Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
2. 2.Show
   Determine the relevant sources of fluid output (see Table 8.3) and note them on the fluid balance chart.
   To ensure all possibilities have been considered to ensure accurate (as far as possible) output determination (McGloin [98], E).
3. 3.Show
   Wash hands and/or use an alcohol‐based handrub and apply personal protective equipment necessary for handling body fluids.
   To appropriately decontaminate hands and prevent cross‐contamination ([115], C).

Procedure

1. 4.Show
   Explain to the patient that it is necessary to monitor the volume of fluid excreted, including that from the bowel, particularly if the stool is loose/watery.
   To keep the patient informed about their current care and observations, to ensure co‐operation in monitoring fluid output (Liaw and Goh [86], R).
2. 5.Show
   Provide the patient with bedpans or commodate, even if able to mobilize to the bathroom; ask them to place the bedpan over the toilet bowl; ask them to inform you of each episode.
   To enable inspection and measurement of fluid lost via the bowel. E
3. 6.Show
   If the stool is loose enough, this can be transferred into a jug and the volume measured. Alternatively, weigh the bedpan as per local policy.
   To quantify fluid output from stool (Scales and Pilsworth [158], E).
4. 7.Show
   If the stool is formed and it is not possible to accurately quantify, still note on fluid balance chart that bowels were opened.
   To take into account any insensible losses (Shepherd [168], E).
5. 8.Show
   A rectal tube may be suitable in some patients; refer to local policy regarding the use of rectal tubes. Note any output on the fluid balance chart.
   To ensure correct use of tube and to quantify any fluid losses from the bowel. E
6. 9.Show
   Add losses to the previous losses for the hour.
   To calculate hourly fluid output (Shepherd [168], E).

Post‐procedure

1. 10.Show
   Once all output has been determined and noted on the chart, calculate the total hourly output and then subtract the total output from the total input.
   To calculate hourly fluid balance (Shepherd [168], E).
2. 11.Show
   Document all values on the chart and record any other actions relating to your findings in the patient's notes.
   To ensure accurate documentation (NMC [126], C).