Make every drop count! A QIP to Standardise Hydration Chart Documentation on a General Geriatrics Ward

Introduction:

Accurate hydration chart documentation is pivotal in guiding daily fluid management decisions, particularly on geriatric wards, where older patients living with frailty often cannot advocate for themselves and require monitoring of their hydration status to account for their decreased thirst sensation and ability to concentrate urine (Hooper and Bunn 2015, Bennett 2000, Phillips et al. 1984). On Ward 35 of Aintree University Hospital, inconsistent documentation of drinks consumed along with micturition frequencies rendered hydration charts unreliable for clinical decision-making. This presented a significant risk to patient safety, as elderly dehydrated patients admitted to the hospital are six times more likely to die than those with normal hydration status (El-Sharkawy et al. 2014).

The aim of this QIP was to improve staff compliance of hydration chart documentation by 50% over a six-month period.

Methods:

The project followed a Plan–Do–Study–Act (PDSA) model across four data collection cycles. Baseline data and subsequent collections were gathered from a sample of 10 patients' hydration charts per cycle (n=40 in total). Interventions included ward-based training focusing on the documentation of fluid volumes and output whilst reinforcing the clinical value of these charts.

• Two face-to-face training sessions using hypothetical patient scenarios.
• An interactive feedback session analyzing real chart inconsistencies and explanation of the poster created to prompt accurate documentation.

Results:

Baseline data showed that less than 50% of hydration charts met the desired documentation standards. By the final intervention of the poster, correctly documented fluid intake improved to 78.5%, and accurate urine output documentation rose from 32% to 43.7%. Challenges included limited training attendance due to staff shift patterns, low engagement with initial online surveys, staff turnover and missing notes.

Conclusion:

A structured, multi-phase intervention targeting staff education and documentation standardization can significantly improve the quality and clinical significance of hydration charts.