Adequacy of fluid balance chart documentation on wards

Aims

To to ensure that fluid balance charts are completed adequately for clinicians to compose safe management plans for patients.

Methods

This is a retrospective audit against a standard adapted from an NHS trust guideline. The standards audited against were (1) oral fluids to be documented in mL, (2) IV fluids to be documented in mL, (3) fluid output to be documented in mL, and (4) documentation of receptacle emptying. Data collection involved review of fluid balance charts on two surgical wards over five randomly chosen days in December 2014 and data were analysed on MS Excel.

Results

The audit found an overall of 52% of fluid balance charts that were inadequately completed. Oral and IV fluid input were 94% and 98% compliant respectively, with only 50% compliance in fluid output. Recording whether receptacles were emptied was done particularly poorly, with 23% compliance to the standard.

The audit provided the following recommendations for quality improvement, all of which were implemented: (1) educate staff about the importance of fluid balance record-keeping in patient care, (2) provide accessible guidelines for staff to use on the wards, (3) re-audit.

The re-audit involved the same method. Following the audit recommendations, the re-audit results showed a remarkable improvement, with inadequately completed charts dropping to 38%. Fluid input and output records were 100% and 62% compliant respectively, with an improvement to the recording of receptacle emptying at 64%.

Conclusions

Standardised and unambiguous documentation of fluid balance is a key part of managing patients. The education and training of both doctors and nurses, along with clear guidelines, can greatly improve the documentation and management of fluid balance. Hence, it is vital that staff involved in the care of patients understand the reasons why recording fluid balance is important, thereby maintaining a high standard of care as well as patient safety.