Collaborative documentation of intake and output Elise Howard, S.N., B.S. The Pennsylvania State...
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Collaborative documentation of intake and output Elise Howard, S.N., B.S. The Pennsylvania State University School of Nursing Results Nurse Perception Questionnaire Pre-Intervention Questionnaire Nurses participated n=11 Making Clinical Decisions: All 11 nurses reported relying heavily on fluid balance charts to guide their clinical decisions Doctors Look at FBCs: All 11 nurses reported perceiving doctors always, if not almost always, look at fluid balance charts when making clinical decisions Accuracy of FBCs: 9 nurses reported accuracy of fluid balance charts are mostly never accurate or were neutral on the topic Intake Recorded: 1 nurse checked ”Intake is Never Recorded” 8 nurses checked “Intake is Mostly Not Recorded” 2 nurses checked that they were “Neutral” about the topic Effectiveness of FBCs: 7 nurses checked that FBCs are “Mostly not Effective” 4 nurses checked that they are “Not Effective at All” Post-Intervention Questionnaire Nurses participated n=11 Accuracy of FBCs: Overall increase in nurse perception of accuracy of FBCs if implemented 9 checked “Mostly Accurate” 2 checked “Very Accurate” Increase in ratings of effectiveness rose with ratings of increased accuracy Intake Recorded: 8 reported “Intake is Mostly Recorded” 3 reported “Intake is Always Recorded” Introduction Research has cited many area of missed patient care and accurate documentation of patients’ intake and output was named as one of the leading issues. It cites trays being taken away from patients’ room before nursing staff was able to document what was consumed and a lack of systematic recording methods involving meal trays. After speaking with nursing staff on the trauma step-down unit 3SAE/W at the Hershey Medical Center, it was a prevalent issue on the floor. This study aims to answer the PICO question: is the collaborative documentation of I&Os between nursing staff and dietary staff effective in accurately depicting and maintaining patients’ hydrations statuses? Methods & Materials A pre-intervention questionnaire that asked how they would rate their perceptions of fluid balance charting as they are currently done on the floor. A post-intervention questionnaire was given after the nurses saw the amount of missed fluids to measure how the intervention affected nursing perception of fluid balance charts. Dietary assistants document and gave the total volume (in mL) intake from each meal tray of the selected to the principal researcher. The dietary assistants were provided with a card that details fluid containers Conclusions The results show that patients who are ordered intake and output observation are experiencing gaps in their care with an average of 637.79 mL going undocumented. While interprofessional collaboration can be a difficult task, it should be pursued if there is the possibility of better patient outcomes. The Penn State Hershey Medical Center had developed a bedside whiteboard tool which can be utilized to facilitate communication between dietary assistants and nursing staff to accurately and more completely document intake of patients. Use of the reference table of common containers and their corresponding volumes proved useful and accurate. Nursing staff overwhelmingly considered that this intervention would improve accuracy of fluid balance charts. Acknowledgements References Scales, K., & Pilsworth, J. (2008). The importance of fluid balance in clinical practice. Nursing Standard, 23(47), 50–57. Wise, L. C., Mersch, J., Racioppi, J., Crosier, J., & Thompson, C. (2000). Evaluating the reliability and utility of cumulative intake and output. Journal of Nursing Care Quality, 14(3), 37–42. Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality Vol. 21, No. 4, Pp. 306-313, 21(4), 306–313. I would like to thank the staff of the 3SAE/W nursing floor as well as the dietary staff for their time and patience in participating in Breakfast Lunch Dinner 0 500 1000 1500 2000 2500 580 360 600 1740 1345 1000 Nurse Estimation vs. Dietary Calculation Day 1 Nurse Estimation Totals mL Totals Breakfast Lunch Dinner 0 500 1000 1500 2000 2500 3000 3500 1040 960 360 2280 2160 1860 Nurse Estimation vs. Dietary Calculation Day 2 Nurse Estimation Totals mL Totals Breakfast Lunch Dinner 0 500 1000 1500 2000 2500 3000 360 240 480 2330 1200 1380 Nurse Estimation vs. Dietary Calculation Day 3 Nurse Estimation Totals mL Totals Comparison of Nursing Estimations and Dietary Calculations Patients eligible n=18 Average differences between dietary calculations and nursing estimation: Day 1: 696.25 mL Day 2: 451.11 mL Day 3: 766 mL Total average difference: 637.79 mL Average length of stay: 4.8 days 3 liters can go undocumented
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Transcript of Collaborative documentation of intake and output Elise Howard, S.N., B.S. The Pennsylvania State...
Collaborative documentation of intake and outputElise Howard, S.N., B.S.
The Pennsylvania State UniversitySchool of Nursing
Results
Nurse Perception Questionnaire
Pre-Intervention Questionnaire Nurses participated n=11 Making Clinical Decisions:
All 11 nurses reported relying heavily on fluid balance charts to guide their clinical decisions
Doctors Look at FBCs: All 11 nurses reported perceiving doctors always, if
not almost always, look at fluid balance charts when making clinical decisions
Accuracy of FBCs: 9 nurses reported accuracy of fluid balance charts are mostly never accurate or were neutral on the topic
Intake Recorded: 1 nurse checked ”Intake is Never Recorded” 8 nurses checked “Intake is Mostly Not Recorded” 2 nurses checked that they were “Neutral” about
the topic Effectiveness of FBCs:
7 nurses checked that FBCs are “Mostly not Effective”
4 nurses checked that they are “Not Effective at All”
Post-Intervention Questionnaire Nurses participated n=11 Accuracy of FBCs: Overall increase in nurse perception
of accuracy of FBCs if implemented 9 checked “Mostly Accurate” 2 checked “Very Accurate” Increase in ratings of effectiveness rose with
ratings of increased accuracy Intake Recorded:
8 reported “Intake is Mostly Recorded” 3 reported “Intake is Always Recorded”
IntroductionResearch has cited many area of missed patient care and accurate documentation of patients’ intake and output was named as one of the leading issues. It cites trays being taken away from patients’ room before nursing staff was able to document what was consumed and a lack of systematic recording methods involving meal trays. After speaking with nursing staff on the trauma step-down unit 3SAE/W at the Hershey Medical Center, it was a prevalent issue on the floor. This study aims to answer the PICO question: is the collaborative documentation of I&Os between nursing staff and dietary staff effective in accurately depicting and maintaining patients’ hydrations statuses?
Methods & MaterialsA pre-intervention questionnaire that asked how they would rate their perceptions of fluid balance charting as they are currently done on the floor. A post-intervention questionnaire was given after the nurses saw the amount of missed fluids to measure how the intervention affected nursing perception of fluid balance charts. Dietary assistants document and gave the total volume (in mL) intake from each meal tray of the selected to the principal researcher. The dietary assistants were provided with a card that details fluid containers commonly found on meal trays and their corresponding volumes. A chart review was completed on the patients to compare nursing estimation to dietary calculations.
ConclusionsThe results show that patients who are ordered intake and output observation are experiencing gaps in their care with an average of 637.79 mL going undocumented. While interprofessional collaboration can be a difficult task, it should be pursued if there is the possibility of better patient outcomes. The Penn State Hershey Medical Center had developed a bedside whiteboard tool which can be utilized to facilitate communication between dietary assistants and nursing staff to accurately and more completely document intake of patients. Use of the reference table of common containers and their corresponding volumes proved useful and accurate. Nursing staff overwhelmingly considered that this intervention would improve accuracy of fluid balance charts.
Acknowledgements
References Scales, K., & Pilsworth, J. (2008). The
importance of fluid balance in clinical practice. Nursing Standard, 23(47), 50–57.
Wise, L. C., Mersch, J., Racioppi, J., Crosier, J., & Thompson, C. (2000). Evaluating the reliability and utility of cumulative intake and output. Journal of Nursing Care Quality, 14(3), 37–42.
Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality Vol. 21, No. 4, Pp. 306-313, 21(4), 306–313.
I would like to thank the staff of the 3SAE/W nursing floor as well as the dietary staff for their time and patience in participating in this study.
Breakfast
Lunch
Dinner
0
500
1000
1500
2000
2500
580
360 600
1740
13451000
Nurse Estimation vs. Dietary CalculationDay 1
Nurse Estimation Totals
Dietary Calulation Totals
mL
Tota
ls
Breakfast
Lunch
Dinner
0
500
1000
1500
2000
2500
3000
3500
1040960
360
22802160
1860
Nurse Estimation vs. Dietary CalculationDay 2
Nurse Estimation Totals
Dietary Calulation Totals
mL
Tota
ls
Breakfast
Lunch
Dinner
0
500
1000
1500
2000
2500
3000
360240
480
2330
1200 1380
Nurse Estimation vs. Dietary CalculationDay 3
Nurse Estimation Totals
Dietary Calulation Totals
mL
Tota
ls
Comparison of Nursing Estimations and Dietary Calculations Patients eligible n=18 Average differences between dietary calculations and
nursing estimation: Day 1: 696.25 mL Day 2: 451.11 mL Day 3: 766 mL
Total average difference: 637.79 mLAverage length of stay: 4.8 days
3 liters can go undocumented
