fluid output is not routinely recorded. Post intervention, 89% of staff felt that offering a drink at first contact is a suitable hydration promotion campaign. The project scored 58% using the NHS sustainability model (ACT Academy, 2018) suggesting reason for optimism. As it is a behaviour change project, further engagement and momentum is dependent on ongoing enthusiasm to drive the #ButFirstADrink approach. This intervention is free, simple and innovative and stimulates behaviour change, raises drinking awareness and increases hydration.

Surgical Fluid Prescribing: When Are the Last Orders?

IntroductionInappropriate fluid prescriptions result in excess morbidity and mortality in surgical patients. The majority of prescriptions are done by foundation year one doctors (FY1s) despite repeated evidence of poor knowledge and prescription habits among them when it comes to prescribing fluids.Materials and methodsThis was a retrospective observational study conducted at a 798-bed district general teaching hospital. Data for one year from an out-of-hours (OOHs) electronic task record system was extracted. An analysis was performed on all surgical ‘Fluid Reviews’ jobs recorded in the period from August 1, 2018, to August 7, 2019.ResultsDuring the 371-day study period, 1,283 requests for fluid reviews were made. Of these, 1,228 (95.7%) were assigned to the FY1 and 1,185 (92.3%) were requested by nurses. There was a mean of 3.5 ±2.1 requests per day. A bimodal distribution of requests was noted with peaks at 1900 and 2400. There was no discernible variation between different days of the week.ConclusionFluid reviews were most frequently requested by nursing staff at times that coincide with their handover and the commencement of a new fluid chart at midnight. Reducing the number of inappropriate requests for fluid reviews may reduce the opportunity for inappropriate fluid prescribing. Improvements could be achieved through interventions in the ward rounds and by encouraging a multidisciplinary approach to education on fluid prescribing. Reducing the number of fluid prescriptions OOHs promotes continuity of care and education through patient follow-ups.

Modification of Fluid Balance Chart for Nurses to Monitor Fluid Volume Disturbance in Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Hematopoietic stem cell transplantation involves the intravenous infusion of autologous or allogeneic stem cells to reestablish hematopoietic function in patients whose bone marrow or immune system is damaged. This study aimed to modify the fluid balance chart for nurses to monitor fluid volume disturbance in patients undergoing hematopoietic stem cell transplantation. Design: A prospective, single - centered research design was utilized in this study. Setting: The study was conducted at the Bone marrow transplantation unit at South – Egypt Cancer Institution. Subject: A purposive sample of 25 adult conscious patients undergoing stem cell transplant, from both sexes and age range between (20 – 65years).Tools: three tools were used; a structured interview questionnaire, modified fluid balance chart, and a fluid volume disturbance monitoring sheet. Results: There was a statistically significant difference between the modified and routine fluid charts regarding the mean amount of daily fluid balance (10750.00 ± 409 ml) and (8333. 63 ± 388 ml) respectively with (P.value = 0.001). Conclusion: modification of fluid balance chart has a great effect on accurate monitoring of the fluid intake, output, and fluid volume disturbances.

Improving intravenous fluid prescribing in the Eastern Cape in South Africa

Intravenous fluids are an essential component of patient care, but a 2013 National Institute for Health and Care Excellence (NICE) guideline noted that inappropriate prescribing or administration may lead to...

Goal-directed fluid therapy in urgent GAstrointestinal Surgery—study protocol for A Randomised multicentre Trial: The GAS-ART trial

IntroductionIntravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration...

Disorders of Water Balance Following Sellar and Suprasellar Surgeries: Patterns, Determinants and Utility of Quantitative Analysis.

Background and Objective:The primary objective of this study was to evaluate the application of principles of quantitative analysis to assess disorders of water balance following surgeries for sellar and suprasellar masses and also to investigate potential factors influencing the occurrence and course of these disorders.Materials and Methods:A total of 36 consecutive adult patients who underwent surgery for sellar and suprasellar masses between 2014 and 2015 were prospectively followed up in this observational study. Twenty-one patients had complete laboratory parameter records for quantitative analysis. Clinical parameters, daily fluid balance, and sodium balance were calculated based on the fluid chart and the estimation of sodium concentration of fluids and urine. Classical Edelman equation was used to predict the sodium values. Time course of these disorders and association with etiological and other clinical parameters were assessed. Standard institutional protocol was used in the management of patients studied.Results:Comparison between predicted values of quantitative analysis and observed values of sodium showed that 80-95% of the observed readings on various days showed concordance with calculated reading, with <5% error. 77.7% manifested at least one episode of dynatremia relating to water balance disorder during the postoperative period. Postoperative diabetes insipidus (DI) observed in 58% of patients, whereas syndrome of inappropriate antidiuretic hormone secretion observed in 47% of patients. Both DI and SIADH in different time points were noticed in 28%, and classical triple phase response was seen in 2.7%. Nearly 83% manifested one episode of dynatremia relating to water balance disorder during the post-operative period. Prolonged DI was noted in 11% and no case of cerebral salt wasting was observed in any of the patients studied.Conclusion:We observed high degree of correlation between the predicted and observed sodium values. Quantitative analysis in the management of patients with disorders of water balance in postsurgical settings in neurosurgery has the potential for improving clinical care.

The effect of oral versus intravenous fluid therapy on maternal and neonatal outcomes for women with oligohydramnios

Background Oligohydramnios may increase the perinatal morbidity and mortality rate and is associated with adverse fetal outcomes. Aim The aim of this study was to assess the effect of oral versus intravenous fluid therapy on maternal and neonatal outcomes for women with oligohydramnios. Study design This was a quasi-experimental study model. Setting Th study was conducted at a high-risk pregnancy department at a specific private hospital in El-Mansoura City, Egypt. Participants and methods A purposive sample of 45 pregnant women with oligohydramnios was included in the study, and the women were divided equally into three groups, with 15 women per each group: the first group was administered intravenous (i.v.) isotonic solution, second group was administered i.v. hypotonic solution, and the third group was administered oral water. Data were collected during the period of 6 months from the first of December 2016 to the end of August 2017. Tools Four tools were used to conduct this study: maternal characteristics questionnaire, sonographic report for measuring amniotic fluid index (AFI) in oligohydramnios women before and after hydration, fluid chart, and maternal and neonatal assessment sheet. Results The AFI was significantly increased from 0.35±0.07 to 1.7±0.5 in the i.v. isotonic group whereas the AFI was significantly increased from 0.37±0.08 to 1.9±0.9 in the i.v. hypotonic group. Moreover, the AFI was more markedly increased from 0.37±0.07 to 2.7±0.8 in the oral water group. The maternal and neonatal outcomes did not differ significantly among the groups but were more markedly increased in the oral water group. Conclusion Oral hydration is as effective as intravenous hydration in significantly increasing the AFI in the third trimester oligohydramnios. The AFI was more markedly increased in the oral water. Maternal and neonatal outcomes did not differ significantly among the groups. Recommendations Oral hydration is recommended for pregnant women with oligohydramnios till delivery.

Effectiveness of a fluid chart in outpatient management of suspected dengue fever: A pilot study.

IntroductionDengue infection is the fastest spreading mosquito-borne viral disease in the world. One of the complications of dengue is dehydration which, if not carefully monitored and treated, may lead to shock, particularly in those with dengue haemorrhagic fever. WHO has recommended oral fluid intake of five glasses or more for adults who are suspected to have dengue fever. However, there have been no published studies looking at self-care intervention measures to improve oral fluid intake among patients suspected of dengue fever.ObjectiveTo assess the feasibility and effectiveness of using a fluid chart to improve oral fluid intake in patients with suspected dengue fever in a primary care setting.MethodsThis feasibility study used a randomized controlled study design. The data was collected over two months at a primary care clinic in a teaching hospital. The inclusion criteria were: age > 12 years, patients who were suspected to have dengue fever based on the assessment by the primary healthcare clinician, fever for > three days, and thrombocytopenia (platelets < 150 x 109/L). Both groups received a dengue home care card. The intervention group received the fluid chart and a cup (200ml). Baseline clinical and laboratory data, 24-hour fluid recall (control group), and fluid chart were collected. The main outcomes were: hospitalization rates, intravenous fluid requirement and total oral fluid intake.FindingsAmong the 138 participants who were included in the final analysis, there were fewer hospital admissions in the intervention group (n = 7, 10.0%) than the control group (n = 12, 17.6%) (p = 0.192). Similarly, fewer patients (n = 9, 12.9%) in the intervention group required intravenous fluid compared to the control group (n = 15, 22.1%), (p = 0.154). There was an increase in the amount of daily oral fluid intake in the intervention group (about 3,000 ml) compared to the control group (about 2,500 ml, p = 0.521). However, these differences did not reach statistical significance.ConclusionThis is a feasible and acceptable study to perform in a primary care setting. The fluid chart is a simple, inexpensive tool that may reduce hospitalization and intravenous fluid requirement in suspected dengue patients. A randomized controlled trial with larger sample size is needed to determine this conclusively.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN) Registry ISRCTN25394628 http://www.isrctn.com/ISRCTN25394628

Fluid resuscitation in critically ill patients-timing and dose matters.

Fluid management is a complex subject in healthcare, particularly when pertaining to critically ill patients. Following a literature search on international recommendations regarding fluid administration for shocked patients, an audit was undertaken at Rotorua Public Hospital, New Zealand, to assess how the local fluid resuscitation strategy could be improved. The first part of the audit looked at the fluid resuscitation approach used to treat shocked patients admitted to the ICU of Rotorua Hospital in 2014 and changes required to achieve best practice recommendations. The second part tested the success and impact of the subsequently implemented, more measured approach to fluid resuscitation in 2016. Data was extracted from patient files, fluid charts and electronic records to assess fluid administration and de-escalation measures. The collated information was analysed and compared to recommendations found in the literature. The complete audit cycle revealed not only a significant improvement in adherence to best practice guidelines, but also an association with better patient outcomes.

The Impact of Intravenous Protocols During Labor on Maternal \ Newborn Outcomes

common practice in labor. Adequate rehydration has shown a reduction in labor duration. However results of other trials proposed that labor duration could be decreased by administering IV fluids at a rate of 250ml/hr which is better than giving such fluids in a rate of 125ml/hr. Aim: Thus, the aim of the current study was to assess the effect of three protocols of intravenous fluids on the progress of labor and newborn weight loss during the first week post partum. Design: A descriptive Correlation research design was adopted. In this study in order to investigate the research hypothesis. Sample: A convenient sample of 150 laboring women (divided to 50 each group) was selected. Partograph, fluid chart and baby weight and diaper sheet was used to collect the data. Setting: The study was conducted at the labor room in two Egyptian governmental hospitals. You can submit your Manuscripts at: https://symbiosisonlinepublishing.com/submitManuscript.php

Impact of an education session on clinical handover between medical shifts in an emergency department: A pilot study.

To evaluate the impact of a medical education session on the implementation of a new change of shift medical clinical handover format in an urban hospital ED. This pilot study used a pre- and post-intervention design. The intervention consisted of a 1 h education session to teach a new handover format, SBARM (Situation, Background, Assessment, Recommendation, Medication). Data were collected through observations of doctors performing clinical handover and individual interviews with participants. The educational intervention led to an increased focus on checking medication charts, but had minimal effect on changing other aspects of clinical handover at doctors' change of shift times. Perceived increased time spent on handover using the new system was seen as a major barrier to the implementation of SBARM. The addition of 'M' to 'SBAR' heightened awareness of checking medication and fluid charts. Time pressures need to be taken into consideration when introducing changes to current processes. Also, it is recommended that, in addition to ongoing education, senior clinicians are engaged during the planning and execution stages of changes to practice.

A nurse-led intervention improves detection and management of AKI in Malawi.

Acute kidney injury is common and has significant impact on mortality and morbidity. There is a global drive to improve the lack of knowledge and understanding surrounding the recognition, diagnosis and management of patients with AKI in resource poor healthcare systems. We propose a nurse-led education programme to medical and nursing staff of the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, will improve the overall care and understanding of patients with AKI that will still be effective 3 months later. This was a three phase, prospective interventional pilot study which evaluated base line knowledge and clinical practice amongst healthcare workers, provided a comprehensive combination nurse-led class room and ward based teaching programme and evaluated the change in knowledge and clinical management of patients in the high dependency areas of the hospital immediately, and 3 months, after the teaching intervention. The nurse-led intervention significantly improved the healthcare workers attitudes towards detecting or managing patients with suspected AKI (p < 0.0001). There were also significant improvements in the completion of fluid charts and recording of urine output (p < 0.0001), corner stones of AKI management. Knowledge and clinical intervention was still present three months later. There was however little change in the understanding that AKI could be a significant clinical problem in QECH and that it may have a major impact on mortality and working practice and this needs to be addressed in future teaching programmes. A low cost, nurse-led AKI educational intervention improved the knowledge and management of AKI at QECH, which was still evident 3 months later.

Prevalence and Hospital Management of Amphotericin B Deoxycholate-Related Toxicities during Treatment of HIV-Associated Cryptococcal Meningitis in South Africa.

BackgroundWe aimed to establish the prevalence of amphotericin B deoxycholate (AmBd)-related toxicities among South African patients with cryptococcosis and determine adherence to international recommendations to prevent, monitor and manage AmBd-related toxicities.MethodsClinical data were collected from cases of laboratory-confirmed cryptococcosis at 25 hospitals, October 2012 –February 2013. Anemia was defined as hemoglobin (Hb) concentration <10 g/dl, hypokalemia as serum potassium (K) <3.4 mEq/L and nephrotoxicity as an increase in serum creatinine (Cr) to >1.1 times the upper limit of normal. To determine adherence to toxicity prevention recommendations, we documented whether baseline Hb, K and Cr tests were performed, whether pre-emptive hydration and IV potassium chloride (KCl) was administered prior to 80% and 60% of AmBd doses and whether daily oral KCl supplementation was given ≥60% of the time. To determine adherence to monitoring recommendations, we ascertained whether a daily fluid chart was completed, Hb was monitored weekly and K or Cr were monitored bi-weekly.ResultsOf 846 patients, clinical data were available for 76% (642/846), 82% (524/642) of whom received AmBd. Sixty-four per cent (n = 333) had documented baseline laboratory tests, 40% (n = 211) were given pre-emptive hydration and 14% (n = 72) and 19% (n = 101) received intravenous and oral KCl. While on AmBd, 88% (n = 452) had fluid monitoring; 27% (n = 142), 45% (n = 235) and 44% (n = 232) had Hb, K and Cr levels monitored. Toxicities developed frequently during treatment: anemia, 16% (86/524); hypokalemia, 43% (226/524) and nephrotoxicity, 32% (169/524).ConclusionAmBd-related toxicities occurred frequently but were potentially preventable with adequate monitoring, supplemental fluid and electrolyte therapies.

Assessment of a Self-Reported Drinks Diary for the Estimation of Drinks Intake by Care Home Residents: Fluid Intake Study in the Elderly (FISE).

We evaluated the accuracy of a newly developed self-completed Drinks Diary in care home residents and compared it with direct observation and fluid intake charts. Observational study. Residential care homes in Norfolk, UK. 22 elderly people (18 women, mean age 86.6 years SD 8.6, 12 with MMSE scores <27). Participants recorded their own drinks intake over 24 hours using the Drinks Diary while care staff used the homes' usual fluid intake chart to record drinks intake. These records were compared with drinks intake assessed by researcher direct observation (reference method), during waking hours (6am to 10pm), while drinks taken from 10pm to 6am were self-reported and checked with staff. Drinks intake assessed by the Drinks Diary was highly correlated with researcher direct observation (Pearson correlation coefficient r=0.93, p<0.001, mean difference -163ml/day) while few staff-completed fluid charts were returned and correlation was low (r=0.122, p=0.818, mean difference 702ml/day). The Drinks Diary classified 19 of 22 participants correctly as drinking enough or not using both the European Food Safety Authority and US recommendations. The Drinks Diary estimate of drinks intake was comparable with direct observation and more accurate (and reliably completed) than staff records. The Drinks Diary can provide a reliable estimate of drinks intake in elderly care home residents physically and cognitively able to complete it. It may be useful for researchers, care staff and practitioners needing to monitor drinks intake of elderly people, to help them avoid dehydration.

Clinical Assessment of Fluid Balance is Incomplete for Colorectal Surgical Patients.

Fluid balance for the surgical patient has been proven very important for the postoperative outcome and development of complications. The aim of this study was to evaluate, for the first time in modern times, the accordance between nurse-based fluid charting (cumulated fluid balance) and body weight change for general surgical patients. This was a descriptive study with prospectively collected data from two clinical randomized multicenter trials. A total of 113 patients from American Society of Anesthesiology group I-III undergoing elective colorectal surgery were included. Cumulated fluid balance and body weight change were charted preoperatively and daily at the same time during a postoperative period of 6 days. Differences were calculated by subtracting cumulated fluid balance from body weight change (1 g = 1 mL), and agreement was assessed by making Bland-Altman plots as well as Pearson correlations. From day 1 to 4, the mean difference between cumulated fluid balance and body weight change was below 0.4 kg/L. On day 5 and 6, the discrepancies increased with mean differences of, respectively, 1.2 kg/L (p < 0.002*) and 2 kg/L (p < 0.0001*). Bland-Altman plots showed increasingly poor agreement for all postoperative days with wide limits of agreement, ranging from more than 6 kg/L to almost 10 kg/L. Pearson correlations were moderate to strong at all times ranging from 0.437 (day 1) to 0.758 (day 4). The accordance between cumulated fluid balance and body weight change for colorectal surgical patients is relatively good for the first four postoperative days, however, with large uncertainty, whereas on the fifth and sixth postoperative day, the discrepancy is statistically and clinically significant. The fluid chart cannot stand alone in interpretation of the patient's fluid balance; body weight and clinical judgment is indispensable.

Is National Emergency Access Target dumbing down emergency physicians?

Is National Emergency Access Target dumbing down emergency physicians?

G311(P) Improving paediatric oncology supportive care in a resource-limited setting: focus on neutropaenic sepsis

BackgroundOur institution is the only tertiary paediatric oncology centre serving a low-income country with a population of over 35 million. Outcomes are limited by social factors, material resources and shortages...