Water good idea: Trust praised for hydration project

A patient is helped by a student nurse with hydration
A patient is helped by a student nurse with hydration

Bucks Healthcare NHS Trust has been praised for its ‘Evian Project’ - an initiative designed to improve the hydration of patients.

The Chief Inspector of Hospitals highlighted the initiative following the Care Quality Commission (CQC) inspection in June.

It was praised as one of the ‘real differences made in a relatively short time to improve quality and the patient experience’.

Consultant nurse Jenny Ricketts said: “Our aim was to ensure that patients who needed support with hydration were identified and monitored accurately.

“This involved reviewing our fluid balance charts, which staff use to measure and record the amount of fluids individual patients have, as well as ensuring that drinks were available and within the reach of all patients.”

Through observations and discussions with ward staff, the team identified that many of the current charts were being filled in for patients who did not require monitoring, the forms were difficult to complete, and there was a lack of understanding around the best practice to identify those who needed support.

Jackie Efurbie, deputy sister on ward 16a said: “We found it difficult to accurately measure the amount of fluids patients had as different cups of different sizes were used, and we had no quick, easy way to identify those who needed support with their drinking.

“Since the hydration project we now have standardised cups, with posters in each bay clearly highlighting how much fluid each cup holds so we can record the correct amounts.

“In addition, those patients who need support drinking are easily identifiable as they are provided with red jugs and cups.

“These small changes have made such a big difference to the quality of care for our patients.”

Alongside the changes, a new fluid balance chart was trialled after training sessions were provided for staff around the importance of the charts, which patients required them, and how to complete the new design.

The project team based themselves on the ward in order to support the staff and to identify any difficulties that might be experienced.

Kelvin Jones, who was an in-patient during the initial pilot: “It was fantastic to see that, as a patient, I was also encouraged to be involved in this project. “By making my own records of my fluid intake, I could recognise whether I was drinking enough or needed to drink more.

“I was also provided with leaflets and information about the impact and risks of dehydration.

“It allowed me to take more control of my own health and I am now aware of the importance in drinking regularly.”

After just one month of the project, more than 70% of patients were appropriately on a fluid chart, compared to just 21% before the changes were put in place, and 98% of patients had a jug of fresh water nearby, in comparison to 60% at the start.

Jenny Ricketts, consultant nurse added: “A lot of patients were on the charts unnecessarily adding to the staff workload.

“The decision to remove a chart from a patient was often met with concern and anxiety by staff and those who were appropriately using the charts had great difficulty completing them.

“However with support, training, and a new design of chart, we have seen fantastic improvements.

“Due to this success, these changes are now being rolled out across all of our acute hospitals and community hospitals as we hope to see the figures continue to dramatically improve throughout the trust.”