4PROMOTING ORAL FLUID INTAKE IN HOSPITAL: THE NORTHUMBRIA ASSESSMENT OF HYDRATION

Abstract

Background: Older people in hospital are susceptible to dehydration due to pre-existing and acute health problems. There is no routinely used standardised nursing assessment to identify those patients without intravenous fluids who remain at risk of poor oral fluid intake. Innovation: The Northumbria Assessment of Hydration (NoAH) tool was developed through a literature review and thematic analysis of interviews with nursing staff (n = 55) and patients/relatives (n = 11) to be a nurse-led fluid intake risk assessment and response protocol for older patients within 48 hours of hospital admission. Nurses followed three escalating grades of clinical care response including formal elicitation of drinking preferences, patient held intake charts and a regular senior nurse review according to a NoAH score from 0-10, which reflected medication, communication, visual perception, fluid consistency recommendation, orientation, mucosal appearances and ability to drink from a glass. This was deployed on 4 wards (acute, rehabilitation and stroke units) across 3 hospitals between March-July 2015. Evaluation: Amongst 650 admissions, 143 were ineligible because the patient was already receiving intravenous fluids, a fluid restriction or palliative care. 304 NoAH tools were completed (54% low, 43% medium, 3% high risk gradings). Incompletion rate was 31%. Compared to a baseline audit of 100 patients in the same settings, increases were observed in documentation of fluid balance charts (5% vs 88%; p < 0.001), urine output charts (1% vs 83%; p < 0.001), support with hydration (11% vs 79%; p < 0.001) and discussions about hydration (5% vs 13%; p < 0.05). In post-implementation interviews staff suggested a higher score weighting for cognitive status and less emphasis on mucosal appearances. Conclusions: A formalised oral intake score was well received in secondary care and improved relevant documentation. Next steps include promoting routine application and demonstration of reduced intravenous fluid replacement.