A study on accuracy and precision of fluid volume measurements by nurses, patients and healthy persons in a clinical setting

Evaluation of a real-life experience with a digital fluid balance monitoring technology

BACKGROUND

Innovations in healthcare technologies have the potential to address challenges, including the monitoring of fluid balance.

OBJECTIVE

This study aims to evaluate the functionality and accuracy of a digital technology compared to standard manual documentation in a real-life setting.

METHODS

The digital technology, LICENSE, was designed to calculate fluid balance using data collected from devices measuring urine, oral and intravenous fluids. Participating patients were connected to the LICENSE system, which transmitted data wirelessly to a database. These data were compared to the nursing staff's manual measurements documented in the electronic patient record according to their usual practice.

RESULTS

We included 55 patients in the Urology Department needing fluid balance charting and observed them for an average of 22.9 hours. We found a mean difference of -44.2 ml in total fluid balance between the two methods. Differences ranged from -2230 ml to 2695 ml, with a divergence exceeding 500 ml in 57.4% of cases. The primary source of error was inaccurate or omitted manual documentation. However, errors were also identified in the oral LICENSE device.

CONCLUSIONS

When used correctly, the LICENSE system performs satisfactorily in measuring urine and intravenous fluids, although the oral device requires revision due to identified errors.

Emergency department assessment and management of children with gastroenteritis

BACKGROUND

Acute gastroenteritis is a major cause of morbidity and mortality in children. The aim of this study was to explore assessment and management of children aged between 6 and 48 months presenting to the emergency department (ED) with acute gastroenteritis.

METHODS

This retrospective cohort study included 340 children aged 6-48 months. Data were collected by medical record audit for children presenting between 1 January and 31 December 2019.

RESULTS

General assessments were appropriate, specific dehydration assessment, blood pressure measurement and fluid balance chart documentation could be improved. Management of children with severe or no/mild dehydration was largely compliant with current recommendations: there was variability in management of children with moderate dehydration. There were no significant differences between Australian Aboriginal and non-Aboriginal children in terms of dehydration severity and pathology abnormalities, however there were differences in management strategies.

CONCLUSIONS

ED management of children with gastroenteritis was largely consistent with, or superior to, evidence-based recommendations. There was variability in the management of children with moderate dehydration and Australian Aboriginal children but it is unclear whether this is suboptimal or patient specific care. This study has highlighted areas for further research in this unique context.

A Survey for Charting Intake, Output, and Body Weight in the Electronic Medical Record

BACKGROUND

The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned.

METHODS

We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test.

RESULTS

One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight.

CONCLUSIONS

Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.

Digitizing fluid balance monitoring may offer a solution for optimizing patient care

BACKGROUND

Precise fluid balance monitoring is essential for patient treatment, as incorrect fluid balance can lead to disorders.

OBJECTIVE

This study aimed to assess the accuracy of the digital technology LICENSE (LIquid balanCE moNitoring SystEm) for fluid balance charting and compare it to the standard method (SM) to determine its usability in clinical practice.

METHODS

This prospective study included 20 patients. The results from LICENSE were compared to those from SM and a reference measurement (manual weight of fluids, RM). Three LICENSE devices were used for urine output, intravenous fluids, and oral fluid intake. The accuracy of methods was evaluated using Bland Altman plots.

RESULTS

The mean difference between LICENSE and RM was less than 2 millilitres (p= 0.031 and p= 0.047), whereas the mean difference between SM and RM was 6.6 ml and 10.8 ml (p< 0.0001). The range between the upper and lower limits of agreement was between 16.4 and 27.8 ml for LICENSE measurements and 25.2 and 52 ml for SM.

CONCLUSION

LICENSE is comparable to or more accurate than the standard method for fluid balance monitoring. The use of LICENSE may improve the accuracy of fluid balance measurements. Further research is needed to evaluate its feasibility in daily clinical practice.

Quality of fluid balance charting and interventions to improve it: a systematic review

INTRODUCTION

Fluid balance monitoring is pivotal to patients' health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality of fluid balance monitoring in medical, surgical and intensive care units, with an emphasis on the completeness of charting data, calculation errors and accuracy, and to evaluate methods used to improve fluid balance charting.

MATERIALS AND METHODS

Quantitative studies involving adult patients and reporting data on fluid balance monitoring were included in the review. We searched MEDLINE, Embase, CINAHL and the Cochrane Library. The risk of bias in the included studies was assessed using tools developed by the Joanna Briggs Institute.

RESULTS

We included a total of 23 studies, which involved 6649 participants. The studies were quasi-experimental, cohort or prevalence studies, and every third study was of low quality. Definitions of 'completeness' varied, as well as patient categories and time of evaluation. Eighteen studies reported the prevalence of patients with complete fluid balance charts; of those, 10 reported that not more than 50% of fluid balance charts were complete. Studies addressing calculation errors found them in 25%-35% of charts, including omissions of, for example, intravenous medications. The reported interventions consisted of various components such as policies, education, equipment, visual aids, surveillance and dissemination of results. Among studies evaluating interventions, only 38% (5 of 13) achieved compliance with at least 75% of complete fluid balance charts. Due to the heterogeneity of the studies, a meta-analysis was not possible.

CONCLUSION

The quality of fluid balance charting is inadequate in most studies, and calculation errors influence quality. Interventions included several components, and the impact on the completion of fluid balance charts varied.

Quantifying the daily intake of water from morning and spot urine samples; retrospective analysis of a clinical trial in volunteers

BACKGROUND

The hydration status can be indicated by biomarkers in the urine. However, the sensitivity and specificity of single measurements of biomarkers in morning urine and spot urine samples to quantify previous and current daily water ingestion is unclear.

METHODS

The water content of food and liquid consumed by 20 volunteers (mean age 42 years) was calculated daily for two weeks. The volunteers increased their consumption of water by approximately 30% during the second week. They measured their excreted urine volume and sampled the morning urine and 24-h collections of urine for analysis of osmolality and creatinine during the first four days of both weeks (N = 157). The same biomarkers of hydration were measured in spot samples taken at every voiding on the other days (N = 762). Receiver operating characteristic (ROC) curves were used to study the ability of pre-specified ranges of biomarkers to quantify the water intake.

RESULTS

The biomarkers in the morning urine obtained during normal fluid intake quantified the water consumption with an average area under the ROC curve (AUC) of 0.72 for osmolality and 0.66 for creatinine. Spot urine yielded an AUC of 0.74 for osmolality and 0.70 for creatinine. The AUCs obtained for days of increased fluid intake were approximately 10% lower. Large intakes (3-4 L daily) were identified with a sensitivity of 50-80% and low intakes (< 1.5-2 L) with a sensitivity of 20-50%, while false positives occurred in approximately 10%.

CONCLUSION

Biomarkers in morning urine and spot urine samples distinguished between large and small daily water intakes. Osmolality was slightly superior to creatinine. The indications were less useful during days of increased fluid intake.

The Potential of Self-Assessment and Associated Factors for Delayed Symptomatic Hyponatremia Following Transsphenoidal Surgery: A Single Center Experience

(1) Background: We identified screening parameters and associated factors for delayed, symptomatic hyponatremia (DSH) following inpatient discharge after transsphenoidal surgery (TSS). (2) Methods: In this prospective, monocentric study, 108 patients who underwent TSS for pituitary pathologies were included, provided with a questionnaire and instructed to document urine specific gravity, fluid intake/urine output, body weight and clinical symptoms for every of five days following discharge from hospital. (3) Results: The overall incidence of DSH within 14 days following discharge from the hospital was 14.8% (n = 9). Symptomatic patients presented on average 8.6 days after surgery. Mild DSH was present in 3.3% of the patients, moderate in 1.6% and severe hyponatremia in 9.8% of patients. Female sex (p = 0.02) and lower BMI (p = 0.02), as well as nausea (66.7%; p < 0.01) and emesis (33.3%; p < 0.05), were associated with DSH. A significant weight delta between morning and afternoon weight two days before the event of DSH between both groups (1.26 kg (n = 5) vs. 0.79 kg (n = 52), p < 0.05) was detected. (4) Conclusions: Handing out a symptom questionnaire at discharge seems to be an easy and feasible tool for the detection of DSH after hospital discharge.