Barriers to Accurate Fluid Measurement in Perioperative Patients: A Mixed Methods Approach

Area of Science:

• Perioperative Medicine
• Healthcare Quality Improvement
• Nursing Practice

Background:

• Accurate fluid intake and output (I/O) measurements are vital for assessing resuscitation and fluid balance in surgical patients.
• Variability in I/O measurement accuracy and consistency exists across different nursing units.
• This study aimed to identify barriers to accurate fluid measurements and propose solutions.

Purpose of the Study:

• To investigate the barriers encountered by healthcare professionals in obtaining accurate fluid intake and output measurements for surgical patients.
• To explore potential solutions to enhance the accuracy and efficiency of fluid I/O monitoring.

Main Methods:

• A mixed-method, sequential study design was employed.
• A survey was administered to Registered Nurses (RNs) and Patient Care Technicians (PCTs) across 8 non-intensive care units.
• Four focus groups were conducted to further explore survey findings, with qualitative data analyzed using a hierarchical methodology.

Main Results:

• Patient load and staff time limitations were identified as significant barriers to accurate I/O measurements.
• Approximately half of respondents reported inaccurate fluid measurements, with PCTs experiencing greater challenges due to higher patient loads and complex cases.
• Key themes from focus groups included understaffing, insufficient training, reliance on temporary staff, and communication issues regarding new orders.

Conclusions:

• Improving fluid I/O measurement accuracy and efficiency requires addressing understaffing and enhancing educational programs.
• Implementing in-room kiosks for electronic data entry and standardizing I/O measurement processes are recommended solutions.
• Streamlining electronic medical record (EMR) data entry and order sets can also contribute to improved accuracy.