Hydration Policy
Hydration Policy
Effective Date: [Original NPP Date]
Revised Date: [Current Date]
Goal:
To maintain the resident’s hydration to the extent possible based on an assessment of each resident’s care needs, preferences, and quality of life.
Policy:
Residents will be assessed and those at risk for dehydration will be identified. At-risk residents will be reviewed by the Interdisciplinary Team (IDT) and provided with interventions to promote hydration based on their physical and mental abilities, resident/responsible party’s wishes, and quality of life.
Procedure:
Assessment and Identification:
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Residents at risk for dehydration will be placed on intake and output (I&O) monitoring until adequate hydration status is achieved or until I&O monitoring is no longer clinically indicated based on the resident’s condition and preferences.
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The following residents are considered at risk for dehydration:
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New admissions/readmissions for 72 hours
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Residents with indwelling catheters (outputs only for long-term indwelling catheters if adequate hydration is established)
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Residents on fluid restrictions
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Residents with vomiting (2 or more episodes in 24 hours)
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Residents with loose stools (3 consecutive loose stools in 24 hours unless a chronic, stable condition)
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Residents with elevated temperature (>101 degrees)
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Residents on tube feedings
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Residents receiving parenteral fluids
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Residents on antibiotics (unless long-term prophylactic use, topical antibiotic eye drops)
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Residents on new thickened liquids or with a downgrade in thickened liquids for 72 hours
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The Registered Dietitian (RD) and/or nurse will determine fluid needs for all new admissions and when there is a change in condition that affects intake (normally 25-30 ml per kg of body weight).
Interventions:
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Interventions will be implemented to promote hydration based on the resident’s assessed needs, preferences, and quality of life.
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I&O data will be reviewed daily, and fluids will be encouraged if the resident is consuming less than the required amount of fluid.
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If the resident consumes less than the estimated needs/day for 3 consecutive days or per MD order, the resident will be evaluated for signs and symptoms of dehydration. The MD, Dietitian, and Responsible Party will be notified of the resident’s fluid intake and dehydration evaluation findings.
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The resident’s plan of care will be reviewed and revised to reflect the resident/family wishes concerning hydration and interventions to promote hydration. This may include discontinuing I&O monitoring.
Discontinuing Fluid Balance Monitoring:
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When a resident meets their individual fluid needs and does not exhibit signs and symptoms of dehydration, the IDT may discontinue I&O. If the resident remains at risk, their care plan will reflect the appropriate interventions.
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If a resident does not meet their individual fluid needs for 3 consecutive days but does not show symptoms of dehydration and drinks/eats well on most days (adequate solid food intake can contribute as much as 1000cc of fluid per day), the IDT may discontinue I&O.
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If a resident does not meet their individual fluid needs for 3 consecutive days and shows symptoms of dehydration, the physician, dietitian, and family will be notified to determine any changes to the plan of care.
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I&O may be discontinued after documentation of the discussion with the resident, family (as applicable), and physician regarding the medical status of the resident, changes to the plan of care, and/or invasive measures of hydration.
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The physician is encouraged to write a progress note addressing any discussion with the resident/family (as applicable) regarding changes to the plan of care, advanced directives, and/or invasive measures for hydration.
Documentation:
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Certified Nursing Assistants and Licensed Nurses on each shift are responsible for documenting the resident’s intake and output on the Intake and Output worksheet.
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All fluids consumed, parenteral fluids, and tube feedings are recorded. Outputs are measured each time the resident voids or, if a catheter is in place, at the end of the shift. Output measurement will include the amount of urine output, vomitus, gastric solutions, and diarrhea. If the resident is incontinent, the number of times will be recorded when accurate output in centimeters is unable to be measured.
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Each shift will chart the eight-hour total for that shift on the Nursing Flow Sheet. Intake and Output will be totaled every twenty-four hours.
Dehydration Evaluation
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Temperature Over 101
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Dry Mucous Membrane
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New Onset or Increased Confusion
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New Onset or Increased Lethargy
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Pulse Over 100, If New Finding
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Blood Pressure – Systolic Under 100 and/or Diastolic Under 60, If New Finding
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Urine – Change in Color, Consistency, Odor and Amount
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Output Significantly Greater Than Intake, If New Finding
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MD Notification
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Nurses Initials |
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Resident Name: _______________________________________________
Findings are to be Communicated to MD, Along With Fluid Intake Data.
Comments: _________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
References:
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Centers for Medicare & Medicaid Services. State Operations Manual, Appendix PP - Guidance to Surveyors for Long-Term Care Facilities. [Link to current CMS SOM]
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CMS Requirements of Participation for Long-Term Care Facilities. [Link to current guidelines]
