FBC Details and Implementation Notes 15-07-10

8/21/2019 FBC Details and Implementation Notes 15-07-10

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FLUID BALANCE - CHECK AT A GLANCE

A NEW WAY OF DISPLAYING CUMULATIVE TOTALS

The monitoring of patients' fluid balance in order to prevent either dehydration or over-hydration isa relatively simple task, nonetheless fluid balance recording is notorious for being inadequately andinaccurately completed. In addition, data on fluid balance charts, even if accurately recorded, mustbe checked on a regular basis if trends which give cause for concern are to be identified early. Thedetailed data currently recorded on charts, while necessary and useful, may not be easy to graspquickly. umulative totals, from which trends over time may be identified, are also usually hiddenunder the daily charts.

The new chart described here converts the figures recorded on the cumulative charts into avisually compelling bar chart which if displayed on the front of the fluid balance folder is visibleeven across the ward, providing 'at a glance' information about a patient's fluid balance status.

HOW DOES IT WORK?(see sampe !" #!mpe$e% #&a'$ ! e)$ pa*e+

The numbers at the side of the chart indicate the number of mls !in 1""ml divisions#$a,!e% positive balance, ,e!. % negativebalance, m/%/e% perfect balance of input andoutput.

Two lines across the ,a#0centre line indicate a balance which is neither &venor -ve.

cross over the ,a#0centre line indicates that the day's recordings are incomplete and it is

not possible to calculate the balance for the preceding () hrs.

*or totals e+ceeding mls shown on chart in either direction a red or blue arrow is addedabove or below the line.

FILLING IN THE CHART

1+ CALCULATE AS USUAL

t midnight !or whatever fi+ed time per day is selected# the day's input and output is added up, and

the total !&veor -ve# balance derived for the preceding () hours. The figure for that day is enteredas the day's balance. This figure is then added to the previous cumulative balance !calculated theprevious day# to show the cumulative balance over time !see sample chart on age (# .

2+ CALCULATE TOTAL FOR BAR CHART

The calculated total is made up to the nearest whole 1""mls a,!ethe actual figure - thus if thetrue figure were &234ms, that would be made up to 5677ms!see sample chart on age (#.

6+ ENTER TOTAL ON BAR CHART

thick white board marker pen is used to make a line on the bar chart

ositivebalances !more recorded input than output# are filled in inred, negativebalances !morerecorded fluid output than input# are filled in in blue.

hris ennett ("1" - not to be modified without permission


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SAMPLE CHARTS

/ection of a standard chart showing daily and cumulative balances

DATE INTAKE IN MLS OUTPUT IN MLS

0ral I 2utrition T!$a 3rine 2aso-4astric

omit owel5/toma

6rains T!$a6aily

alance&5-

Initialsumulative

alance&5-

day 1 1""" " " 1""" 7(" " " " " 7(" &17" &17"

day ( ("" 1""" " 1("" 7"" " " " " 7"" &)"" &87"

day 9 " 18"" " 18"" :"" " " " " :"" &;"" &1)7"

day ) " 8"" " 8""


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The bar chart format means cumulative totals are visual and easily compared over time

>orrying trends !increasing &veor -vebalances# can be quickly identified

rosses on the chart !indicating that the previous day's chart was incomplete and thebalance could not be calculated# should act as a reminder to staff to fill in the chart properly

hart is designed to be displayed either separately in a visible position or as the top sheet

on the fluid balance folder - allowing 'at a glance' assessment

6aily ()hr charts and cumulative totals chart are filled in as normal - hence none of the

detailed information is lost

alculating and filling in the bar chart takes staff only a couple of e+tra moments after

calculating the daily totals for the usual charts

/pace is provided for doctors to initial the chart each time the cumulative total is reviewed

NB

harts are only as good as the data they represent. ?ence there may be more than onee+planation for the data displayed. *or instance a high &vebalance may mean fluid overload, butmay alternatively mean inadequate output measurement, or indicate that a patient has been verydehydrated and is being aggressively re-hydrated.

The value of the system is that the clear visual image prompts questions$

@>hat does this meanA Is there a problemA@

The answers should be found in the more detailed information in the normal daily and cumulativefluid balance charts and in the notes.

It should be remembered, when making clinical decisions based on cumulative totals, thatinsensible losses may account for up to 7"" mls pe' %a8 of any positive balance.

IMPLEMENTATION ISSUES

It may be useful to have the cumulative totals chart printed upside down on the back of the

bar chart. This means that the bar chart, attached on the front of the folder may be lifted upto allow easy reading of the detailed information on which the bars are based

It is essential that the chart is printed on paper which does not allow the ink from the marker

pens to leak through. There are various types of paper which would be suitable !forguidance for the supplier - /mooth uncoated or Batt, /ilk, or /atin coated >eight 19"-18"gms#.

To be effective the chart must be displayed where it is visible to all staff, and preferably topatients and relatives also. /taff may sometimes be resistant to this, for instance if there islimited suitable space at the end of the bed, or if the cumulative charts are normally filedbelow the daily fluid balance charts.



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THE CHART ADAPTED FOR TWO AND FOUR TIMES DAILY RECORDING

0n occasions, for instance after surgery, or on children's wards, it may be important to monitorcumulative fluid balance more frequently than daily. daptations of the bar chart to showcumulative balances either two or four times daily !whichever is most appropriate# are available.They are filled in in e+actly the same way, using the same types of line or symbol, as the dailychart. 0ne type of chart may be used throughout a patient's stay in hospital, or may be replacedby charts which allow recording with greater or lesser frequency as required.

TWICE DAILY CUMULATIVE BAR CHART (SAMPLE+NB- actual chart accommodates up to )"""mls &veand ("""mls -vebalances

:""-:;;

8""-8;;

)""-);;

9""-9;;

(""-(;;

1""-1;;

1-;;1-;;

1""-1;;

(""-(;;

9""-9;;

)""-);;

8""-8;;

:""-:;;

Da8=M!$&

m% m


FOUR TIMES DAILY CUMULATIVE BAR CHART (SAMPLE+NB- actual chart accommodates up to )"""mls &veand ("""mls -vebalances

:""-:;;

8""-8;;

)""-);;

9""-9;;

(""-(;;

1""-1;;

1-;;

1-;;1""-1;;

(""-(;;

9""-9;;

)""-);;

8""-8;;

:""-:;;

Da8=M!$&

4 12 1; 29



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2amet. 2o. or addresso ra h

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FBC Details and Implementation Notes 15-07-10