Factors associated with documentation of fluid intake and output in post-operative patients at Mansa General Hospital

Abstract

Introduction: Ensuring patients are adequately hydrated is an essential part of nursing care but the performance assessment and nursing audit reports demonstrated a gap in the documentation of the post-operative patients fluid balance charts at Mansa General Hospital (MGH). The main objective of the study was to evaluate factors affecting documentation of intake and output on the fluid balance charts in post-operative patients at MGH. Methods: This was a hospital based descriptive cross-sectional study with a quantitative approach conducted at Mansa General Hospital. Following the approval of the research by ERES Converge, data was collected from a total sample of 53 nurses and midwives working in four surgical wards. To check for completeness of the documentation of the intake and output charts, a checklist was developed and a total of 319 intake and output charts of postoperative patients admitted to surgical wards between January and June 2015. Analysis of data was done using STATA version 13.0 for windows. Frequency tables, cross tabulations and percentages were used to present the simple descriptive statistics. Pearson chi-square test was used to test associations between documentation of intake and output on fluid balance charts and several key independent variables expected to influence the dependent variable. A semi-structured interview schedule and audit tool were used for data collection, Pearson’s chi-squared test was used to assess the relationship among variables. Results: The Pearson chi-square test was 3.3673 while the p-value was 0.408 indicating a non-statistically significant relationship. The results showed that service of 5 years and above, high knowledge on documentation and working in the maternity ward were associated with documenting fluid intake and output (P < 0.01, P<0.02 and P<0.04 respectively) at 5%. The findings show that 59% of the patients charts had the patients name, 89% had the patients age and sex respectively. Eighty three percent (83%) of the fluid balance charts had names of the ward recorded on them, 86% had a date of admission, 7% percent had a bed number and 44% had a patient’s diagnosis indicated. Most (97%) of the patients fluid balance charts had the name of the fluid administered, 94% had time of commencement, amount of fluid given (96%) and output indicated. The other parameters indicated on the fluid balance charts included the nurses and midwives shift balance (21%) flow rate (5%) and the doctor’s name (6%). viii Conclusions: The findings indicates a gap in the documentation of fluid intake and output among post-operative patients at Mansa General Hospital. Long period of service and high levels of knowledge significantly increase the probability of documentation. Recommendations: Refresher courses targeting all nurses and midwives, with a special focus on the importance of documentation of intake and output should be introduced. Management should advocate for increased number of nurses and midwives on the staff establishment, because an increased patient to staff ratio leads to heavy workload for nurses and midwives. Reducing the patient to health staff ratio may reduce the stress and fatigue on the part of nurses. Thus, leading to improvement in the documentation of fluid intake and output. Keywords: Post-operative patients, intake and output, fluid balance chart, Nurse and Midwife