Guidelines on correct completion of fluid balance charts'

1
Guidelines on correct completion of fluid balance
charts.

• Practice Development Team.

2
Aims and outcomes of session.

• Aim
• To instruct staff in the correct completion of
  the fluid balance charts according to Trust
  guidelines.

• Outcomes
• Demonstrate the ability to correctly complete and
  calculate a fluid balance chart with the use of a
  clinical scenario.
• Explain the need for correct and accurate
  completion to colleagues in the clinical
  environment.

3
1.Confirmation when to chart data.

• If IV fluids via normal giving set, charted as
  name of fluid and when due.
• DO NOT chart the quantity of fluid to be infused.
• At 06.00, 12.00, 18.00 and 24.00hrs chart the
  amount of fluid that has been titrated and add to
  running total. Also chart on completion.

4
Cont-

• On completion of the bag, double lines should be
  drawn below to indicate completion.
• If IV fluids are given via infusion pump, it must
  be recorded hourly and added to running total.
• Chart to go with patient to theatre and recovery
  staff to complete with a cumulative total.

5
Agreed heading of columns.

• Both input and output columns have blank
  headings, this is to allow for wide diversity of
  needs throughout clinical areas.
• Each clinical area responsible for deciding
  format of columns according to need.

6
Cont-

• Awareness that all forms of input and loss need
  to charted, especially IV drugs and enteral
  feeds.
• IV Drugs are mixed with a fluid medium and
  potentially can increase input by a large amount.

7
Confirmation of standardised values.

• Now agreed standardised quantities of certain
  fluids on guidelines for chart. E.g. cup sizes.
• Other fluids have quantity indicated on
  packaging.

8
Importance of urine and running totals.

• There is now a running balance that MUST be
  completed.
• If patients are catheterised and do not require
  frequent measurements, the agreement with
  Infection control is to empty and chart 12 hourly.

9
Cont-

• Clinical judgement is required to indicate if
  measurements need to be more frequent i.e.
  hourly.
• Average acceptable urine output is 0.5mls/kg/hr
  i.e. for a 60kg patient it would be 30mls.
• Required to maintain functions of kidneys.

10
Need for registered nurse signature.

• Any healthcare professional can complete chart.
• Responsibility of trained nurse to sign at
  indicated 6 hourly intervals.
• Enable assessment of fluid status and
  identification of potential problems.
• Drs can be contacted and review treatment in the
  day wherever possible.

11
Need for 24 hour view.

• Ensure patients balance is transferred from
  previous day.
• Weight important as this can be a better
  indication of fluid imbalances.
• Completion of 24 hour running total charts is
  essential including a cumulative review.
• Charts MUST be filed in patient notes.

12
Conclusion.

• The fluid chart monitors patient fluid status. It
  is a legal and professional requirement to
  complete this accurately.
• NMC guidelines for records and record keeping.
  Page 9
• NMC code of professional conduct 4.4 and 4.5
• There is no excuse for omission!!

13
Recent fluid chart audit

• Ward 7, 1Z, 3X
• All less than 33 completed fluid balance
  charts!!!
• Discuss..