Fluid Balance Continuation Sheet

Fluid Balance Continuation Sheet
Fluid Balance Sheet Expected Hourly Urine Output =
Expected Hourly Urine Output =
......................................
......................................
ml/hrml/hr
(0.5ml/kg)
(0.5ml/kg)
Fluid Balance Continuation Sheet
Fluid Balance Continuation Sheet
Fluid Balance Continuation Sheet Expected Hourly Urine Output =
Expected Hourly Urine Output =
......................................
......................................
ml/hrml/hr
(0.5ml/kg)
(0.5ml/kg)

Date:............................
Date:............................
Name:
Name:
.....................................................
.....................................................
Hospital
Hospital
No:..........................
No:.......................... Date:
Date:
............................
............................
Name:
Name:
......................................................
......................................................
Hospital
Hospital
No:...........................
No:........................... Patient label

TimeTime
Oral/Oral/
Intake
Intake
I.V. I.V. Running
Running
TotalTotal Urine
Vomit/
UrineAspirate
Output
Vomit/
Output
Running
Running
TimeTime
Oral/Oral/
Intake
I.V. I.V.
Intake
Running
Running
TotalTotal Urine
Vomit/
UrineAspirate
Output
Vomit/
Output
Running
Running Adult
Adult Name: ............................................. Date of Birth:...................

Observation
Observation
Intragastric
Intragastric Aspirate TotalTotal Intragastric
Intragastric Aspirate TotalTotal Hospital no:...............................................................................
08:00
08:00 08:00
08:00
NHS no: .....................................................................................
09:00
09:00 09:00
09:00
Chart
Chart Consultant: ...............................................................................
10:00
10:00 10:00
10:00
Ward:.............................................. Weight: ............................
11:00
11:00 11:00
11:00
Clinical Response to National Early Warning Score (NEWS) Triggers
12:00
12:00 12:00
12:00
NEWS Score Frequency of Monitoring Clinical Response
13:00
13:00 13:00
13:00
Minimum 6–12 hourly, follow the
• Continue routine National Early Warning Score (NEWS)
14:00
14:00 14:00
14:00 0 standards for undertaking clinical
monitoring with every set of observations
observation policy
• Inform registered nurse who must assess the patient
15:00
15:00 15:00
15:00 LOW Minimum 4–6 hourly follow the
• Registered nurse to decide if increased frequency of monitoring
standards for undertaking clinical
16:00
16:00 16:00
16:00 Total: 1–4 observation policy
and/or escalation to doctors, or outreach nurse is appropriate.
• Re-check and document observations within 5–15 minutes
• Registered nurse to re-check and document observations
17:00
17:00 17:00
17:00 MEDIUM within 5–15 minutes, consider starting a fluid balance chart
Total: 5–6 •  Registered nurse to immediately inform the surgical team
18:00
18:00 18:00
18:00 Increased frequency to
caring for the patient using the SBAR tool, the nurse in
or minimum 1 hourly
charge and the outreach nurse on bleep 665
19:00
19:00 19:00
19:00 3-in-one • Urgent assessment by the patients team within 30 minutes
Parameter • Consider clinical care in an environment with monitoring
20:00
20:00 20:00
20:00 facilities i.e. Alan Bray Unit
•  Registered nurse to urgently inform the surgical team
21:00
21:00 21:00
21:00 looking after the patient, this should be at least a
registrar
22:00
22:00 22:00
22:00 HIGH •  Do a 12 lead ECG and start a strict fluid balance chart
Continuous monitoring • Emergency assessment by the outreach nurse bleep 665
23:00
23:00 23:00
23:00 Total: 7 or of vital signs •  Consider transfer to Alan bray unit for HDU/ITU care
more • Consultant to be informed within 1 hour of NEWS
24:00
24:00 24:00
24:00 scoring 7 or more, surgical team to inform
•  If in any doubt, or delay in medical response, place a
01:00
01:00 01:00
01:00 Medical Emergency Call via 2222

02:00
02:00 02:00
02:00 Critical Care Outreach
Critical Care Outreach
03:00
03:00 03:00
03:00 Outreach nurse Bleep 665 NEWS Key 0 1 2 3

3
3
04:00
04:00 04:00
04:00 ITU registrar Bleep 662
05:00
05:00 05:00
05:00 Physiological
Physiological

NC= nasal cannula FM = face mask

2
2
3 3 2 2 1 1 0 0 1 1 2 2 3 3

Action recorded Y/N N/A

NEWS
Parameters
Parameters

Escalation plan Y/N N/A

Bowels Open

Admission
06:00
06:00 06:00
06:00

Pulse rate
Conscious
Pain Scale
Respiration Rate
Respiration Rate <8 <8 9-11
9-11 12-20
12-20 21-24
21-24 >25>25

Blood Glucose level

0 - 10 Movem’t
07:00
07:00 07:00
07:00

1
1

/min
Oxygen Saturations
Oxygen Saturations <91<91 92-93
92-93 94-95
94-95 >96>96

level
Totals
Totals Totals
Totals Any supplemental
Any supplemental

Print initials
oxygen
oxygen YesYes NoNo

100
110
120
130
140
V/P/U
0
0

30
40
50
60
70
80
90

50
60
Alert
Temperature
Temperature <35.0
<35.0 35.1-36.0
35.1-36.0
36.1-38.0
36.1-38.0
38.1-39.0
38.1-39.0>39.1
>39.1

Rest
Y/N
24 Hr Total Intake =
24 Hr Total Intake = mlsmls
Total Output =
Total Output = mlsmls 24 Hr Total Intake =
24 Hr Total Intake = mlsmlsTotal Output =
Total Output = mlsmls
Systolic BP
Systolic BP <90<90 91-100
91-100101-110
101-110
111-219
111-219 >220
>220

NEWS Key
NEWS Key
24 Hr Fluid Balance =
24 Hr Fluid Balance = mlsmls 24 Hr Fluid Balance =
24 Hr Fluid Balance = mlsmls Pulse
Pulse <40<40 41-50
41-50 51-90
51-90 91-110
91-110111-130
111-130>131
>131
If urine output falls below the expected hourly amount for 2 consecutive hours,
If urine output falls below the expected hourly amount for 2 consecutive hours, If urine output falls below the expected hourly amount for 2 consecutive hours,
If urine output falls below the expected hourly amount for 2 consecutive hours, Consciousness
Consciousness A A V, P or U
V, P or U
call SHO and Outreach (Bleep 665) immediately.
call SHO and Outreach (Bleep 665) immediately. call SHO and Outreach (Bleep 665) immediately.
call SHO and Outreach (Bleep 665) immediately. AVPU = Alert, Voice, Pain, Unresponsive
AVPU = Alert, Voice, Pain, Unresponsive
 Date
Date Date Date
Time Time
SBAR Handover Communication Tool
SBAR Hand over Communication Tool Time Time

This format Admission

Resp >25 >25 Resp
Thisshould beshould
format used to
behandover a deteriorating
used to handover patient. patient.
a deteriorating Resp 21-24>25 >25 Resp
Rate/min 21-24 Rate/min

S - Situation
Identify yourself and your position, patient’s name and Rate/min
Admission ___ 21-24
12-20 12-20 21-24 Rate/min
the current situation. Describe what is going on with Document 12-20
9-11 9-11 12-20
Document
Identify yourself and position, patients name Document 9-11 9-11 Document

S
the patient. Rate
Rate
<8
<8
<8 Rate
<8 Rate
- Situation and the current situation. Describe what is

B - Background
State thegoing
relevant
onhistory
with and
the physical
patient.assessment O2 Sats
Admission
>96 >96 O2 Sats
relevant to the problem, treatment/clinical course 94-95 >96 94-95 >96
AdmissionO___ 2Sats O2Sats
summary and any pertinent changes. 92-93
94-95 92-93 94-95 %
Document % Document
State the relevant history and physical Document2% <91
92-93 <91 92-93 2 Document %

A -B
litres litres
Inspired O <91 Inspired
<91 O
assessment relevant to the problem,
per minute per minute

- Background
Assessment Offer your conclusion about the present situation.
treatment/clinical course summary and any
Mode of delivery 2 NC/FMlitres
Inspired O per minute
NC/FM Mode
litres of delivery
per minute Inspired O2
Mode of delivery NC/FM NC/FM Mode of delivery
pertinent changes. Temp ºC >39 >39 Temp ºC

R - Recommendations
Temp  oC 38
>39 38 >39 Temp oC
Explain what you think needs to be done, what the Admission ___
3738 37 38

A - Assessment
patient needs
Offerand when.
your conclusion about the present
Document 3637 36 Document
37
Document
temp temp Document
<3536 <35 36
temp temp
situation. <35 <35
Verify any critical information received, review the history, seek
clarification, ask questions and read back critical test results Admission 230 230
NEWS uses 220 220 NEWS uses
230 230

R
systolic BP 210 210 systolic
Date Time Score ExplainAction
what you think needs Signed
to be done, 220 220 BP
- Recommendations what the patient needs and when.
NEWS uses
systolic BP
200
210
190
200
190 210 NEWS uses
systolic BP
200 200
180 180
190 190
170 170
180 180
160
170 160 170
Blood Blood
Verify any critical information received, review the history, seek Pressure
150
160
140
150
140
160
Pressure
Blood 150 150 Blood
clarification, ask questions and read back critical test results mmHg
Pressure 130
140 130 mmHg
140 Pressure
mmHg 120
130 120 130 mmHg
110
120 110 120
Admission ___ 100 100
110 110
90
100 90 100
8090 80 90
7080 70 80
6070 60 70
5060 50 60
50 50

Admission 140 140

140
130 130 140
130
120 120 130
120
110 110 120
110 110

3
100 100
100 100
Pulse rate 90 90 Pulse rate
90 90
Pulse rate
/min 80 80 /min Pulse rate
80 80
/min 70 70 /min

2
70 70
6060 60 60
Admission ___ 5050 50 50
1 4040 40 40
3030 30 30
Conscious
Conscious Alert Alert Alert Conscious
Alert Conscious
level V/P/U
level V/P/U V/P/U level
V/P/U level
0

NEWS
NEWS
Pain Scale
Pain Scale Rest Rest Rest Pain
RestScale Pain Scale
Spinal Cord injured patients with an injury at level T6 and above are at risk of 0 -010- 10 Movem’t
Movem’t Movem’t 0 Movem’t
- 10 0 - 10
NEWS Key

Autonomic Dysreflexia. Any rise in blood pressure that is 15-20mmhg above the baseline with Bowels
Bowels OpenOpen Y/N Y/N Bowels Open Monitoring Y/N frequency
associated headache, rash or other symptoms may be a sign of Autonomic Dysreflexia. THIS IS Escalation
Escalation plan plan Y/NY/NN/A Y/N Y/N N/A plan
Escalation Escalation plan
Action
Action recordedY/N
recorded Y/NN/AN/A Y/N N/A
Y/N N/A Action recorded Action recorded
A MEDICAL EMERGENCY THEY MAY NOT SCORE ON NEWS. Find the cause of the autonomic Blood Glucose level Weight kg
Blood glucose if V/P/U Blood glucose if V/P/U
dysreflexia i.e. bladder, bowel, pain if not found within 10 mins call for urgent help. PrintPrint initials
initials Print initialsPrint initials
NC= nasal
NC= cannula
nasal cannulaFMFM= face mask
= face mask