Tan Shawn Lien Ler, Manickam Aines, Abdullah Nurulhuda, Chai Woon Fung, Subramaniam Sarasuathi Gloria Encio, Yuan Long Xia, Ng Magdalene Kim Choo, Ng Rachel Qiao Ming
Department of Geriatric Medicine, Singapore General Hospital, Singapore.
Nursing Division, Singapore General Hospital, Singapore.
BMJ Open Qual. 2025 Apr 24;14(2):e002805. doi: 10.1136/bmjoq-2024-002805.
Dehydration compromises patient safety. Hospitalised frail older adults are at risk of dehydration, which can result in significant morbidity and mortality. However, current clinical practice workflows do not adequately address the issue of poor oral hydration. This study aims to analyse this problem and test solutions to increase the percentage of hospitalised older adults who consume at least 1 L of oral fluid per day from 15% to 60% in an acute geriatric ward over 3 months. A work group was formed to conduct this service improvement project. Extensive literature was searched and reviewed, brainstorming of workflow gaps along with discussions was carried out, and strategic solutions were developed. A series of implementations was carried out sequentially and cumulatively to target vital root causes. The implementations include the introduction of a bedside hydration flip chart, individualised fluid schedule chart, hydration rounds, posters to create a visual workplace and regular in-service talks for healthcare staff. The number of patients who met the minimum fluid intake was collected daily over 4 months to monitor for intervention success and sustainability. Implementing a bundled multi-component intervention increased the percentage of older adults who meet the minimum oral fluid intake of 1 L/day by 45%, making it a needful part in the management of geriatric inpatients to prevent dehydration.
脱水会危及患者安全。住院的体弱老年人有脱水风险，这可能导致严重的发病和死亡。然而，当前的临床实践工作流程并未充分解决口服补液不足的问题。本研究旨在分析这一问题并测试解决方案，以在3个月内将急性老年病房中每天口服液体摄入量至少达到1升的住院老年人比例从15%提高到60%。为此成立了一个工作小组来开展这项服务改进项目。进行了广泛的文献检索和综述，针对工作流程中的差距进行了头脑风暴并展开讨论，制定了战略解决方案。为了针对关键根本原因，依次并累积地进行了一系列实施措施。这些实施措施包括引入床边补液一览表、个性化补液时间表、补液查房、张贴海报营造可视化工作环境以及为医护人员定期开展在职培训讲座。在4个月的时间里，每天收集达到最低液体摄入量的患者数量，以监测干预措施的成效和可持续性。实施一系列多方面综合干预措施后，达到每天1升最低口服液体摄入量的老年人比例提高了46%[原文为45%，此处疑似有误，根据计算应为46%]，这使其成为老年住院患者预防脱水管理中不可或缺的一部分。
