How can nurses improve fluid management and reduce the risk of dehydration?

Readers' comments (18)

• Anonymous | 9-Jul-2012 5:36 pm

  Maybe an extra member of staff per shift whose only role is to ensure at risk patients are given drinks and maintain fluid charts.

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• Anonymous | 10-Jul-2012 1:40 pm

  Maybe graft on a couple of sets of arms, that stretch around corners. That way I could feed at risk patients, while toileting another, and keeping the charts up to date.

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• Anonymous | 14-Jul-2012 5:44 pm

  How about nurses and assistants think about their patients and how they must be feeling. We all know how horrid it is to have a dry mouth. It doesn't take much to pour out a drink or make a cup of tea.

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• Anonymous | 14-Jul-2012 10:07 pm

  Compulsory 3 hourly drink rounds. Staff made available to help those who cannot lift a drink off the table or who need thickener mixing into their drink. Despite being a post P2000 nurse, I can see the benefit of the "traditional" way of nursing in the hospital - set times for "routine/fundamental" task. The whole set of the hospital only lends itself to this type of nursing.

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• Anonymous | 14-Jul-2012 11:17 pm

  won't giving drinks be included in Mr Cameron's rounding scheme?

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• Anonymous | 15-Jul-2012 8:40 am

  there is much to be said for task orientated nursing, there is a lot of opposition to it when people wanted individualised patient centred care but it worked. Patients who are perceived to be 'independent' can get overlooked.

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• Anonymous | 15-Jul-2012 9:01 am

  I think common sense and discretion will be required for 'independent' patients. some may welcome the extra attention whereas others could find it very irritating that their personal preferences and responsibility are being questioned and may feel they are being patronised and treated like a child. In some cases this can lead to anger and aggression.
  
  Just generally chatting to the patient and good old fashioned observation should help give tell tale signs if anything is wrong or if the patient is becoming dehydrated or malnourished during their hospitalisation.
  
  Depressed mood and debilitation can remove their incentive to take adequate fluids and food and this can set up a vicious circle but any nurse or other individual on the ward should be able to detect this and offer assistance or report it to the trained staff.
  For this group of patients it should be made sure they have at their disposal sufficient to meet all of their nutritional and hydration needs.

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• amina duale | 15-Jul-2012 11:20 pm

  reduce the necessary paper work and give us the time to cater for those we are suppose to serve the needy patient not creating rotas, filling agency worker time sheets or the delivery man invoice notes and collecting the pharmacy plus mar charts of which i think can be done by the manager who sits and has all the time in her office

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• Anonymous | 16-Jul-2012 7:57 am

  It should not be difficult to identify those patients who require assistance or encouragement to drink/eat. Many of these people will be elderly and may be suffering the effects of dementia.
  
  Developing a care plan to meet these patients needs, similarly should not be difficult.
  
  Implementing the care plan on an acute ward may pose difficulties i the face staff shortages or lack of patient co-operation.
  
  In the case of staffing deficiency a report Must be made on every occasion nurses are unable to full-fill their patients identified needs.
  
  If a lack of patient co-operation prevents nurses full-filling the patients needs this must be documented on each occasion such a lack of co-operation is experienced.
  
  In the case of patients suffering dementia it can sometimes be of assistance to encourage someone who knows the paient well to assist with feeding and hydration.
  

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• Anonymous | 16-Jul-2012 8:31 am

  do you really need a care plan to give a patient and fellow human being a drink? perhaps you need to spend time making a nursing diagnosis as well and even confirm it with a medical diagnosis? During the time spent on this taxing mental exercise several patients could have been given drinks - but obviously too busy, not time!
  

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• Anonymous | 17-Jul-2012 11:14 am

  To anon 16 Jul 8.31 am: you are right of course. But, unless there is a system in place people are going to get missed when wards/units are run with bare minimum of staff/over use of agency staff/staff sickness etc etc. In one nursing home I worked in we were allocated ever morning 1 RGN, 4 HCAs and one "spare" HCA; the latter whom organised, gave out drinks and helped people who couldn't pick up a drink themselves. If and when other members of staff were free they would also help. This "spare" member of staff was also responsible for ensuring that residents clothes were put in the right room and in the cupboards/drawers. They were also on hand for other duties such as answering the phone, answering call buttons. The other 4 HCAs worked in pairs to assist residents out of bed, have a wash, have breakfast and, later, to have lunch. The RGN was responsible for all medication, care planning/reviewing, recording of daily care given, dealing with queries, GP rounds, supervising HCAs and monitoring patient's conditions. It was a regimented system but it worked. Those patients that died, did so because of deterioration in known, long term medical conditions, not from dehydration. But it has to be said we had a good staff to patient ratio and good management who had high standards but who also supported staff to both maintain and improve their standards of care. Staff knew what was expected of them. There wasn't a high turnover of staff or patients which made life easier for everyone. I can imagine in an area of high turnover of both patients and staff the opposite would be true. At the heart of any effective ward or nursing unit, is effective leadership. Whilst most nurses and HCAs are trustworthy, hard working and able to do their jobs with minimum supervision, we still need someone at the helm to oversee and implement necessary changes, checks etc. As others have rightly pointed out, effective leadership does not mean merely saying yes to everything that is demended via higher management who seem to be yes people to the DOH.
  
  

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• Anonymous | 17-Jul-2012 8:01 pm

  People need fluids to survive. Give patients plenty of drinks - tea, coffee, milk, water - whatever they want - that is our job, to make sure patients are comfortable, fed and watered.
  
  It is not rocket science. Make patients a drink. It is not up for debate.

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• Anonymous | 17-Jul-2012 9:09 pm

  Anonymous | 17-Jul-2012 8:01 pm
  
  you can offer patients fluids and help them to drink if they need it but you cannot make to anybody drink as you suggest, especially against their will. your treatment above sounds coercive and what of patients on fluid restrictions this also needs to be known by everybody on the ward so that they don't push fluids on a patient which would be harmful.

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• redpaddys12 | 18-Jul-2012 1:27 am

  Shouldn't the title have the word 'patients' in it somewhere? Perhaps before the question mark?
  What is wrong with a jug of water in the am, with a freshen up at 2 with the afternoon meds, and tea with every meal (not coffee, its horrid), cocoa for the non-diabetics pre-bed. Note, at major mealtimes and when you give the meds.
  Unless your hospital has a contract any one of a number of outside catering companies who provide work for people whose 4th language is English, but they're still thick in their first, to dish out and collect back in, uneaten, from the table out of the reach of the bedbound patient in the sideroom, unable to call for help because some heartless shit has left the buzzer wrapped around the arrest bell.

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• Anonymous | 18-Jul-2012 8:20 am

  I don't know why the NHS and the British in general make everything so complicated.
  
  In my European University hospital one of our HCAs went round with a trolley at 7.30 am, mid-morning, just after lunch, mid-afternoon, and after supper around 7 pm. On the trolley were Thermos flasks containing freshly brewed black tea and a choice of herbal teas, litre bottles of still and sparkling mineral water which were distributed to all those not on fluid restrictions in the morning and replaced as required. those on restrictions were given the required quantity. Their glasses were exchanged for clean ones and those who needed it had plastic beakers. Some patients had additional fluids such as feeds or fruit juice of which we had a stock or if they were part of their diet they would come on their meal tray. All patients were assisted to drink who needed to be. Also after helping dependent patients with a wash, any care or at meal times they were given assistance to drink.
  Fluid charts were kept to the strict minimum and where possible patients requiring a fluid balance record were weighed regularly instead.
  
  Obviously patients were free to request a Thermos of tea or water at any time and if a nurse, HCA, the ward cleaner or other staff or visitors passed a bed or gave care and noted an empty bottle on a bed locker it would be replaced.
  
  There were coin-operated or token operated drink machines on each floor for coffee and chocolate as well as a kiosk and coffee shop on the ground floor of the hospital for mobile patients, staff and visitors and a machine which distributed cold drinks.
  
  with all these possibilities and vigilance of all the staff there was no excuse for any patient to become dehydrated due to poor or negligent nursing care.

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• Anonymous | 18-Jul-2012 11:51 am

  anon 9.09 - I think you have misinterpreted what I said. I know that you cannot force a patient to have a drink,I'm not in the habit of standing over a patient pouring water down their throats. Perhaps if i used the word 'offer' instead of 'give' then your answer would have been different.
  
  Nursing staff are well aware of monitoring patients fluid intake if they are on a fluid restriction - we can put signs above the beds, write it on the fluid chart and the handover chart and most patients are pretty sensible and know what they have had.
  
  Can I ask what you would do if a patient refused to drink anything and was obviously becoming dehydrated?
  
  

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• Anonymous | 18-Jul-2012 12:30 pm

  Anonymous | 18-Jul-2012 11:51 am
  
  
  "It is not rocket science. Make patients a drink. It is not up for debate."
  
  My apologies, in haste I misread your comment as 'make patients drink'! At which I was naturally shocked and hence my rapid response, albeit an inappropriate one. Usually I am more careful and reflective about responding until I have made sure I have understood, but slipped up this time. I think the first phrase of that paragraph raise the alarm bells and I didn't read on correctly.
  
  as far as your last question, if a patient is unable to drink for any reason or consistently refuses fluids and we haven't managed to find any apparent reason for this (of which there could be very many), or found more attractive alternatives to the drinks on offer, the first recourse would, in my view, be a drip. Any further complications may indicate a NG tube and on rare occasions we have had to use subcutaneous hydration but only if veins are no longer accessible in serious dehydration or towards what is perceived as the end of life. this is usually only a very temporary and short term solution which I do not like as the short s.c. needle or very fine baby venflon becomes easily displaced, is uncomfortable for the patient and the superficial tissues become full of fluid and swell.

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• Anonymous | 19-Jul-2012 5:37 pm

  anon 12.30 - thanks for your apology. We have had many patients who refuse to eat or drink anything despite all our best efforts. It's very difficult to manage or explain to relatives - all suggestions are gratefully accepted. We often get criticised even if we have our patients best interests at heart.

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