Investigating the recording and accuracy of fluid balance monitoring in critically ill patients

Abstract

Background. The accurate assessment of fluid balance data collected during physical assessment as well as during monitoring and record-keeping forms an essential part of the baseline patient information that guides medical and nursing interventions aimed at achieving physiological stability in patients. An informal audit of 24-hour fluid balance records in a local intensive care unit (ICU) showed that seven out of ten fluid balance calculations were incorrect.

Objective. To identify and describe current clinical nursing practice in fluid balance monitoring and measurement accuracy in ICUs, conducted as part of a broader study in partial fulfilment of a Master of Nursing degree.

Methods. A quantitative approach utilising a descriptive, exploratory study design was applied. An audit of 103 ICU records was conducted to establish the current practices and accuracy in recording of fluid balance monitoring. Data were collected using a purpose-designed tool based on relevant literature and practice experience. 

Results. Of the original recorded fluid balance calculations, 79% deviated by more than 50 mL from the audited calculations. Further­more, a significant relationship was shown between inaccurate fluid balance calculation and administration of diuretics (p=0.01). 

Conclusion. The majority of fluid balance records were incorrectly calculated.