Though it sounds easy, measuring the fluid intake to make sure that the intake is sufficient is not an easy job. A group of nurses who were part of the bariatric surgery team decided to standardize the process by which they can measure the fluid intake of patients and to increase the water intake of the patients.
‘Increasing water and fluid intake by using measuring cups, water bottles after bariatric surgery reduces the risk of dehydration, nausea and vomiting.’
Dehydration After Bariatric Surgery
Dehydration can cause vomiting, head ache, dizziness and can require immediate medical attention. "Preventing dehydration helps to improve the patient's recovery, as well as decrease emergency room visits and hospital admissions," she said.
"Coupled with drastically reduced stomach capacity, it can be very difficult for patients to meet their hydration goals for some time after the procedure," said Cheryl Williams, MS, RD. Ms. Williams, the study's primary author and the bariatric program coordinator at Greenwich [Conn.] Hospital.
Usually, patients are encouraged to drink water in between meals and there was no actual method to measure the quantity that the patient consumes. There was also no restrictions on the movement of water or beverages to the patient bed side.
As a result, "it was really tough for nurses and patients to get an accurate picture of how much fluid patients were drinking," Ms. Williams said.
Measuring Water and Fluid Intake
After sleeve gastrectomy and Roux-en-Y gastric bypass operations, the team decided to limit the number and type of water containers available to patients admitted to the hospital. Patients were given six 8-ounce water bottles numbered consecutively and 1-ounce measuring cups at meals.
Nurses were in charge of water and meal provision in order to have a clear picture of the patient's intake. Data collection was done for 7 months and is still ongoing. As part of the study, patients were provided with a clear message regarding fluid goals. Nurses, nursing assistants, and food service staff members were educated about the program.
The method has helped patients to increase their fluid intake and for the nurses to assess the fluid intake levels. Over a period of 7 months, the average intake has increased three-fold from a baseline of 381.5 ml patients to 1007ml.
"By standardizing the intake and supplying and numbering the water bottles, this project was a great success in terms of being able to monitor how much the patients were drinking because you knew how many bottles they had," said Jacquie Hyland, RN, MHA, a study coauthor and senior performance management specialist at Greenwich Hospital.
Ashutosh Kaul, MBBS, FACS, medical director of the bariatric surgery program at Greenwich Hospital, said that post operative care with regard to the improved intake of patients reduces the need for readmission and facilitates early discharge.
"We built a core team that implemented a simple, low-cost, structured, and well-defined water distribution and documentation process, which resulted in better compliance of water intake," Dr. Kaul said.
- Cheryl Williams et al., Monitoring fluid intake may help improve outcomes for bariatric surgery patients, American College of Surgeons Quality and Safety Conference(2017).