Authors (including presenting author) :
Chan YC(1), Cheung TW(1), Wong MH(1), Ying NY(1)
Affiliation :
(1) Department of Surgery, United Christian Hospital
Keyword 1: :
Colorectal Patients
Keyword 2: :
Fluid Balance Monitoring
Introduction :
Fluid balance is a critical component of medical care, particularly in surgical settings where postoperative patients are vulnerable to complications such as dehydration, hemorrhage, or fluid shifts. In colorectal surgery, inadequate fluid management may lead to postoperative ileus, infection, and anastomotic leakage. The Enhanced Recovery After Surgery (ERAS) protocol highlights the importance of fluid management, though its application remains largely limited to elective colorectal procedures. Accurate intake and output (I&O) charting is a core nursing responsibility that supports timely clinical decisions. However, observations in clinical practice reveal opportunities to enhance documentation appropriateness, consistency and staff awareness. Staff education is needed to strengthen fluid monitoring competencies and reinforce best practice, ultimately supporting better patient outcomes.
Objectives :
We aim to increase staff awareness of the importance of fluid balance monitoring, and to improve the consistency and clinical relevance of I&O charting practices for all postoperative colorectal patients, in order to enhance overall patient safety and optimize recovery outcomes.
Methodology :
A baseline, unannounced audit of 20 five-day I&O charts from postoperative colorectal patients was carried out. A multi-faced educational intervention was delivered to nurse and healthcare assistants, comprising brief role-specific training sessions and a visual poster to reinforce key concepts. Effectiveness was evaluated through pre- and post-test to assess knowledge acquisition, and follow-up random audits conducted two months after the training to measure sustained improvements in documentation quality.
Result & Outcome :
The intervention significantly improved staff knowledge of fluid balance monitoring, with post-test passing rates rising from 72% to 96%. Subsequent audits demonstrated notable improvement in documentation, particularly in the use of quantifiable units (e.g. millilitres) for stoma output, supported by the use of appropriate measuring tools. Other documentations, such as fluid intake, also showed slight improvements. Positive participant feedback approved the training’s effectiveness. The educational intervention significantly raised staff awareness and competency in fluid imbalance monitoring, as reflected in better I&O documentation and knowledge scores. These enhancements promote better clinical practice and patient care. Ongoing audits and a supportive framework are recommended to sustain long-term adherence and reinforce best practices, including support to new staff. Strengthening fluid monitoring in postoperative colorectal care may reduce complications associated with fluid imbalance, supporting earlier recovery and discharge.
