Fluid administration is staple of medical care around the world. Restrictive fluid administration and accurate monitoring of fluid balances have become recognized as critical to reducing mortality and morbidity in critically ill patients. Evidence has linked cumulative fluid overload, as well as overtly negative balances with higher mortality, acute kidney injury, extended time on mechanical ventilation, and longer hospital stays. Despite this, and the ubiquitous use of intravenous fluids, there are still many instances in which administration is not individualized to the patient, and charting of fluid balances remains inaccurate.
This major paper proposes a quality improvement project to be conducted in an adult Medical Intensive Care Unit aiming to improve accuracy of fluid balance monitoring, and promote more restrictive, and patient specific fluid administration. Targeted staff education, reinforcement of intake and output documentation goals, with addition of monitoring tools such as daily weights, and laboratory data will be used to optimize trending of fluid volume. The Quality Health Outcomes Model will be used to guide the project to assess how patient characteristics, organizational factors, and components of the intervention interact and influence mortality and other clinical outcomes.
Outcomes will include improving the accuracy and completeness of charting, decreasing administration of unnecessary fluids, early identification of fluid overload, and ultimately decreasing the occurrence of acute kidney injury and mortality in critically ill patients. From this project, findings are expected to drive best practice, education initiatives, and ongoing research to guide future care for advanced nursing practice.
