how does your facility measure I&O

[n.vere]

Hello everyone,

I am working on a quality improvement project for one of my classes.

I was assigned to look into intake and output documentation. I know that on my unit this has been a major issue. Some shifts there is documentation and others there is not.

How does your facility keep track of this? Is your facility struggling too? What do you do to make sure you keep track of your patients i&os? Do you use flow sheets or daily logs? If so are they patient driven or does the staff fill them out? Are they for each shift or for 24 hour period? Do you think they work? What could be done differently? What are some of our barriers for not documenting?

Any comments, tips, suggestions are appreciated!!!!

[calivianya, BSN, RN]

I have seen some floors put an I/O sheet on the patient's bathroom door. It had in and out columns for every hour, so every time someone brought the patient a drink they were supposed to record the mls on the sheet. At the end of the shift, the RN was responsible for logging the totals into the computer. Of course, that was a med/surg floor, so it was a little more lax for keeping up with I/O.

I can't imagine what the barriers for not documenting are - that's nuts. It sounds like what your facility needs more than anything is inservices on the importance of keeping up with patient I/O and even possibly disciplinary action for repeat offenders who are failing to monitor their patients.

[Here.I.Stand, BSN, RN]

We measure hourly on a flowsheet. We use Epic, and we document continuous IV infusions on the VS flowsheet; it has a calculator that we click on every 2 hours, that way if it's a drip we're titrating we don't have to figure out how much volume the pt actually got if something has been at five different rates in the span of an hour. We enter volumes for tubefeeds, IV boluses, IV piggybacks, urine, drains, PO fluids, etc. on the I/O flowsheet.

All data is entered by the RN or the CNA, if the CNA is the one to give the pt a drink or empty the foley.

Places I've worked without computer charting have had similar paper flowsheets. The only difference is we have to add our own totals and figure out the net I/O.

The only times it is not done is if it's one of those crazy-busy-no-time-to-chart shifts. Personally I&O is one thing that I will stay late to document, and I always chart drip changes in real time. I might not stay late to do a narrative note if everything I have to say is also documented elsewhere in the chart...but I&O is important for the critically ill/injured.

[mmc51264, BSN, MSN, RN]

Everything is doe through the computer. Q4h is expected. Problems we have are pts whose family brings them drinks and pt that can go to the bathroom by themselves and don't save urine.

Our charting is inconsistent and we are working on it.

[VANurse2010]

Any strict I/O order without an indwelling catheter is a joke. That's my story, and I'm sticking to it.

[ambitiousblonde]

One would think this is such a simple task, but for some reason our floor struggles with this as well. After I assess my pt I check in the BR to see if there is a hat, if not I grab one and put it under the seat. Then I ask the pt/family to please not empty it, as I want to keep a close eye on the amt of urine as well as the color.

For intake, I will just ask how many extra Styrofoam cups they've had to drink.

This may not be the best way, but it is what works for me.

The CNA's are suppose to chart the I/O's along with VS, q4hr., but not all of them do it.

Ultimately, I am responsible for my pt and documentation, I don't have time to run behind them and make sure they are doing what is asked of them.

[lurn1234]

We place hats or urine collection in toilet seat and don't give them water unless we give them and measure all intake and all outputs