Hydration Stickers - Improving oral hydration in vulnerable patients

Abstract

Dehydration is a growing problem among elderly patients in hospital wards. Incidents such as those raised in the Francis Report highlight a problem that may not have been sufficiently addressed by current schemes. This improvement project aimed to identify the barriers faced by staff in improving oral hydration and to design and implement an effective solution. A 33 patient pilot study carried out at Chelsea & Westminster Hospital NHS Trust, United Kingdom, revealed that a significant proportion of patients were reported to be dehydrated on admission, with few having their hydration needs addressed. Staff cited time pressures and unclear task responsibility as the major barriers. The intervention was a Hydration Sticker education scheme. These stickers were placed on patient cups, notes and beside areas as a visual prompt for staff and family members to encourage the patient to drink. The intervention was implemented on the Acute Assessment Unit and Stroke ward through a poster campaign. The Hydration Stickers scheme resulted in a 6.5-fold increase in patients’ hydration needs being assessed and addressed. Coupled with the low implementation cost and ease of use, Hydration Stickers may be a simple, effective, transferable and sustainable solution to the problem of dehydration among elderly inpatients.

Wet Your Whistle with Water (W3) to Improve Water Intake in Seniors’ Care

“…The site team noted that regular rotation and introduction of new hydration promotion posters was needed to keep up the interest of team members, family and residents. These findings are consistent with prior research, that reminders are easy to implement, however their effect is likely insufficient to change behavior (Bhatti et al, 2017;Gaff et al, 2015).…”

Dehydration predicts longitudinal decline in cognitive functioning and well-being among older adults.

“…Early detection and interventions to manage dehydration could have important implications not only for older adults' health, but also for cognitive functioning, well-being, and overall quality of life. For example, it has been found that a combination of different approaches could be beneficial for combating dehydration in older adults, including easy access to and availability of different types of beverages, educating staff in residential care homes (Bunn, Jimoh, Wilsher, & Hooper, 2015), as well as using visual prompts such as high-contrast fluid containers (e.g., bright-colored cups; Dunne, Neargarder, Cipolloni, & Cronin-Golomb, 2004) and stickers or badges (e.g., "hydration stickers"; Bhatti, Ash, Gokani, & Singh, 2017) to motivate higher fluid intake among older adults.…”

Factors associated with low‐intake dehydration among older inpatients: A pilot study

“…An effective approach was the Hydration Sticker education scheme piloted by a UK National Health Services (NHS) Trust hospital which provided visual prompts for staff and family members to encourage patient drinking and demonstrated a 6.5-fold increase in the number of patients having their hydration needs met. 21 In the UK long-term care home setting findings of a detailed fluid intake assessment in the UK Dehydration Recognition In our Elders (DRIE) study indicated intake of drinks was mostly between meals and with medications. 22 Offering water and drinks more often through the day, especially with medications, is likely to increase fluid intake as drinking needs to be driven by routine rather than reliance on patient thirst.…”