Ins and outs- what's the point?!

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    I've talked to some fellow nurses lately getting opinions on the use of fluid balance charts in their specialty units. Everyone had different opinions.

    The issue discussed was how fluid balance charts are so rarely properly filled out/ amounts are missed so the balance is never truly accurate; so they figure what good are they actually doing?

    My ICU friends disagreed, obviously fluid balance is critical in ICU and with a 1:1 nurse to patient ratio plus IDC and ng/IV lines being able to get exact input and output, an accurate fluid balance is much more achievable.

    One cardiologist I've worked with never ordered a fluid balance, believing a strict daily weight was the most accurate way to manage a CHF patient as he often found discrepancies in I+O charting- so he simply trialled working without them.

    I know it depends on your specialty unit but I would love to hear everyone's opinions/stories and experiences (vents) with I + O charting.

    Is this charting being properly performed where you work?
    Do you believe fluid balance is critical where you work even when you have found discrepancies?
    Do you think more education needs to be provided on the importance of recording an accurate fluid balance?

    Thanks everyone
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  4. 0
    good question. The data is important as a quick way to determine any trends, but if the charting is incomplete then the purpose is missed. Of course it is important for critical patients. In pedi we always consider any kid on IV fluids gets strict I&O's. For adults, I guess it depends on overall condition of patient. Looking forward to reading this thread.
  5. 1
    Hospital bed scales in the ICU can be iffy at best. Push the button 3 times and get 3 different numbers. If I was confident on the I/O, then I could use that to verify if the weight I just got was accurate or go back and try to get the weight again. It's nice to know that if the I/0 indicates -1,000cc for 24 hours and the weight is -1kg, then things are being done right! Like stated though, you've got to do your job in properly recording ALL the data though.
    nrsang97 likes this.
  6. 4
    I&O can be crucial. If they are not accurate I suggest finding out why and the working to make sure everyone makes sure they are as accurate as possible.

    Are prople filling water pitchers and emptying urinals without documenting the amount?
    Does dietary pass trays? Then have nursing personnel write down how much liquid was served so the amout the patient drank can later be recorded.

    Do you have enough staff? If not work together to convine management that sufficient staff will save money.

    One example. My 85 year old husband was drinking too much juice and such at home and at his lodge. Last December he was admitted for exacerbation of CHF. I told his admitting nurse that he needed reinforcement and education on why and how to restrict fluids. The RNs and CNAs coordinated to be very accurate with his I&O. He was made aware of how much he drank.

    He came home New years dayu. He has been very good with his restriction.
    For about two years before that he began to have leg edema about a month after leaving the hospital and coughing up fluid the second month. He has not needed hospitalization so far this year.

    Because hospital reimbursements are less for patients readmitted for the same diagnosis and for hospital aquired infections and decubitus ulcers it is cost effective for hospitals to provide enough staff.

    Look at page ten here for research studies: [COLOR=#0000ff]Safety in Numbers -Focus on Ratios[/COLOR]
    nursel56, nrsang97, Spidey's mom, and 1 other like this.
  7. 4
    I/O is a crucial assessment point for many patients.

    If documentation is done inaccurately, my response would be to take the steps necessary (re-education, providing good data collection tools, etc.) to get it done accurately.
    nursel56, canoehead, nrsang97, and 1 other like this.
  8. 3
    We do calorie counts on all of our burn patients, at least for the first few days. It can be a cluster if the patient is taking PO. We encourage patients to eat the food that they like and for families to bring in food from home which nursing should be documenting but I can't imagine that the calorie counts are right, esp. with home cooked food and I'm sometimes at a loss as to what the patient is even eating because it's an ethnic dish that I've never seen. Dietary is supposed to fill out calorie counts on hospital trays but it's a high turnover job that is mostly staffed by high school students. Half the time they don't even collect the trays...

    Intake/output charts on our big burns - the ones that we need to fluid resuscitate - are always giggle-inducingly absurd. Partially because of the insensible fluid loss that we can't measure. So a patient might look like they're up 25 L of fluid. Although sometimes they are, and then they go into flash pulmonary edema...sigh.
  9. 5
    I agree I think education of staff on the importance of a fluid balance record is critical, so many nurses don't seem to understand the consequences that could occur.

    I get so frustrated when weights and I+O aren't completed it effects patient care not to mention dealing with the angry MD who wants to know why things haven't been done as ordered (
    nrsang97, jadelpn, herring_RN, and 2 others like this.
  10. 6
    Here's my thing... I'm all for I&Os. But I sure do wish that the residents would order them appropriately. Routine is just about adequate for everyone. Our specialties tend to be a little more lax in the strict I&O ordering, but man the residents want everyone on a cardiac monitor and want us to measure every drop of pee. Does the asthmatic who is taking good PO really need to pee in a urinal?

    I guess I wonder sometimes.. what happened to good old assessment?

    the only truly accurate I&Os on my floor are probably the bottle fed and diapered babies. We can weigh a diaper and measure formula. But a 15 year old will drink a half a soda here, four sips of water there, and half the time flushes the pee because they forget to pee in the hat.

    We over monitor SO MUCH, imo.... on all kinds of fronts! This is just one of them.
    mind_body_soul RN, nrsang97, wooh, and 3 others like this.
  11. 3
    Quote from ~PedsRN~
    Here's my thing... I'm all for I&Os. But I sure do wish that the residents would order them appropriately. Routine is just about adequate for everyone. Our specialties tend to be a little more lax in the strict I&O ordering, but man the residents want everyone on a cardiac monitor and want us to measure every drop of pee. Does the asthmatic who is taking good PO really need to pee in a urinal?

    I guess I wonder sometimes.. what happened to good old assessment?

    the only truly accurate I&Os on my floor are probably the bottle fed and diapered babies. We can weigh a diaper and measure formula. But a 15 year old will drink a half a soda here, four sips of water there, and half the time flushes the pee because they forget to pee in the hat.

    We over monitor SO MUCH, imo.... on all kinds of fronts! This is just one of them.
    I agree so much! Some doctors order strict fluid balance on every patient regardless of diagnosis! And yes it's so hard when you have a patient who is a walkie talkie and can just drink a bottle of water and forget to tell the nurse!

    That's what I mean about the in accuracy of I +O charting.
    nrsang97, herring_RN, and Fiona59 like this.
  12. 1
    I became a little paranoid about recording I&O early on.
    There was a case years ago about a prisoner in the prison hospital around here. He was admitted for psych reasons, but the staff didn't record any I&Os. When the prisoner died 3 days later, the cause was found to be dehydration. Nobody seemed to notice that the man had taken nothing by mouth for days. I was big news, and the doctor in charge and several nurses were disciplined.
    herring_RN likes this.


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