Dehydration among stroke patients has been cited in various research studies as it potentially affects the ischemic penumbra and influence stroke evolution in their acute phase of stroke.
A team from Tuen Mun Hospital (TMH) Acute stroke unit (ASU) developed the fluid management bundle to ensure patients receive adequate hydration since July 2018 till present, aims to:
- Evaluate the barriers encountered by staff in improving oral hydration
- Formulate and implement a simple and cost-effective interventions
A mixed methodology approach, in which three ‘Plan Do Study Act’ (PDSA) cycles were undertaken in October 2018, December 2019 and July 2021, adopted to achieve our aims.
Amongst the 3 PDSA cycles, a new screening tool BUN/Creatinine ratio adopted besides the traditional Intake/Output chart followed by education and communication to nursing staffs as underpin the foundations of the workstream at the early stage. Program team then aware that be user-friendly, readily accessible and a consistent approach in real practice are the core principles for successful fluid management.
Program then go through PDSA cycle 2 and 3, bundle workflow reviewed eventually. Educational leaflet of hydration and special water cup were dispatched to patients and bed head signage were designed and launched for alertness of ward staff.
Outcome & Conclusion
Evaluation in each PSDA cycles noticed that a significant raised in the awareness of hydration needs from ward staffs with 93% of hydration plan in average were initiated by nurses. Throughout the new assessment tool, there were 69.6%, 73% and 64% of dehydrated patients being identified on admission, while in Day 4-7 reassessment, improvement of BUN/Creatinine ratio in dehydration risk patient was 8.7%, 15% and 13% respectively in the evaluation of the 3 PDSA cycles.
A successful sustained fluid management program can only happen by ensuring a whole-team approach.
