Barriers to Accurate Fluid Measurement in Perioperative Patients: A Mixed Methods Approach

• Published in: The Journal of surgical research 2021-04, Vol.260, p.95-103
• Main Authors: Wehrle, Chase J., Walker, Morgan, Worthey, Ayana, Jones, Caitlin E., Lewis, Frank, Arora, Tania K.
• Format: Article
• Language: English
• Subjects: Fluid intake; Fluid output; Fluids management; Reliability of fluid measurements
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2020.11.073

Surgeons depend on fluid intake and output (I/O) measurements for assessment of resuscitation and fluid balance during the perioperative period. Frequently, these measurements are taken by Registered Nurses (RNs) and/or Patient Care Technicians (PCTs). There is variability in the accuracy and consistency of these measurements across nursing units. The goal of this study is to establish what barriers exist in obtaining accurate fluid measurements and potential solutions. A mixed-method, sequential study design was utilized. First, a survey was conducted at a tertiary care institution of 8 nonintensive care nursing units assessing the perceptions of RNs (n = 85) and PCTs (n = 38) regarding fluid intake and output measurements for surgical patients. Four focus groups were then conducted to expand upon the results of the survey. Fourteen participants (10 RNs and 4 PCTs) were interviewed, and transcripts were analyzed by three reviewers. Qualitative data were manually coded by reviewers using a hierarchical methodology. Survey response rate was 40.6%. The strongest barriers in the survey were patient load and staff time limitations. About half (49%) of the respondents acknowledged that fluid measurements were inaccurate half of the time. PCTs spend more time collecting and charting I/Os and have higher patient loads (P