Improving Documentation of Intake & Output on St.

Francis 4th Floor Unit

Abstract Data and Analysis of the Issue Root Cause AIM - Proposed Solution
Data was collected in a variety of ways.
▪ We AIM to reduce documentation
Previous chart audits on I/O documentation for October
Fluid documentation is vital to patient and November of 2022 were submitted from SFMC 4th The root cause of noncompliance in the charting inaccuracies of intake and output by 20% with
homeostasis acting as an asset to provider Floor Orthopedics Unit Director Alita Yates of intake and output was improper the help of the huddle helper to help clarify the
decisions and is often inaccurate or incomplete. communication between Nurses & PCTs. roles by the end of 2023.
We put together a Quality Improvement project on • The average percentage of Input documentation ▪ Improve input/output documentation via the
documentation of intake and output (I/O) by compliance was 34.75% In research done in a study it was found that use of the huddle helper we created.
nursing staff on the 4th floor unit of St. Francis. • The average percentage of Output documentation ▪ We will provide these huddle helpers at the
compliance was 65%
inadequate training was a major reason for poor
Pre-intervention data shows input documentation quality of documentation (Madu, 2021). start of the shift to the 4th floor.
• The audits revealed a lack of I/O documentation
compliance at 34.75% and output compliance at ▪ Our proposed solution is to help the RNs
• It is important to note that this unit provides care to
65% and identifies role confusion between Patient patients following orthopedic surgeries and PCTs improve the accuracy of I/O.
Care Technicians (PCTs) and nursing staff. Using a • Fluid management is crucial for patients with
new huddle helper, and role clarification, we are estimate blood loss due to a surgical procedure Hypothesis: If we implement a tool for nursing &
initiating a new system to improve the accuracy of (Zhang et al., 2021) PCT staff to utilize, then documentation &
I/O documentation by staff. We expect a post- accuracy in the charting of intake and output will
intervention audit to show at least a 20% decrease increase.
in the inaccuracies of I/O documentation. In Conclusion
conclusion, our aim is to reduce
documentation inaccuracies via the use of the
huddle helper to assist in clarifying PCT and nursing Logistics
• Huddle Helper print outs
Documentation of intake and output are extremely vital in
roles by the end of 2023.
• PCT/Nurse education regarding new Huddle Helper ensuring patient safety. Accuracy in documentation is a
• Changes to current handoff procedure for PCTs shared responsibility between the nursing staff as well as
• Establishing accountability for Huddle Helper PCTs. Communication between the two ensures accuracy
and timely documentation. Based on the data collected from
compliance
SFMC for November and October of 2022, the average
percentage of input documentation was 34.75% whereas the
Introduction and Description of Stakeholders average percentage of output documentation was 65%.
During the interviews with the nurses and techs on the unit we
the Issue Nurses, PCTs, Nurse leader/manager, found that the main reported causes for
inaccuracies included time constraints, inability to accurately
Macro Description:
director track Is and Os, large patient load, and improper handoff. Our
• Fluid balance is vital to patient homeostasis. aim for our proposed huddle helper is to reduce
• Fluid input & output charting provides doctors valuable documentation inaccuracies of intake and output by 20% by
information on intravenous administrations and possible
Potential costs the end of 2023.
complications of disease processes or procedures. • Printer Paper (for huddle helper at beginning of each
• Inaccuracies of intake & output documentation, as well as shift)
noncompliance by nursing staff, on hospital units places • Printer Ink
References
patient safety at risk.
• Any resulting hypovolemia or hypervolemia increase the Data was also collected using an online survey. The • Huddle Helper Editor/Organizer Madu A, Asogan H, Raoof A
survey was conducted on 2/9/23 and polled four full-time Education and training as key drivers for improving the quality of fluid
risk of common complications of inpatient stay such as balance charts: findings from a quality improvement project
hospital-acquired pneumonia, peripheral edema, acute nurses and one part-time nurse on SFMC 4th Floor Timeline BMJ Open Quality 2021;10:e001137. doi:10.1136/bmjoq-2020-
kidney injury, and possible death or serious injuries
(Vincent & Mahendiran, 2015).
Orthopedics Unit (5 total).
• The survey revealed that all the nurses believed I/O
•• Data was collected
001137
Surwit, E. A., & Tam, T. Y. (n.d.). The Global Library
Clinical site visit and assessed for potential problems of Women's Medicine's. Global Library of Womens Medicine.
• Presentation was finalized and presented to leadership
Micro Description:
• Patient intake & output documentation compliance by
documentation was important
• The nurses listed a variety of factors for the lack of I/O • Starting the project end game Retrieved March 10, 2023, from https://www.glowm.com/section-
view/heading/Postoperative%20Care/item/36#.ZAucFezMI-Q
nurses on the 4th floor of St. Francis Medical Center compliance, but notably communication difficulties
Vincent, M., & Mahendiran, T. (2015). Improvement of fluid
shows less than 50% of intake (P.O. & IV) being recorded. between PCT staff, Nursing staff, and patients balance monitoring through education and rationalization.
were frequently cited Data Collection BMJ Quality Improvement Reports, 4(1).
Doi: https://doi.org/10.1136%2Fbmjquality.u209885.w4087
The data will be collected through surveys on
Zhang, L., Xu, F., Li, S., Zheng, X., Zheng, S., Liu, H., Lyu, J., & Yin,
surveymonkey.com that will be administered to
H. (2021). Influence of fluid balance on the prognosis of patients with
employees on the 4th floor of SFMC. sepsis. BMC anesthesiology, 21(1), 269.
https://doi.org/10.1186/s12871-021-01489-1