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 you are monitoring hourly output.
   To ensure the patient understands why their stoma is being checked hourly. To ensure they are up to date with current care (Liaw and Goh [86], R).
2. 5.Show
   Check that the stoma bag is drainable; if not, change it (see Procedure guideline 6.26: Stoma bag change).
   To ensure ease of draining the bag's contents and to reduce the number of times the adhesive flange is removed, in order to protect the skin. E
3. 6.Show
   Using protective equipment such as incontinence pads, empty the contents of the stoma bag into the measuring jug, noting the volume.
   To determine output from the stoma for 1 hour. E
4. 7.Show
   Dispose of contents using protective equipment, adhering to local policy.
   To ensure correct disposal of contents and prevent cross‐infection (Loveday et al. [91], R).
5. 8.Show
   Note the volume of the stool on the chart; add this to any other losses for the hour.
   To ensure correct documentation of output and allow calculation of fluid balance (NICE [122], C).
6. 9.Show
   Add the hourly total (all outputs) to the cumulative output (see Figure 8.9).
   To enable fluid balance determination (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. 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).