Fluid balance chart: do we understand it?

Abstract

Introduction The fluid balance chart is used as a non-invasive tool to assess the surgical patient's hydration status. Surgical trainees prescribe fluids on a daily basis, an essential part of patient fluid management. A good understanding of these charts is important, as inaccurate interpretation can have a detrimental effect on patient outcome. Therefore, we asked the question: can surgical trainees interpret and calculate fluid balance charts correctly? Method We prospectively asked 25 surgical trainees including 12 at Specialty Training (ST) level and 13 at Foundation Year (FY) level, to calculate the total input and output of 13 fluid balance charts, and rate how difficult these charts were to interpret. Results Clinical experience does not appear to influence the correct calculation of the total input and output values of the fluid balance charts. However, out of the 13 charts, there is a statistically significant difference from the original documented values in eight of the ST group and nine of the FY group for the total input values, and three of the ST group and four of the FY group for the total output values, with some by a large magnitude. Conclusion This study shows alarming results with cause for concern where there is a huge variation in surgical trainee calculated and original documented values, as well as variations between trainees irrespective of training grades, which is a potential risk management issue. It highlights that inaccurate interpretation of these charts are not due to lack of clinical experience, but the fundamental problem lies within the lack of education and inconsistent poor documentation of these charts.

Learning to prescribe intravenous fluids: A scoping review

“…They infrequently examined patients and, when they did, could not reliably determine fluid volume status [ 27 ]. Discussing patients with nurses, reviewing laboratory results, and reading medical records and fluid balance charts contributed to the assessment of clinical need [ 28 , 30 ] though junior doctors did not always interpret those sources of information correctly [ 31 ].…”

Prevention of dehydration in hospital patients

“…It is essential all amounts of fluid should be quantified in millilitres to allow for precise measurement and all staff need to be aware of the capacity of different containers I.e., cups, beakers, and glasses (Smith and Roberts, 2011). Tang and Lee (2010) recognise the importance of documenting fluid balance in acutely ill patients, however they also argue that many FBC's are completed inaccurately due to staff shortages, staff workload and lack of training. Inaccurate completion can lead to misdiagnosis, failure to recognise deterioration, and also consequences for nursing staff as the NMC (2015) state such factors are no excuse for inadequate record keeping.…”

HEAL: a strategy for advanced practitioner assessment of reduced urine output in hospital inpatients

“…Reid et al . () state that inaccuracies are common in recording urine output, while Tang and Lee () found that even in the calculation of fluid balance charts, severe errors were made. It is of vital importance that accurate measurement, recording and calculation of urine output and appropriate escalation of management are carried out in patients at risk of deteriorating kidney function.…”