BALANCING FLUIDS

It is not surprising to find nearly every patient on a ward is on a fluid balance chart.

Even patients who are ambulant and are able to drink and void normally.

It is a ritual that occurs ‘just in case’.

Nurses do many things that are not necessary.

It is easier to carry out a barrage of unnecessary observations in case a question is asked.

Apparently the amount of time wasted doing unnecessary observations is better than not being confident in defending the clinical judgement that the observation is not needed.

In the next breath, it will be argued that there is not enough time in the day to do everything that needs to get done.

The reliability and accuracy of the observations should be questioned when so many patients have unnecessary observations undertaken.

It is possible to look at fluid balance charts and find that no entry has been made for some hours.

The patient is asked what they had to drink and it is dutifully recorded.

Is this accurate?

Is this reliable?

The recollection of a confused patient who is able to pour a drink is neither accurate and reliable.

Neither is measuring the volume of fluid remaining in a water jug.

Who else may have drunk the fluid in the jug?

So nurses measure patient’s fluid intake and output with the expectation that the data collected will be used to determine appropriate fluid management.

But the data is often ignored as inaccurate.

If the data includes the words ‘out to toilet’ and ‘wet bed’ then the fluid balance is inaccurate.

Regular review of fluid balance charts is the first step in improving accuracy.

Stop any unnecessary fluid balance charts.

Essential and accurate charts are better than a large number of inaccurate charts that are incorrectly filled in.

One survey found that the ease of completing fluid balance charts on a scale of 1-10 ranged from 3 to 10.

The average score was 7.4.

Better design of the fluid balance chart would lead to better monitoring.

Fluid monitoring is important and it should be done correctly.

When there is so much time pressure on nurses, it is unnecessary to keep doing charts that are not essential and inaccurate.

To learn more about fluid balance charting:

Jeyapala, Sobanakumari, et al. “Improving fluid balance monitoring on the wards.” BMJ quality improvement reports 4.1 (2015): u209890-w4102. http://qir.bmj.com/content/4/1/u209890.w4102.full

McGloin, Sarah. “The ins and outs of fluid balance in the acutely ill patient.” British Journal of Nursing 24.1 (2015). https://www.ncbi.nlm.nih.gov/pubmed/25541871

Ruxton, Carrie. “Promoting and maintaining healthy hydration in patients.” Nursing Standard 26.31 (2012): 50-56. http://journals.rcni.com/doi/pdfplus/10.7748/ns.26.31.50.s48