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Should oral fluids be prescribed to at risk patients in hospital?
Recent news stories have highlighted problems with dehydration in hospitals. NHS Kidney Care recently launched the Hydration Matters campaign to encourage staff to better monitor and manage inpatients’ fluid status. It aims to remind all healthcare staff that monitoring fluid status and ensuring correct hydration should be an essential core component of care for all patient.
Should oral fluids be considered a “treatment” and prescribed for patients are risk of hydration? Who should be responsible for prescribing and monitoring intake?
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Readers' comments (19)
cheryl wilson | 9-Jul-2012 11:00 am
do you mean " at risk of dehydration " ? para 2
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Anonymous | 9-Jul-2012 11:34 am
"Should oral fluids be prescribed to at risk patients in hospital?"
sadly, if this is the only way they are going to get the fluids they need.
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Anonymous | 9-Jul-2012 4:10 pm
If oral fluids are prescribed won't there be a danger that patients will only be given drinks at the prescribed time.
For goodness sake, this is basic stuff that everyone should know. We all need water to survive, god help us if nurses don't know how to recognise dehydration.
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Anonymous | 10-Jul-2012 9:00 am
NO! Most drinks are given by students, HCAs or domestic staff. If they were prescribed they'd have to be given by nurses at set times, and the patients might not necessarily feel thirsty at that time. And the doctor will have to prescribe them too, and some doctors can be a pain to get hold of. And what do you mean "at-risk"? Everyone can be dehydrated of they don't drink!
Even in the recent news about the young man who died because he was given no water... as the drug round wasn't done he would still have been withheld water and would have dried to death
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Anonymous | 10-Jul-2012 10:14 am
Patients (if able) and nurses are responsible for ensuring patients drink enough fluids.
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Jane Ingram | 10-Jul-2012 3:01 pm
It is a nurse's responsibility to ensure the patient is sufficiently hydrated and this duty can be delegated. However, if the nurse cannot be bothered, then we have no choice but to prescribe fluids to prevent deaths.
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Anonymous | 10-Jul-2012 3:12 pm
If nurses cannot be trusted to carry out their duties then other stricter measures, perhaps with penalties, have to be taken.
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Anonymous | 13-Jul-2012 6:38 pm
Do we not have fluid balance charts anymore? Many years on night shift, it was my job to add these up and report any imbalance at handover for the vulnerable patients (mainly elderly and those with IVIs or Catheters).
If fluids refused (as is the patient's right) - this used to be logged on the chart as well.
Its very basic - or am i missing something?
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Jason Woods | 14-Jul-2012 2:31 pm
This is an issue about basic patient care. We need to instill into all nurses the need for fluid intake of all patients be they young middle aged or elderly. Its the basics of training that is lacking here.
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Carol Ellison | 14-Jul-2012 3:49 pm
If basic nursing care is so difficult to achieve in hospitals today why not develop a new role; that of the 'Basic Care Specialist'. This could be an HCA who has undertaken extra training and who is given a band 3/4 in accordance with the importance of the role. What better way to demonstrate to patients and staff the committment of the NHS to ensure basic needs are met. Unfortunately it appears many HCA's as well as registered nurses see this as 'menial' work, when in fact it is the basis of all care given. Provide a patient with good basic care; hygiene, toileting and nourishment, in a compassionate and considerate manner and they can forgive a lot. I am sure most of the complaints received by hospitals begin with failings of basic needs. It IS important so let's show we are doing something about it!
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Anonymous | 14-Jul-2012 5:43 pm
I agree with Jason Woods, making sure patients drink enough fluids is basic stuff. No-one should have to be 'taught' that you need to drink water, it's ridiculous to think that nurses need to be reminded of this.
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Anonymous | 14-Jul-2012 9:48 pm
Nurses are at risk of dehydration too. How often do we get to drink when we need to? And when we do finally have a drink, how often do we stop ourselves from passing water when we need to? My local continence service informed me that nurses have a high rate of bladder problems in later life due to repeatedly delaying micturition over time. In the community the risks are higher due to no set break times, no immediate access to toilet facilities.
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Anonymous | 15-Jul-2012 8:36 am
I wondered how long it would take until someone mentioned that nurses get dehydrated too, it's very true. Easy to go through a whole shift without stopping to have anything to eat and drink but I guess we are pretty healthy so our bodies cope with it better than someone who is ill.
Better order the conti-pads now!
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Anonymous | 15-Jul-2012 2:00 pm
It is part of BASIC nursing care to ensure that patients are adequetly hydrated. anyone at risk should be monitored and as required on a fluid chart further more isnt it a SOVA issue.
I do agree with many of the previous writers however when it is stated nurses are at risk.
Time is so precious. many times I have gone home hen having worked a 12 hour shift without a drink/meal break and been told well thats just the way it is !!!
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Anonymous | 15-Jul-2012 3:39 pm
we kept our fluid charts to the strict essential minimum and for as few days as possible as we found the more we had the more filling them in was neglected rendering them worse than useless. In this way we could concentrate on those which were crucial. Many of our patients we weighed daily or less frequently according to their diagnosis and condition and found this to be a more effective, simpler and more accurate means of observation than half completed fluid charts. It was very frustrating for the named nurse who may have been meticulous in recording accurately to return and find the missing quantities when we needed the totals. it was not unknown for one or two colleagues, including the boss, to use a bit of guess work based on the previous pattern to avoid being told off by the doctors, which defeats the object!
we tried imposing different and strict measures on all our colleagues regarding the charts but some were simply better at remembering or more conscientious than others and sometimes we were so rushed off our feet with other priorities we simply did not have the time especially when there was only one member of staff on duty for a few hours. However, our patients were always offered and assisted where necessary with adequate fluids it was just recording each glass which was the problem!
whether pushing or restricting fluids the difficulties in accurate recording were the same.
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Anonymous | 17-Jul-2012 5:27 pm
Hypothetically, if water were to be prescribed, what would the dose be and at what frequency? I know what people will say the quantity is, 1.5 litres. However, this is a falsehood based on an incomplete reading of an article published in the 1940's, the author did state that we require approximately 1 ml of water for each calorie but they went on to say that most of this comes from the food we eat. There is also a falsehood that states we are already dehydrated if we feel thirsty. Fluid charts are fine to measure gross quantities of fluid lost through micturarion, vomiting etc, but they cannot quantify fluid lost through breathing or sweating.
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redpaddys12 | 18-Jul-2012 0:39 am
Anon 5.27
Insensible loss
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Anonymous | 21-Jul-2012 1:54 am
Sadly after the death of the young man in a hospital setting for want of a drink, yes it looks like they do need to be prescribed!
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Anonymous | 8-Nov-2012 10:17 pm
If prescribing is the only way in which patients can be adequately hydrated in hospital, then we should just do it. Patients have suffered enough because some nursing staff haven't the intelligence to see that this is essential care.
I've got an elderly friend in hospital right now with a heart problem and his wife has to go in twice a day to make sure he gets fed and given something to drink. She realised that he simply wasn't being helped at all unless she did this. She's not strong enough to cope with getting him showered and shaved, but has to nag & coax the nursing staff to help him do this. They're quite happy to leave a bowl with a few inches of tepid water on his table and leave him to try to wash his face and hands, but otherwise seem to ignore his needs for hygiene unless she raises the question. Goodness knows what would happen to him if he had no sharp eyed relatives living locally!
I am not proud to be a nurse right now.
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