Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Why are fluid balance charts notoriously difficult to maintain accurately?

  • Comments (8)

Every week we’ll choose a practice article and pose a few questions for debate, post your questions or answers below …

Key points

  • Fluid balance is a term used to describe the balance of the input and output of fluids in the body to allow metabolic processes to function;
  • To make a competent assessment of fluid balance, nurses need to understand the fluid compartments within the body and how fluid moves between these compartments;
  • Dehydration is defined as a 1% or greater loss of body mass as a result of fluid loss. Physical symptoms of dehydration include impaired cognitive function, headaches, fatigue and dry skin. Severe dehydration can lead to hypovolaemic shock, organ failure and death;
  • The three elements to assessing fluid balance and hydration status are clinical assessment, including vital signs, body weight and urine output, review of fluid balance charts, and review of blood chemistry;
  • Fluid balance recording is often inadequately or inaccurately completed. Reasons identified for inappropriate completion of fluid balance charts include staff shortages, lack of training, and lack of time.

Let’s discuss

  • Why are fluid balance charts notoriously difficult to maintain accurately?
  • What role should healthcare assistants play in fluid balance monitoring and assessing patients’ hydration needs?
  • In the clinical situation are signs of dehydration and fluid overload easy to identify? When do you find it challenging?

You might also like to read

 

 

  • Comments (8)

Readers' comments (8)

  • Anonymous

    Nurses so understand the importance of hydration,but the gods honest truth is that on a 30 bedded ward with at least half of those needing nutritional help by way of feeding and fluid intake,there are NOT ENOUGH STAFF,i could spend 20-30mins easily on ONE patient needing help to eat and drink properly,unhurried and unrushed,giving them time to eat,but it DOES'NT happen and it wont till we get the support that we need.Stop giving me gov guidelines,budget crisis etc,etc,illness affects all.To ALL the managers,government and budget holders,wake up and smell the coffee,if YOUR family member was ill,what would you want????
    You know the answer,so do it,get back to basics and let us do our job,we so want to,so let us

    Unsuitable or offensive? Report this comment

  • Anonymous

    if increasing staff numbers is definitely not going to happen how about changing the mix of patients on a ward so that there are fewer on the same ward who need so much assistance with feeding and drinking.

    Patients at meal times need to go at their own speed and rhythm and not according to some busy ward schedule for which they are not responsible. you cannot force food and fluids into somebody at a speed which suits all the other tasks on the ward. this is also something that should not be constantly interrupted. meal times are often psychologically important to patients too as they break up the day and may give them something to look forward to. it is a time of personal contact with the staff, and many other reasons some of which we should appreciate from our own basic human experience.

    please think, those who make up the rules and work planning, what it is like at your own meal times when you are in a rush and with constant interruptions or have to grab a bite quickly, and think how you feel when you have eaten badly or in a rush and the effect it may have on your digestive system and general well being. also think how it feels when you really enjoy a relaxing meal without the fear of being disturbed. the elderly and sick need even more time than you do for assisted feeding and it is unpleasant if they are made to feel that the one helping them is in a rush to go off and do something else and not able to give them their full undivided attention.

    re fluid balance charts - we tried to reduce these as much as possible and where precise measurements were not critical weighed our patients instead as we found that badly filled in charts were less helpful than none at all.

    in my student days we had a pile of about 30 to add up on night duty at midnight. I don't know if this practice still continues but it is not optimal for concentration! this was also in the days before calculators!

    Unsuitable or offensive? Report this comment

  • Anonymous

    There are very few patients on my busy medical ward who can tell nurses what they have drank. It is a near impossible task and much of it is done on guess work. Trying to find out if a cup/beaker was drank or taken away is like a Sherlock Holmes enquiry. If we had more staff to monitor accurately and push fluids for our patients I am sure it could reduce length of stay but I do not think management will go along with that idea in the present financial climate.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Anonymous | 18-Jul-2011 11:39 pm

    "If we had more staff ..... I do not think management will go along with that idea in the present financial climate."

    same problem everywhere but seems like a lame excuse as many managers are apparently suffering from acute myopia and refuse to look further than then ends of their own noses. they may understand administration but do not understand the complex needs of patients or staff or how and why care is delivered, nor do they even seem to understand the budgets they are supposed to be managing. more appropriately trained and qualified staff where they are needed would probably save vast sums of money in the long run in terms of adequate care, and also in terms of staff motivation and satisfaction at being able to do their work to the highest standards. this would also reflect in a better and more useful working and learning environment in their organisation with greater trust and improved communications.

    Unsuitable or offensive? Report this comment

  • Totally agree with the above statements. As staff Nurses we understand the need and clinical reasons for hydration and the importance of monitoring this, we pass this information onto HCA's who can fill in fluid balance charts with training and then pass that information onto us. We often have to rely on HCAs to do this, and that NEEDS decent training and ensuring the HCA's are up to it. However, the simple fact remains that this becomes impossible when there are far too few staff and far too many patients, especially when fluid balance (as important as it is) is only one task amongst many.

    Unsuitable or offensive? Report this comment

  • Anonymous

    I am surprised there are not more responses to this discussion. It is a long standing problem that must eventually be resolved for the good of patients and staff.

    Unsuitable or offensive? Report this comment

  • Anonymous

    not very helpful that two of the articles referred to above which i tried to access are subscription only.

    Unsuitable or offensive? Report this comment

  • Fluid Balance Charts are notoriously difficult to fill in for many reasons.

    One of the main reasons is that historically they have been very difficult to fill in, so have been filled in inaccurately, so clinicians do not value the information they hold. This diminishes the value of the completion, which leads to people not filling them in...

    They are a broken tool that has been expected to do to do many different jobs, and they do none of these jobs well!

    I read Alison Shepherd's article ( NT 19.07.11 /vol 107 No 28) with great interest it summarised the physiology and causes of dehydration well, and then went on to talk about the problems of fluid balance charts, discussing the numerous studies that show how poorly they are completed. the next page showed an "accurate" and "inaccurate" fluid balance chart. Whilst i understand what she was suggesting in terms of best practice of completion both are meaningless! Because a fluid balance chart is filled in neatly it is no indication of accuracy, the chart remains completely subjective. There are any end of ways to assess accurately fluid input and output, this breaks down when you place it in the context described above. For any 24 hour period you have many staff who are responsible for a fluid balance chart and if any one of these staff doesn't manage to keep up to date the fluid balance that 24 hour chart is meaningless.

    This is before we discuss the insensible fluid loss from respiration, sweating or exposed wounds that is captured on only very few charts i have seen.

    We need to move away from subjective fluid balance charts to more objective measures, daily weights where possible, and other measures where this is not appropriate.

    We need to stop thinking about charts and start thinking about what the information is that is needed by busy clinicians to make important decisions about patient care.

    I argue that currently fluid balance charts are a unhelpful distraction from clinical care and that we have to think of both technological and practice based solutions to determine the information required to make changes and stop be-moaning the fact that nurses dont fill in charts and start thinking differently.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment.

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.