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Practice comment

Nurses must ensure patients are weighed on admission to hospital

  • 7 Comments

Nurses rely too heavily on risk assessment, and it is now time to put the art back into nursing through measures such as weighing patients, argues Liz Lees

I believe all patients should be weighed on admission to hospital. The reasons for this were taught in my nurse training (1988–1991), and they remain unchanged, despite the evolution of nursing practice towards a risk assessment culture.

Three main principles form the basis of why we should weigh patients: to monitor the extent of loss in organ function; to judge the effectiveness of medications (mainly diuretics); and to enable calculation of medication dosage.

Nurses reading this will probably cringe at the thought of this potentially old-fashioned, dictatorial approach, but at least it enabled standards to be maintained, albeit in a rather task-allocated way.

I work in an acute medical unit, with emergency admission units embedded as part of the admission process. The focus of nursing practice in the unit involves completing a plethora of assessments to enable nurse decision-making.

Long before such units were established in the early 1990s, full sets of observations, urinalysis and patients’ weight were fundamental to a complete nursing assessment on admission.

It seems that, while assessment units speed up admissions and move patients away from inappropriate waits in A&E, they have contributed towards a reductionist approach. This means nurses doing basic, essential tasks only while patients are in the admissions unit, leaving non-essential tasks until later in their stay.

Practitioners have also rebelled against task allocation and other models of nursing, in favour of individual nursing. Perhaps it is time to re-examine the factors affecting the approaches we use, and reinvigorate the art of nursing.

Nurses carry out many risk assessments and investigations, but weighing patients has slipped out of routine practice, giving way to other aspects of care seen as priorities.

Risk assessments can help to build a profile and do provide objective, measurable data. While nurses complete nutritional screening on all patients, this will not detect all those who need to be weighed – it is a guide and must be treated as such.

Despite improvements in assessments and the focus on risk, the nursing process has become fragmented. Nurses’ knowledge of patients – alongside their judgement, intuition and experience – cannot be replaced by a risk assessment.

Reorganising nursing workload will allow time to be allocated to weighing patients and reassessments.

A key aspect of patient assessment is reassessment and monitoring to ensure relevant and timely actions are taken to improve outcomes. In this case, weighing patients – perhaps weekly after admission – surely cannot be such a bad idea?

Nurses often cite ‘time’ to weigh patients as the inhibiting factor, but they should reconsider their approach to care. Empowering and leading HCAs, who often have more patient contact time than nurses, is an approach that should be used more.

Finally, using models of nursing – such as Roper, Logan and Tierney’s model based on activities of living – also seems to be relegated to the past, ultimately losing the emphasis on structure and organisation of workload.

The particular model used directly supports the nursing process; without this, there will be a degree of ambiguity between different nurses’ approach on different shifts. Reorganising nursing workload will allow time to be allocated to weighing patients and reassessments.

Failure to weigh patients is unacceptable practice and nurses must explore ways of ensuring that patients are weighed as part of the admission process. The art and science of nursing need to be combined for the holistic care of our patients.

Liz Lees is consultant nurse, Heart of England NHS Foundation Trust, Birmingham

Look out for Liz Lees’ blog on putting the art back into nursing, coming soon

  • 7 Comments

Readers' comments (7)

  • Treat every one the same is politically incorrect - not holistic care
    I dont want to be weighed just because it is part of the routine in the ward. As a Nurse I can assess and recognise when weight needs to be a factor for assessment and consideration - I am being sarcastic of course

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  • Ideally, I agree, weighing patients on admission is optimum. However, I work on a very busy trauma unit, where it is often impossible to weigh patients on admission.. have you tried to weigh a patient with a fractured spine, pelvis or neck of femur! This is where risk assessment is key, not because we are bad nurses but because we care about our patients, their diet, pressure area care etc, when we cannot take the easy option of weighing them.

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  • I thoroughly agree with this actricle. Having been a qualified nurse since 1975, it was always one of the first things we need, taking baseline observations, how else can you monitor the effectiveness of your care. There are now many pieces of equipment available to assist with recording baseline observations such as hoists that are fiited with scales. I appreciate that not all patients can be weighed due to injury but the majority of admissions to hospit could be weighed.

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  • I agree also with the author and the third contributing respondent - there is a strong element of "in my day...." which is still relevant today (I trained 1976-79) and there was no question of being 'too busy' throughout my subsequent time in Renal Services. "Guesstimation" by any healthcare professional would not be acceptable when recording Blood Pressure or Heart Rate, and bodyweight is no less significant. A wide range of technology is available to address the more dependent patient's requirement for a known, measured bodyweight. One facet overlooked in this and the related article, though, is the Manual Handling Operations Regs which clearly describes the requirement for load handlers - of any bent - to have "precise and accurate information about the nature and weight of a load". This will enable the Trust to ensure the allocation of appropriate equipment for the more obese patients, and should flag up the suitability of e.g. the department's hoist for their 'regular' patients. How about amending Trust Policy to have every patient weighed at the earliest possible opportunity if it cannot be done on admission - including via A&E. Otherwise, why bother with Nutritional screening or pay less than lip service to NICE guidelines?

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  • In a transitional status from student to qualification within the next few weeks, I am always continually striving to improve my admission and continuity of care documentation. Weighing patient is another facet of information that will be conscientiously adopted to include within nursing documentation and one that is noticably absent from many drug charts. In consideration of the focus necessary and vital attention to patients dietary intake in the acute wards and the importance of patients nutritional status this measure should be intrinsic, where practical in practice and I am grateful for the reminder.

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  • While I sincerely agree with the content of the article - and support the necessity of weighing patients - I cannot help but feel that the three principles given in support of this need (to monitor the extent of loss in organ function; to judge the effectiveness of medications (mainly diuretics); and to enable calculation of medication dosage) overlook one important factor - that of the patients' nutritional status. It is well known that malnutrition is rife in hospital patients - and that this has been acknowledged since the 1930s. The patients' weight is an important indicator of nutritional adequacy - and a 'clue' to their nutritional status (whether under- or overnourished). Weighing patients on admission also provides an important baseline against which future changes can be judged - in this case, it is not only an important basis for caclulation of drug dosages etc (and, therefore, a determinant of therapeutic efficacy) but also an indicator of the patients current condition and of nutritional vulnerability (i.e. an indicator of risk). We must take care that we don't wash the baby away with the bath water in suggesting that risk assessment is an inappropriate indicator of the need for basic nursing care.

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  • I work in a small community hospital and we weigh every patient every week. An admission weight gives me a bench-mark to work on in my role as a nutrition-link nurse.

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