The Implementation of an Innovative Hydration Monitoring App in Care Home Settings: A Qualitative Study

Abstract

Background In response to marked concern regarding inadequate fluid intake recording in care homes, an innovative mobile hydration app was collaboratively developed. “Hydr8” aimed to facilitate accurate recording and communication of residents’ fluid intake and ultimately increase care quality and patient safety. Objective The aim of this study was to examine the implementation of Hydr8 in a sample of care homes in one area in England. Methods The principles of Realist Evaluation and Action research were drawn upon throughout the study. Overall, 5 care homes participated in this study, 3 interview-only sites and 2 case-study sites, where interviews and observations were conducted at 3 time-points. Furthermore, 28 staff members participated, including care staff, management, a registered nurse, and administrative staff. Results Findings suggest that Hydr8 benefits practice, enhancing the understanding of hydration and person-centered care and improving staff communication. However, technical glitches hindered the seamless embedding of Hydr8 into everyday practice, and enthusiasm for long-term use was dependent on the resolution of issues. In addition, Hydr8 heightened perceptions of personal accountability, and while managers viewed this as positive, some staff members were apprehensive. However, individuals were enthusiastic about the long-term use and potential of Hydr8. Conclusions Utilizing the findings of this study to further develop and adapt Hydr8 indicates the long-term use of Hydr8 as promising. Although perceptions of Hydr8 were primarily positive, setbacks in its implementation and use created difficulties in normalizing the solution into everyday practice. This study highlights the need for education related to hydration practice and a change of infrastructure in care home settings to implement technical solutions and changes to care.

Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond

“…Evidence coincides with the strategies identified in this study including: considering the social and physical environments; providing prompts to drink; staff communication; access to fluids including beverage carts, cups and glasses; and, determining drink preferences 14 15 24. Recent research suggests the value of mimicry to support fluid intake25 and the use of technology to support communication of fluid intake among staff 26. A key outcome of this study is the consideration of individualised strategies to meet the specific needs of residents, rather than using global strategies and assuming they work for most.…”

“… 14 15 24 Recent research suggests the value of mimicry to support fluid intake 25 and the use of technology to support communication of fluid intake among staff. 26 A key outcome of this study is the consideration of individualised strategies to meet the specific needs of residents, rather than using global strategies and assuming they work for most. Prior research has noted that when interventions are tailored to the resident, such as considering their preferences and offering choice, there is an increase in fluid intake.…”

What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world

“…PWD, People with dementia; PWA, People with Alzheimer; PWAD, People with advanced dementia. 121 Kwok et al, 122 Steven et al, 123 Simmons et al, 124 Stange et al, 125 Carlsson et al, 126 Simmons et al, 127 Krikorian et al Lin et al, 130 Zanini et al, 131 Beck et al 132 Finger foods for PWA, 129 Montessori method to increase eating ability for institutionalised PWD, 130 Texture-modified food programme for older adults with dysphagia, 131 Marchini et al, 136 Juthani-Mehta et al, 137 De Visschere et al, 138 Lewis et al, 139 Sumi et al, 140 Tomata et al 141 Bucco-dental healthcare, 7 Oral hygiene protocol, 136 137 Oral healthcare guideline, 138 Provision of professional oral care, 139 140 Educational programme and dietitian consultation. 141 Skin Health (n=1) Interventions for skin care and pressure injure prevention 2 Brienza et al, 142 Hahnel et al, 143 Skin protection wheelchair seat cushions, 142 Standardised skin care regimens on skin dryness.…”

A study on accuracy and precision of fluid volume measurements by nurses, patients and healthy persons in a clinical setting

“…Low technical solutions could include using glasses or cups with a printed measure of volume on the inside or outside. High technical solutions could include hydration monitoring apps (Steven et al., 2019 ) or, for example, smart water bottles that can do standard volume measurements and detect changes in contained volumes (Borofsky et al., 2018 ).…”