Enhancing Patient Care Through a Quality Improvement Project: A Before-and-After Study of Nurse Training on Effective Fluid Balance Monitoring and Charting

Fluid balance (FB) charting is a common practice in wards across all levels of care—primary, secondary, and tertiary. These charts enable treating physicians to accurately assess the patient's volume status and to prescribe drug therapies for those suffering from cardiovascular, renal, hepatic, and surgical conditions. However, in practice, glaring lapses in FB documentation frequently occur. Nursing staff and caregivers often provide estimates of fluid inputs and outputs that are recorded inconsistently, resulting in inadequate clinical assessment. This project aimed to enhance the quality of FB chart documentation by nursing staff through a comprehensive approach to FB monitoring with a reduction in error rates and enhanced efficiency, thereby favourably impacting patient outcomes and minimising transfers from the ward to the intensive care unit (ICU). A pre-intervention audit was conducted over 15 consecutive days on 246 patients’ FB charts. This was followed by a quality improvement intervention, involving nursing education, and a post-intervention audit in a 38-bed multi-speciality ward to analyse the impact on the accuracy and completeness of the input/output charts. In conclusion, this quality improvement project demonstrated that a targeted, robust nursing education programme, along with the introduction of a redesigned colour-coded FB chart can significantly improve the accuracy and completeness of FB documentation, potentially enhancing patient care and reducing the length of hospitalisation