We set out to develop a population-based quality improvement (QI) program addressing fluid intake documentation gaps on a cardiac unit. Using the new AACN Essentials domains as a framework,1 we created a system to accurately record patients' fluid intake. BSN clinical students applied nursing knowledge (domain 1) to recognize that fluid imbalance results in poor outcomes for patients with heart failure (domains 3 and 5). Students conducted a literature appraisal (domain 4) to identify best practices in fluid measurement and documentation among cardiac patients and collaborated with the unit's QI committee (domain 6). Using the PDSA (Plan-Do-Study-Act) model, they amended the unit-based hourly rounding practice by editing hourly rounding door charts to include a space for I&O documentation. Images of standard cup measurements were also placed in patient rooms to serve as visual cues (domain 2). By engaging patients, importance of fluid balance was emphasized, and safe transitions of care was promoted (domain 7). Two weeks after the project was implemented, students conducted electronic health record chart audits (domain 8) over the subsequent 4 weeks, revealing an increase in documentation of 135%. Students presented findings to the QI committee, nurse managers, and unit educators using PowerPoint and handouts. As a result of this exercise, students learned the value of the nurse's role in recognizing gaps in care, identifying evidence-based practices to address potential risks, and initiating practice improvement (domains 9 and 10).

Reference