A Quality Improvement Project on Fluid balance chart accuracy in medical ward of Ayub Teaching Hospital Abbottabad

Background: Fluid balance monitoring is fundamental to patients’ health. A healthy body is in a state of fluid balance, but hospitalized patients are at risk of fluid balance disorders. Thus, fluid balance monitoring has clinical significance to treating the patient correctly and helps determine the appropriate recommending of fluids and diuretics necessary to achieve or maintain homeostasis and healing Therefore, the aim of the study is to improve the accuracy of the fluid balance chart in the medical ward of Ayub Teaching Hospital, Abbottabad.   Methods: This project (n=100) was conducted in an adult general medical ward at Ayub Teaching Hospital, Abbottabad. Data for the project were obtained from two sources: patients’ clinical records and responses from nursing staff. The fluid balance charts were evaluated for value using two areas: ‘accuracy’ and ‘completeness,’ rationalizing and familiarizing with procedures of previous, similar quality improvement projects stated previously in this report. In evaluating for accuracy, we checked if all measurements in the chart were accurate, if the accesses had been summed up properly, and if the daily totals and balances were correct.   Results: The current project shows that 70% of fluid balance patients’ records were accurate, while the remaining 30% of fluid monitoring records were found to be inaccurate in medical wards. In the inaccurate fluid monitoring records, 16% were found positive with a mean and standard deviation of 450.50 + 155.70 ml, and 14% of fluid balance monitoring records were found negative with a mean and standard deviation of 325.67 + 148.33 ml, with a P-value of 0.0024. It was shown that the nurses' knowledge regarding fluid balance records in the medical ward was moderately adequate, 68%. Regarding the importance of fluid monitoring in the medical ward, it was about 65%, and information about responsible persons was 70%. Regarding the fluid balance sheet, more than 80% were satisfied. While about fluid balance calculation, more than half were satisfied that the 24-hour fluid balance was correctly calculated all the time in the medical ward of Ayub Teaching Hospital Abbottabad.   Conclusion: This project concluded that applying standardized documentation and calculation approaches can decrease errors. Proper training and education for nursing staff on fluid balance charting can advance accuracy. Relating patients in fluid balance monitoring and education can also improve accuracy. The electronic health records with automatic controls can minimize errors and increase charting quality.