accurate I&O's possible??

NurseStephRN · Sep 8, 2009

i work on a post open heart surgery unit and it is very important to keep accurate I/O...

however... i think the only accurate I/O are patients who are on tube feedings, iv, and have foleys, etc. if they are walkie talkies it's way to difficult to know exactly how much they're taking in and how much is coming out. some people refuse to use urinals or hats on the toilet, the cups we get from dietary are not graduated, so there's no way to accurately know how much the patient is drinking. sometimes they take a sip of water... and how much is that? 50 cc? 100 cc? sometimes the families bring them food from home, etc.

i think for these pts the I/O we chart are more of estimations.

NurseWannabe1129 · Sep 8, 2009

I wondered about this often during my previous semesters of nursing school. I wonder if a detailed explanation of the importance of I&O to the patient would make it a little easier to record. I have found in my (meager) experiences that my patients are so much more cooperative when I take time to explain to them why something is important and I'm not just doing it to bother or hurt them!!! Not sure how time would be a factor though....

Virgo_RN, BSN, RN · Sep 8, 2009

Some things that helped me:

When you go in to do your initial assessment, make sure the water pitcher is full and the bedside table is clear of empty cups and dishes. If the patient prefers to drink out of a cup, make sure they have one clean cup on the bedside table and let them know to fill it from the pitcher.

Make sure there is a sanipan in the toilet or a clean urinal at the bedside.

Let the patient know that "we measure everything that goes in and everything that goes out".

As you round throughout the shift, take a peed in the bathroom, look at the water pitcher, check for empty juice cups on the bedside table, etc.

Some floors keep an I&O sheet in the pt. room, and each time anyone empties the urinal/sanipan or gives the pt. a beverage or popsicle/jello/anything that counts as a "liquid", they write it on the I&O sheet in the appropriate column. Some floors do this on a white board in the pt. room. At the end of the shift, all of the info gets tallied, along with whatever is missing from the water pitcher. On some floors, the CNAs do this, and on other floors the nurses do it.

BabyLady, BSN, RN · Sep 8, 2009

The most important part is education and reinforcement q shift.

Tell the patient when you first go in..."we are still keeping track of how much you are drinking so we can better take care of you...if you could do me a favor and not throw away your soda cans, milk cartons, coffee cups, etc..I would appreciate it...just hit the call light and we'll throw those away for you."

Water can be hard to keep track of since pts tend to fill the cup up over and over again to keep it cold...I saw one nurse where she wrote the number of ml on the side of the pitcher on tape and then just wrote down what was consumed...that way the patient wasn't having to keep track.

ChristyRN2009 · Sep 8, 2009

Well honestly it depends on the patient status as to how accurate the I and O is. Obviously if a patient is on a lasix drip, renal issues, fluid restriction, then a patient's fluids are more important to be as accurate as possible. However, it really is difficult to get it within less than 200ml. Think about it, you give the patient a pitcher of water with ice. Well the ice melts. How much is that? A patient spills a sip or two of their coke on the bedside table. How much is that? You will learn too over time how much fluid is generally brought with each tray, Educating the patient about the whys and giving them the tools to record it (a piece of paper and pen, urinal, hat etc.) also helps. But like I said, unless its a patient who is NPO, on tube feedings or TPN, has a foley and a flexiseal, there is not really a way to get 100% correct I and O, just do the best you can.

cardiacmadeline, RN · Sep 8, 2009

I don't think it is possible to have 100% accurate I & O's, unless they are strict NPO with a foley. I think our CV docs look more at the daily weights than anything.

BabyLady, BSN, RN · Sep 8, 2009

Well honestly it depends on the patient status as to how accurate the I and O is. Obviously if a patient is on a lasix drip, renal issues, fluid restriction, then a patient's fluids are more important to be as accurate as possible. However, it really is difficult to get it within less than 200ml. Think about it, you give the patient a pitcher of water with ice. Well the ice melts. How much is that? A patient spills a sip or two of their coke on the bedside table. How much is that? You will learn too over time how much fluid is generally brought with each tray, Educating the patient about the whys and giving them the tools to record it (a piece of paper and pen, urinal, hat etc.) also helps. But like I said, unless its a patient who is NPO, on tube feedings or TPN, has a foley and a flexiseal, there is not really a way to get 100% correct I and O, just do the best you can.

Ice is calcuated at 50% of the volume.

Eyeball spills.

The intake and output is not going to be 100%...depending on the patient's condition...if they are dehydrated, their intake is going to be higher than their output.

If they have generalized edema, their output may exceed their intake.

If they are well hydrated, the intake should slightly be higher than output.

NightOwl0624 · Sep 8, 2009

I'm a new grad working nights. I can tell you about 95% of the time, the morning shift does not total their I&O's before they leave, and nothing is written after 1500. I assume most people who are not NPO do actually drink something with their dinner, but how am I supposed to know when I never see their tray?

I try to track it the best I can the night shift, but I know it isn't accurate for 24 hour intake.

kanzi monkey · Sep 8, 2009

As you round throughout the shift, take a peed in the bathroom,

:lol_hitti

(I'm totally laughing WITH-not AT-you, btw :) )

Bobylon · Sep 8, 2009

Ice is calcuated at 50% of the volume.

Only when starting with a cup/pitcher of ice only ..... water with ice will be quite close to the same volume when the ice melts.

oramar · Sep 8, 2009

Only once in my career were I&Os done correctly and timely manner on a med/surg or telemetry unit. What happened was that the manager made a rule that EVERY patient was on I&O the entire time they were on her unit. Somehow, it worked and the problem was solved.