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Hydration Needs &

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  • Explain the importance of hydration
  • Understand 3 ways to prevent dehydration
  • Understand the importance of accurate documentation
  • Identify and overcome the obstacles to accurate documentation

To provide an understanding of why proper hydration is important in healthcare facilities and how to prevent dehydration.

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To provide a tool to help you create and maintain an appropriate fluid intake documentation process for your community.

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Hydration Needs & Fluid Intake Documentation

Purpose:

Objectives:

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75%

of Americans are chronically dehydrated!

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WHY IS HYDRATION IMPORTANT?

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WHY IS HYDRATION IMPORTANT?

Hydration is taking in the proper amount of fluid.

  • What is the proper amount?
    • About 8 cups per day

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WHAT IS DEHYDRATION?

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WHAT IS DEHYDRATION?

Risk factors for dehydration:

  • Illness - Vomiting, diarrhea, fever
  • Medications - Diuretics, laxatives or enemas
  • Incontinence
  • Dysphagia
  • Renal Disease
  • Intentional restriction of fluids
  • Intake of < 6 cups/day
  • Tube feeding or parental
  • Multiple medications
  • Wounds or burns

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WHAT IS DEHYDRATION?

Signs of dehydration:

  • Thirst
  • Decreased urine output
  • Dark urine
  • Dry mucous membranes
  • Cracked lips
  • Sunken eyes

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  • Fever
  • Weakness/Fatigue
  • Dizziness
  • Confusion
  • Change in mental status
  • Decreased skin turgor

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WHAT IS DEHYDRATION?

Consequences of dehydration:

  • Constipation
  • Fecal Impaction
  • Decreased renal function
  • Fluid & electrolyte imbalance
  • Infection
  • Skin breakdown
  • Falls & bone fractures
  • Confusion, lethargy & fatigue
  • Untimely death

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HOW TO PREVENT

DEHYDRATION

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HOW TO PREVENT DEHYDRATION

Tips to Encourage Hydration

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When?

What?

How?

With & between meals

Water, juice, tea, milk, etc

Provide assistance as needed

Readily available always

Honor resident’s fluid preferences

Supply thickened liquids as ordered

ThEvents, social gatherings, etc.

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Check and follow Plan of Care

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HOW TO PREVENT DEHYDRATION

  • Variety is key!
    • Soup/Stew
    • Sauces
    • Ice Cream, Sherbet
    • Gelatin, Pudding, Yogurts
    • Fruits/Vegetables
  • Rearrange meal times for when the resident is most alert. Small frequent meals may help
  • Update food preferences & monitor diet tolerance
  • Never hesitate to report concerns to nurse & Diet Tech or Dietitian

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WHY IS DOCUMENTATION IMPORTANT?

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WHY IS DOCUMENTATION IMPORTANT?

  • I/Os (Intake vs Output) are very important in the elderly population as the risk for dehydration increases due to many disease states and the decreased sense of thirst.
  • Accurate documentation can help you assess hydration status and if the resident is at risk for dehydration.

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OVERCOMING

Develop a Hydration Committee.

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OBSTACLES

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OVERCOMING OBSTACLES

Develop a Hydration Committee.

  1. Assess if fluid intake is being documented appropriately.
  2. If not, then create a plan of action.
  3. Implement the plan.
  4. Evaluate to see if the plan is working.

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DEVELOP A HYDRATION COMMITTEE

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Assessment Phase

What are the obstacles to accurate documentation in your facility?

Plan Phase

For each obstacle that is identified during the assessment phase, create a solution to each of them.

Implementation Phase

Put the plan into action!

Evaluation Phase

Complete quality checks to see if intakes are being documented.

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ASSESSMENT PHASE

  • What are the obstacles to accurate documentation in your facility?

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  • Here are some common ones:
    • Fluid may be disposed of before it is recorded
    • Lack of time to record
    • Access to appropriate materials for recording

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PLAN PHASE

  • For each obstacle that is identified during the assessment phase, create a solution to each of them.
  • Set a timeline for a plan of completion to stay on track.

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PLAN PHASE

Solutions to Common Obstacles

  • Create or modify a “Policy & Procedure on Fluid Intake Documentation” for during and in between meals. (i.e. after meal consumption by the dietary staff or after 10am water pass by the nurse aides)
  • Post reminder signs in the dining area to NOT discard fluids until recorded
  • Have a designated time allotment for documentation
  • Have a designated spot where forms will be kept

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PLAN PHASE

Solutions to Common Obstacles

  • Train staff that will be recording to the fluid intake on:
    • the importance of accurate documentation
    • times allowed for documentation
    • where to find the fluid intake records
    • what counts as a fluid
    • how to accurately assess and document fluid intake

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IMPLEMENTATION PHASE

  • Now that you have created your plan it is time to put it into action!
  • Train, train & train.
  • Share your new policy with all departments that are involved in the process.
  • Create any new forms, signs or visual aids that are necessary.
  • Get to work on timelines.

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IMPLEMENTATION PHASE

What counts as a fluid?

  • Some foods count as fluid
    • Any food that is liquid at room temp, including ice cream, popsicles, and sherbet
    • Soups, thin stews, gelatin and watery foods like watermelon

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IMPLEMENTATION PHASE

  • What about beverages with caffeine?
    • Have a mild diuretic effect, but do not increase dehydration risk
    • Caffeine can have other side effects including insomnia and headaches

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IMPLEMENTATION PHASE

Don’t forget…

  • Fluids consumed during various activities
  • Fluids consumed from hydration cart if one is offered

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EVALUATION PHASE

  • Do quality checks to see if intakes are being documented
    • Are the amounts documented an accurate assessment of what was consumed?
    • Is the time given to document enough?
    • Are new staff members being trained on the process?

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RESOURCES

  • Gordon Food Service Hydration Recipes & Resources
  • The Texas Health & Human Services has made available a variety of free downloadable materials for use in Long Term Care facilities.
    • Evidence-based Best Practice for Healthy Hydration
    • Dehydration Risk Assessment Tool
    • Best Practice Techniques: Promoting Good Hydration
  • Guidelines to Effective Hydration in Aged Care Facilities
    • Sample Fluid Intake Chart

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Thank you.

If you have questions,

Please contact the Nutrition Resource Center at:

1.800.968.4426

nrc@gfs.com

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