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For chronically critically ill patients, accurately measuring fluid balance – the amount of fluid received by a patient and their urinary output – is a key piece of information in providing the best care.
Getting accurate output measures, especially in incontinent patients, can be challenging. However, by adapting a method generally used with children, the team at University of Virginia Health System’s Transitional Care Hospital (TCH) has found a way to provide more accurate measurements while also reducing a patient’s risk of infection.
Their submission, “Weighing the Significance of Urinary Catheter Reduction,” earned the 2013 Goldberg Innovation Award from the National Association of Long Term Hospitals . This national award is given annually for an innovative process or technology used in a long-term care hospital.
Information that Protects Patients’ Health
“Knowing a patient’s fluid balance is critical, as it may be a clue to more serious health problems,” said Michael McDaniel, director of clinical operations at TCH. Tara Beuscher, a nurse practitioner at TCH, indicated that a patient’s fluid balance may signal whether kidney dialysis is needed. “The sicker a patient is, the more important fluid balance is,” she said. This information is especially critical at TCH, which provides specialized care for patients with serious medical conditions requiring longer stays than at traditional hospitals.
While it is easy for healthcare providers to track how much fluid they provide to patients, getting accurate output measures from incontinent patients has typically required urinary catheters. However, catheters are both uncomfortable and increase patients’ risk for catheter-associated urinary tract infections.
Finding a Better Measurement
The inspiration for a new measurement method came from Dr. Sharon Esau, medical director at TCH, who recalled that pediatric units weigh diapers to determine output.
Beginning in August 2012, TCH staff began buying scales and placing super absorbent pads that can hold up to 1 liter of fluid under incontinent patients. “While the pads absorb a great deal of liquid, their surface remains dry to prevent patients from getting skin infections,” McDaniel said.
The results were immediate. Staff received more accurate output measures to help make better patient-care decisions while reducing catheter use 33 percent and cutting the rate of catheter-associated infections per 1,000 patient days by 41 percent in the first seven months of the initiative. “This helps reduce length of stay and helps patients get better faster,” Beuscher said.
McDaniel credits the entire team at TCH for the initiative’s impact, as the plan depends on staff changing and weighing pads every time they become wet. “For this to have been successful, everyone had to support the program,” he said.
