Research Abstract: Free Paper - Poster Presentation Only Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2023

A Quality Improvement Project to Improve Water Intake among the Elderly in a Teaching Hospital in Singapore.

Mohammad Najib Bin Ibrahim, Teo Pey wen, Syarifah Nasyeera, Janet D/O Santiago, Bote Robenny, Ng Ee Yun, Lim Huiru, Anna Liza Bantilan, SC Lim

Keywords:

Water intake, elderly, inpatient, acute hospital

Abstract

The author’s team realised that 90% of the elderly inpatients in the acute Geriatric Medicine ward were not getting enough hydration. Dehydration is difficult to diagnose and may result in potentially serious side effects like postural hypotension causing falls, delirium, constipation, urinary tract infection, etc. The author’s hospital has a pathway to monitor postural BPs for elderly patients with fall risk, and the first line management strategy for orthostatic hypotension (OH) is to encourage fluid intake for patients with significant OH >20mmHg drop in systolic BP on standing up.

Aims

To increase oral water intake among elderly patient in the ward.

Methods

The team went through PDSA cycles and realised compliance to orders for increase in fluid intake was poor. The main reasons identified included poor communication between care team, inconsistent request and documentation among the care team, patients’ refusal to drink and manpower restriction. Team Hydroboost was set up which consisted of hydration champions to create awareness on hydration, closer collaboration with all members of the care team, visual reminders, caregivers education on importance of staying hydrated and 2 hourly fluid rounds.

Results

The mean volume of water consumed per day for the patients, before project was 378ml/day. At the end of one year, the team managed to improve fluid intake to mean of 975mls/day consistently among the patients (Fig 1).

Conclusion

 Communication and collaboration across the care team was the key to success. The next step is to spread this culture hospitalwide.