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Practice comment

''It is dangerous to think that ending dehydration is simple''


Dehydration is a major problem in healthcare. A review by the Hydration for Health Initiative found evidence of high rates of dehydration in older people in hospitals and other healthcare institutions

The review highlighted a US study showing that it is one of the 10 most frequent diagnoses responsible for hospitalisation.

The prevalence of dehydration across the UK health economy is unknown. It is really only in the last few years that hydration and particularly dehydration have been included in the same sentence as nutrition - the two have often been considered in isolation.

Early work in raising awareness of the importance of good hydration was undertaken by the Water UK and the Water for Health Alliance in 2004, while the National Patient Safety Agency collaborated with the Royal College of Nursing’s Nutrition Now campaign to publish a hydration best practice toolkit.

Despite these efforts, the Francis report into failings at Mid Staffordshire Foundation Trust states: “Some patients were left food and drink and offered inadequate or no assistance in consuming it. Even water or the means to drink it could be hard to come by.”

The experiences at Stafford to which witnesses testified are by no means unique in the NHS in England, as has been shown in dignity and nutrition reports from the Care Quality Commission.

The Francis report is helpful in proposing some basic principles that should be considered to improve hydration: ensuring drinks are within reach; recording fluid balance accurately; delivering drinks in appropriate containers; and using systems to highlight patients who need assistance with hydration.

Efforts to raise awareness of hydration as a patient safety issue have continued with nutrition and hydration patient safety weeks in January 2012 and March 2013.

The articles on pages 12 and 16 summarise two key pieces of work undertaken in 2012 that aimed to gain a greater understanding of challenges facing health professionals in preventing avoidable harm due to dehydration.

The first discusses a review of the National Reporting and Learning System data that aimed to identify the number of patient safety incidents related to hydration reported to the NRLS. The second provides a summary of a survey undertaken by the British Association of Parenteral and Enteral Nutrition, the British Dietetic Association Parenteral and Enteral Nutrition Group and the National Nurses Nutrition Group, which considered hydration practice in relation to patients receiving enteral tube feeding.

The issue of good hydration in healthcare is complex and often complicated by patients’ pre-existing medical conditions. To think that solutions are simple is dangerous. We need to consider the whole continuum of care, from simply getting people to drink more to intravenous fluid management through to enteral fluid management.

Caroline Lecko is patient safety lead, NHS England.

  • Click here for a print-friendly PDF of this article 

Readers' comments (6)

  • That last paragraph should be tattooed onto the forehead of the Editor of the Daily Mail.

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  • Dehydration isnt just a problem in the NHS it is something that is underestimated in many other fields in the UK.
    Schools are a prime example......although there is a mountain of paperwork stating that kids should be allowed to drink water while in class a lot of the teachers dont allow it because then (god forbid!) the kids ask to go to the toilet!
    My 10 year old came home from school the day that the temperature was 24 degrees and told me the teacher wouldnt allow them to have their water bottles on their desks and that they would get a drink when she needed one!! No surprise that she actually had pain in the kidney area that day! This kind of thing is epidemic in the UK.
    Everything is compliant on paper but not in actual practice.

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  • Anonymous | 2-Jul-2013 11:33 am

    I agree with you and sympathise with you and the children and common sense should override any inappropriate rules and guidelines, which should go in all walks of life and even healthcare.

    I do just wonder how people coped however in the days before plastic bottles and carring them around everywhere they go. are they a good thing or a bad idea? personally, I very rarely use one except for long hikes and sports as I always prefer to go and find a café for a drink so I can use their facilities and just make sure I tank up sufficiently on fluids at home so I can go for longer periods without when out if necessary and then let the weather, thirst, the envy for a drink and availability of facilities be my guide.

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  • I totally get what you are saying but I think part of the need now arises from our temperatures being higher and possibly the fact that new buildings dont always have windows that open etc etc.

    I remember as a Student nurse in the early eighties working on the wards with huge big wet patches under my arms! disgusting!
    I just returned from working in the usa and never had that problem or had the urge to constantly drink water but here I feel ill if I dont. The hospitals here are kept too hot its not good for the patients.

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  • Anonymous | 2-Jul-2013 1:53 pm

    ageed, you get dehydrated very quickly working in hot buildings and expending a lot of energy. I got into trouble in a new job for the director of the old peoples' and nursing home for drinking a glass of water in the ward kitchen, which was right on the ward, before my morning cofffee break. we all had to take our break together at a set time and not as needed yet others went off for a quick smoke off the ward when they wished!

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  • our workplace is very hot and demanding, we used to have cold water dispensers but they got taken away, we have tap water now like everyone else. we often don't get breaks so we know how important it is for the staff to drink plenty of fluids - easier said than done.
    with patient, if they can take fluids orally then of course they should do, we need to offer drinks throughout the day and help people who can't manage - isn't this just common sense. for those who can't or won't drink then they may need iv fluids - it ain't rocket science.
    patients often come in from home with dehyrdration too so maybe public awareness and education needs to be addressed.

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