Ins and outs- what's the point?!

classicdame, MSN, EdD · Jul 18, 2013

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.

Biffbradford · Jul 18, 2013

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.

allnurses Guide · Jul 18, 2013

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: Safety in Numbers -Focus on Ratios

Altra, BSN, RN · Jul 18, 2013

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.

dirtyhippiegirl, BSN, RN · Jul 18, 2013

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.

Bringonthenight · Jul 18, 2013

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 (

~PedsRN~, BSN, RN · Jul 18, 2013

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. :sarcastic:

We over monitor SO MUCH, imo.... on all kinds of fronts! This is just one of them.

Bringonthenight · Jul 18, 2013

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.

RNperdiem, RN · Jul 18, 2013

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.

Bringonthenight · Jul 18, 2013

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.

Wow what a sad case!

decembergrad2011, BSN, RN · Jul 18, 2013

Probably specific to my unit in oncology because of my leuks, but I've taken to placing and recording "blood loss" and "lab draws" in the computer flowsheets. I think it's important to monitor how much blood we're taking.

We are supposed to do I&O at 0600, 1400, 2200 on my floor. Techs generally take care of bathroom measurements as they toilet more, as well as catheters, emesis, and certain drains if it's without crazy characteristics. RNs take care of IVF, blood products, and any other measurement they come across in general, although many times my techs are good about putting a urine volume in the chart for me if I tell them.

I totally agree with some patients falling through the cracks, especially related to NPO and people without good IV access. We have patients that are like that and we have to keep an eye on them and make sure they're either drinking or getting maintenance fluids.