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Fluid administration charts

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You will need to use a fluid administration chart if a person is at risk of dehydration.

You might use it to record how you thicken fluids. You would do this for people with swallowing difficulties. The person might be using a feeding tube. Or you might be restricting fluids.

Use the chart to record the amount of fluid administered to or taken by a person. If you give a person a drink, accurately record the quantity taken by the individual. You should also record the quantity offered. Record a running total of fluids consumed.

For some people, you might need to track fluid intake and output more closely. This will ensure adequate hydration. Monitoring the amount of fluid excreted by the body as urine requires a catheter and bag.

Dehydration

Dehydration increases the risk of hospitalisation and mortality. Even mild dehydration can affect mental performance. It can cause feelings of tiredness and constipation. Mental functions affected include memory, attention, concentration and reaction time. Common complications of dehydration include:

  • low blood pressure
  • weakness
  • dizziness
  • increased risk of falls

Poorly hydrated people are more likely to develop pressure sores, skin conditions and urinary tract infections. Dehydration is one of the main causes of acute kidney injury.

Those at risk of dehydration may include:

  • older people. They have a reduced sensation of thirst. This may be more pronounced in those living with dementia or in those that have suffered a stroke. Do not rely on thirst in older people as an indicator of dehydration
  • people with reduced renal function. This affects how the body responds to dehydration, which is key to fluid balance
  • people with cognitive impairment
  • people with swallowing difficulties
  • people with poorly controlled diabetes
  • people taking certain medicines such as diuretics or laxatives
  • people with incontinence. They may try and reduce their fluid intake to relieve their symptoms of incontinence)
  • people with poor oral intake. This may relate to their inability to feed and drink independently. Or it could be due to poor availability of and access to fluids

Staff in care homes should identify people who are at risk of dehydration. They should try to overcome any barriers to drinking. For example, the person might be worried about not reaching the toilet in time. Or they might not be physically able to make or reach drinks.

Staff should be able to recognise the importance of hydration. We would expect them to:

  • know whether the person’s dietitian has put in place an individual daily fluid intake goal
  • know when to refer a person at risk to the Speech and Language Therapy (SALT) or dietetic team
  • use the care plan to identify how to manage dehydration risks. The care plan must also reflect any directions made by the SALT or dietetic team
  • provide preferred fluids throughout the day. Make sure they're always available
  • offer a variety of hot and cold drinks
  • provide help and aids for drinking if needed. This might be a special cup or straw
  • know the amount of fluid that a jug, cup or mug holds. This helps to accurately record fluid intake, instead of estimating
  • know how to adjust people’s fluid intake based on external conditions. Examples include extremes of weather and heating

Fluid restricted patients

A doctor may reduce a person’s fluid intake if they have severe liver, kidney or heart failure. Or their sodium levels might be low. A person may have a restriction in place for a set amount of fluid to be given/taken in a 24-hour period.

Swallowing difficulties

Fluid thickening powder may be prescribed a person. This helps staff to thicken fluids to the correct consistency. Thicker fluids reduce the risk of choking in a person with swallowing difficulties.

Keep an accurate record of when a fluid has been thickened and to what consistency. Record:

  • the volume of liquid thickened
  • the number of scoops of thickening powder used
  • the amount consumed

This record does not need to be on the medicine administration record. It could be a separate fluid record or in the daily care record. There should be a detailed care plan to support it. See dysphagia and thickening powders.

Administration via a feeding tube

A person with a feeding tube may be either partially or fully nil by mouth. You might use a feeding tube to administer liquid feeds, drinks and medicines. A dietitian must review a person before you feed them through a tube. The fluid administration record should reflect what the dietitian has requested. It should include:

  • any liquid feeds administered
  • any water boluses (a volume of water as defined in the care plan) during the day
  • any flushes of water used before, during and after administering food or medicines
Last updated:
03 October 2018

 


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