• Led by Northumbria Healthcare NHS Foundation Trust.
  • Implemented on four wards across three hospitals in Northumbria.
  • Aimed to address the high rate of dehydration among over 65s, who account for 68% of emergency hospital bed days yearly.
  • Developed, implemented and evaluated a standard protocol to recognise and address the risk of poor oral fluid intake in older inpatients.

This project led by Northumbria Healthcare NHS Foundation Trust involved the development of a risk assessment and nurse-led response protocol for inadequate oral fluid intake that can easily be implemented into the care of older patients within 48 hours of admission to hospital.

Older people in hospital are susceptible to dehydration due to pre-existing and acute health problems. This causes complications and prolongs length of stay. They often require support to drink enough fluids. However, judgements about fluid intake are often made reactively, rather than proactively, with no standardised risk assessment or formal protocol.

Simple interventions targeted at higher risk patients to encourage drinking may reduce complications and the need for intravenous fluid replacement. This Shine project began with a systematic review to identify nurse-led hydration risk assessments and simple care interventions to promote oral fluid intake, and interviews with staff, patients and relatives around hydration assessment and fluid support. The resulting Northumbria Assessment of Hydration (NoAH) was developed and deployed on four wards across three hospitals for five months. A pre- and post-project audit was conducted to explore the impact of the tool on each ward.

Overall the audit highlighted an increase in the documentation of fluid balance charts (from 46% to 94%), urine output (from 9% to 88%), drinking preferences (from 10% to 32%) and discussion about hydration with patients (from 5% to 13%). Staff reported positive opinions about the tool and a change in practice resulting from being involved in the development phase of the project. The team will present their findings at the Royal College of Nursing International Nursing Research Conference in 2016.

Challenges during the project included the systematic review being more time consuming than originally anticipated, and the varying performances of the different wards involved in the project.

Contact details

For further information about the project, please email Christopher Price at Northumbria Healthcare NHS Foundation Trust.

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