The efficiency of fluid balance charting: an evidence-based management project

This study began following an observation that fluid balance (FB) charts seemed to be overloading medical records in Hong Kong hospitals. The major issues for this study were the efficiency and appropriateness of FB charting. The study design included an analysis of 250 medical records and an opinion survey. Seventy-five doctors and 98 nurses participated in the survey. The results indicated that 50% of all medical records had FB charts and in these cases they made up between 12 and 16% of the whole medical record. Intravenous infusion and urinary catheterization accounted for almost 70% of the recorded reasons for using them. Thirty-two per cent of FB charts were found to be incomplete or inaccurate. Forty-six per cent of doctors and nurses reported that they believed that charts were not always terminated when they were not required. The most common belief among doctors was that only doctors should discontinue the FB charts. Nurses were almost unanimous in believing that they should not do this without the agreement of the doctors! It was concluded that nurses in the context under study should be empowered to terminate charts when they become unnecessary. In addition, the design of charts should be modified to accommodate different purposes.