Transcript Prevention of dehydration in hospital in

Prevention of dehydration in
hospital in-patients
Dr P. Johnstone, Mr N. Hickey, Dr R. Alexander
Plan
•
•
•
•
Background
Study
Results
Recommendations/Ideas
“Severe dehydration is
one of the main causes
of the condition.”
“It costs the NHS more than
the cost of breast, lung and
bowel cancer combined.”
“Good basic care would save
these lives and save millions
of pounds for the NHS”
1,2,3
Death certificate:
Died because of a 'water deficit‘
and 'hypernatraemia'
‘they won't give
me anything to drink.’
‘He became severely
dehydrated’
4
Dehydration
o Can lead to multiple morbidities and even
5
mortality.
Short-term
Long-term
UTIs
Coronary heard disease
Pressure sores
Breast cancer
Constipation
Hypertension
Pneumonia
Thrombosis
Disorientation
Cerebral infarct
6,7,8,9,10,11
Factors linked to a higher risk of
dehydration in the older adult:
 Functional ability
 Gender
 Visual impairment
 Incontinence
 Ingestion difficulties
 Speaking ability
12,13
Optimal Hydration
Adults = 2L per day
Older adults = no less than 1.6 litres per day.
Makes economic sense as well…
< one tenth of a penny per litre
14
Francis report
“Some patients were left
with food and drink out of
reach and offered
inadequate or no
assistance in consuming
it. Even water or the
means to drink it could be
hard to come by.”
15
In one investigation covering 2003-2012, 549
dehydration related incidents were reported,
ranging from 50 ‘low harm’ incidents to 142
deaths. 150 of these were identified as a
“failure to act”.
16
• NICE guidelines state that “healthcare
professionals should ensure that care
provides…food and fluid of adequate
quantity”
17
Study
1) The equipment used by patients to take in
water
2) Variables surrounding the water jug that could
affect the ease with which patients pour
themselves a glass of water
3) Are there improvements to be made to
optimise the patient’s ability to drink?
Study
• 52 patients, across 3 surgical wards, on 2
occasions.
• Mixed methodology
• Structured interview
Excluded:
AVPU
Cognitive impairment
Opt out
Sample
Sample size = 52
Age range = 38-98
Median and Mean age = 72
40
35
30
25
Males
20
Females
36
15
10
5
0
16
Results
Can patients currently reach the jug of water?
70
60
50
40
30
58
42
20
10
0
Yes
No
Results
Are patients always able to lift the jug of
water?
90
80
70
60
50
40
79
30
20
21
10
0
Yes
No
Results
Percentage (%) of patients able to lift the varying
volumes of jug
100
95
90
%
98.1%
85
90.4%
80
84.6%
75
0.5L
0.75L
Jug volume
1L
Results
Jug preference (%)
50
45
40
35
30
25
47.5
20
15
27.5
10
17.5
5
7.5
0
0.5L
0.75L
1L
0.5/0.75L
Average weight of the jug = 920g
1000 ml
1250g
750 ml
975g
500 ml
700g
Results
Difficulty rating
20
18
16
14
12
Frequency 10
8
6
4
2
0
1
2
3
Difficulty rating
4
5
What do patients want
Control
Colourful
spout
Graduated
Ideas
More
aesthetically
pleasing
Attached lids
Gripped
handle
Limitations
Small sample size
Focused on surgical patients
Interview bias
Conclusion
The mistaken assumption that because water is
provided the patient is hydrated
Individuals’ needs and preferences vary
We need to offer equipment more tailored to
individual needs
Recommendations/Ideas
1) An individual assessment of the patients’
needs on admission to hospital.
2) A scale indication of fluid volume should be
marked on the jug/water container
3) Alternative methods to the water jug and
glass to enable the patient to drink more
easily should be investigated, such as the
“Hydrant”
18
What’s next?
Pilot study
Take home message
Hydration needs to be a
primary staffing priority
References
1 The Guardian reporters. 1,000 hospital patients die each month from avoidable kidney problems. The Guardian. 22 April 2014.
http://www.theguardian.com/society/2014/apr/22/avoidable-deaths-acute-kidney-injury
2 National Confi dential Enquiry into Patient Outcome and Death. Adding Insult to Injury.
A review of the care of patients who died in hospital with a primary diagnosis of acute kidney injury (acute renal failure). June 2009.
http://www.ncepod.org.uk/2009report1/Downloads/AKI_report.pdf
3 Kerr M, Bedford M, Matthews B, O'Donoghue D. The economic impact of acute kidney injury in England. Nephrology Dialysis
Transplantation 2014 Jan.
4 Telegraph reporters. Man, 22, who died from dehydration in hospital rang police for a drink of water. The Telegraph. July 2012
http://www.telegraph.co.uk/health/healthnews/9370376/Man-22-who-died-from-dehydration-in-hospital-rang-police-for-a-drink-ofwater.html
5 Weinberg AD, Minaker KL, Coble YD, Davis RM, Head CA, Howe JP, et al. Dehydration. Evaluation and Management in Older Adults.
American Medical Association. 1995 November 15; 274 (19) 1552-1556
6 Warren J, Bacon WE, Haris T, et al. The Burden and Outcomes Associated with Dehydration among US Elderly, 1991. American Journal of
Public Health. 1994; 84(8):1265-1269 http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.84.8.1265
7 Weinberg AD, MD; Minaker KL. Dehydration. Evaluation and Management in Older Adults. Council on Scientific Affairs, American Medical
Association. JAMA. 1995 Nov; 274(19):1552-6.
8 Stotts NA, Hopf HW. The link between tissue oxygen and hydration in nursing home residents with pressure ulcers: preliminary data. Journal
of Wound, Ostomy & Continence Nursing. 2003; 30(4):184-190
9 Stookey JD, Belderson PE, Russell JM et al. Correspondence re: J.Shannon et al. Relationship of food groups and water intake to colon
cancer risk. Cancer Epidemiology, Biomarkers & Prevention. 1997; 6:657-658
References
10 Chan J, Knutsen SF, Blix GG et al. Water, other fluids, and fatal coronary heart disease: the Adventist Health Study. American Journal of
Epidemiology. 2002; 155(9):827-833. http://aje.oxfordjournals.org/content/155/9/827.long
11 Manz F, Wentz A. The Importance of Good Hydration for the Prevention of Chronic Diseases. Nutrition Reviews. 2005; 63 (Suppl 1):S2-S5
http://onlinelibrary.wiley.com/doi/10.1111/j.1753-4887.2005.tb00150.x/pdf
12 Hodgkinson B, Evans D, Wood J. Maintaining oral hydration in adults: A systematic review. International Journal of Nursing Practice. 2003
Jun 12; 9(3):S19-28. http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&sid=42b97437-425e-4db9-80632006372b523a%40sessionmgr110&hid=124
13 Jocelyn Cornwell. The care of frail older people with complex needs: time for a revolution. The King’s Fund. March 2012.
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/the-care-of-frail-older-people-with-complex-needs-mar-2012.pdf
14 Institute of Medicine (U.S.). Panel on Dietary References Intakes for Electrolytes and Water. Dietary reference intakes for water,
potassium, sodium, chloride and sulphate. Washington DC: National Academies Press. 2004.
15 Francis R. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 2013 Feb; 3: Chapter 20.115
16 Lecko C, Best C. Hydration – the missing part of nutritional care. Nursing Times 2013 Vol 109 No 26 (accessed 20/12/2013)
http://www.nursingtimes.net/Journals/2013/06/28/n/o/w/030713-Hydration-the-missing-part-of-nutritional-care.pdf
17 National Collaborating Centre for Acute Care. Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral
nutrition. National Institute for Health and Clinical Excellence Guideline 32. 2006 Feb.
http://www.nice.org.uk/nicemedia/pdf/CG032NICEguideline.pdf
18 Moran M. Hydrate for Health. http://www.hydrateforhealth.co.uk/