Twilight (The Flamingo Hotel)
Monday, 29 January 2007
6:30 PM - 8:00 PM
Twilight (The Flamingo Hotel)
Tuesday, 30 January 2007
4:30 PM - 6:00 PM

Intake and Output Charting: Current Practices and Recommendations for Change

Mary Ann Emerson, MS, RN, AOCN1, Charlene M. Smith, DNS, (c)1, Barbara Schrage, MS, FNP-C1, Barbara Trill, RN1, Tracie Ewing, BSN, CNM, MSEd1, and Daniel Mendelson, MS, MD2. (1) Nursing, Highland Hospital, 1000 South Avenue, Rochester, NY 14620, (2) Department of Medicine, Division of Geriatrics, University of Rochester School of Medicine & Dentistry, Highland Hospital, Department of Medicine 1000 South Avenue, Box #58, Room S512, 1000 South Avenue, Box #58, Rochester, NY 14620


Staff members of the Highland Hospital Nursing Practice Committee brought forth clinical questions regarding the purpose, importance, and accuracy of Intake and Output (I&O) documentation, and whether the measurement of I&O is valued by medical providers and nursing personnel for clinical decision-making in patient care.  At this facility it is typical practice to measure I&O on all patients who have IV fluids and/or drainage catheters.  An extensive literature review revealed case reports of I&O practices, but minimal reported research.  Therefore a research study was implemented at the facility that adapted a study done in Hong Kong by Chung, Chong, and French (2002).  The specific aims of the study were to review actual I&O documentation practices in the medical record and to evaluate provider, nurse, and technician perceptions of the value of I&O accuracy.  The study involved a retrospective chart review conducted on 63 medical records to analyze I&O charting practices on a medical, a surgical and a geriatric unit.  Perceptions regarding I&O practices were obtained through a survey distributed to nurses, patient care technicians, and medical providers on the three units.  Descriptive statistics were reported and a T-test for independent groups compared responses between Medical providers and nurses. The chart review revealed that I&O forms were present 100%  of the time in the medical record, but measurement was accurate in only 30% of the medical records.  Infusion of IV fluids was the most frequent reason for I&O measurement (45% of the time).  Medical providers and nurses agreed that I&O is used to estimate fluid balance, but 37% of charts had no reference to I&O measurements in progress notes and generally orders were not written for initiating or discontinuing I&O.  Accuracy in measuring and documenting I&O was better on the surgical unit compared to the other two medical units.  Surveys reveal that patient care technicians have a good understanding of the importance of I&O measurement, and that they believe the recording of I&O is more accurate than do nurses and medical providers. Study findings currently are being shared with various clinical practice councils for recommendations.  Some recommendations for practice change include ordering and measuring I&O only when the information gathered will be used to make specific treatment decisions; specific orders for I&O would be written by medical providers or nurses; I&O orders would include a reason for the measurement; and if I&O is ordered there would be an expectation that documentation of I&O-based treatment decisions are recorded in the patient’s progress notes.  Future plans include a follow-up chart review after changes have been implemented, to assess whether these recommendations have improved accuracy of I&O charting.  Further research is suggested to compare daily weights to I&O as accurate measure of fluid balance.

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See more of The NDNQI Data Use Conference (January 29-31, 2007)