Author(s), year, country | Aim | Design | Setting and participants | Sample size | Outcomes regarding fluid balance monitoring | Key findings |
Aitken et al, (2013); UK32 | AKI Quality of care | Cohort study | Medical, surgical, AKI | 243 | Adequate FBD (%), inaccurate FB chart (%) | 51.8% of patients with AKI had adequate FBD; 43.4% of the remainder had inaccurate FB charts in case notes. |
Alexander and Allen (2011) USA33 | Policy for FB monitoring | Quasi-experimental | Medical oncology units | 427 | Compliance with FBD | Before intervention, 12% of patients with indication of FB monitoring had FBD vs 84% after. |
Asfour (2016); Egypt52 | Accuracy of FB monitoring | Cross-sectional | ICU except dialysis | 100 | Accuracy of calculated FB compared with researcher’s calculation | 65% of FB charts were accurate and 35% were inaccurate. |
Baird et al, (2019); UK42 | AKI prediction score | Quasi-experimental | Orthopaedic surgery | 78 | FB monitoring (%) | Before intervention, 62% had adequate FB monitoring postoperatively vs 66% after. |
Davies et al, (2017); UK43 | Reduce AKI alerts | Quasi-experimental | Orthopaedic trauma | 75 | Running hourly input, 6 hourly input subtotal, 6 hourly output subtotal and 24-hour total FB | Before intervention, 80% had running 1 hour totals vs 96% after; 36% had 6 hour output vs 68% after. Before intervention, 12% had 24-hour totals vs 72% after and 32% after 6 months. |
Davies et al, (2019); Australia*44 | Relationship between calculated FB and BW | Prospective cohort study | ICU, requiring CRRT | 61 | FB charts with calculation errors (%), median deviation in millilitres | Calculation errors prevalent in 27% of charts. Median daily calculation error: 58 mL (range 1–1464 mL). Median cumulative calculation error: 131 mL (range 1–2405 mL). |
Diacon and Bell (2014); South Africa34 | FB monitoring and measurement accuracy | Cross-sectional | ICU | 103 | FBD (%), calculation errors (%), deviation in millilitres | 95.1% had FBD. Calculation errors: 68.9% deviated 0–500 mL, 13.5% 500–1000 mL, 6.8% 1001–2000 mL, 5.8%>2000 mL |
Eastwood et al, (2012); Australia35 | Patients receiving IV fluids (%) | Cross-sectional | All inpatients except ICU, ED and PACU | 326 | Percentage with FB charts maintained (%) | 94% of patients receiving intravenous fluids had FB charts vs 44% receiving no intravenous fluids. |
Herrod et al, (2010); UK36 | Prevalence of dysnatraemias and precipitating factors | Cross-sectional | Surgery Na<130 or >150 mmol/L | 55 | Complete FB charts (%) Charts with FB calculated (%), median inaccuracy in FB calculation | 28% had complete FB charts before dysnatraemia vs 44% after; 37% of charts had no FB calculation. Median calculation error: 72 mL (IQR 9–313 mL) before dysnatraemia vs 130 mL (IQR 71–400 mL) after |
Joslin et al, (2015); UK45 | AKI recognition and management | Quasi-experimental | AKI | 192 | Complete FB chart on first day of AKI (%), days with complete FBD (%) | Before intervention, 25% had completed FB charts on first day of AKI vs 34% (p=0.23) after. Before intervention, FBD was completed in 32% of patient days vs 45% after (p=0.002). |
Liaw and Goh (2018); Singapore46 | Fluid intake charting | Quasi-experimental | Acute surgery | 60 | Deduction of input/output at midday and over 24 hours. Calculation of 24 hours FB. Involving patients in fluid intake documentation | Before intervention, 3.3% of the FB charts were complete (midday and 24 hours totalling) vs 100% 1 month and 6 months later. Before intervention, patients were involved in 10% of cases vs 87% 1 month later and 83% 6 months later. |
Lim et al, (2021); Singapore53 | Ordering and documenting fluid in- and output | Cross-sectional | Acute care hospital | 2199 | Accuracy of FBD defined by recording in millilitres | Overall accuracy 77%. Oral and intravenous fluids 100% accurate, output accurate in 21% of cases |
Madu et al, (2021); UK54 | Chart completeness and accuracy | Quasi-experimental | General medicine | 82 | Accurate measurements, calculation errors, complete documentation | Before intervention, 25% of measurements were accurate vs 39% after 1 month and 5% after 6 months, correct daily totals in 20% vs 40% after 1 month and 15% after 6 months, 14% of charts complete vs 31% after 1 month and 5% after 6 months |
Møller et al. (2013); Denmark37 | Quality improvement | Prospective cohort study | Acute surgery, PPU | 1650 | Quality-of-care indicator: daily FBD | Before intervention, 74% had FBD vs 79% after. RR 1.07 (95% CI 1.02 to 1.13; p=0.010) |
Perren et al, (2011); Switzerland*38 | Accuracy of FBD; agreement w BW | Cross-sectional | ICU | 147 | Complete FB charts, FB charts with calculation errors | 12% were excluded due to an incomplete FB chart; 33% of nurse-registered cumulative FB was inaccurate, errors: −3606 mL to +2020 mL. Mean absolute error of 445±668 mL |
Pinnington et al, (2016); UK47 | Complete FBD | Quasi-experimental | Three wards | 120 | Complete FB charts | Before intervention, 32% of FB charts were completed correctly vs 92% after. In AKI patients, 20% had FBD before vs 91% after. |
Szmuda et al, (2014); Poland39 | Calculation errors; FBD and chart completeness | Cross-sectional | NICU and NHDU, SAH | 41 | Complete FB charts, FB miscalculations | 63.4% of FB charts were complete, 80.2% in NICU and 58.7% in NHDU (p<0.01). Fluid intake miscalculations in 27.4% of charts. Most common errors: underestimating intake (80.6%), omitting drugs (66.9%) |
Tura et al. (2020); Ethiopia48 | Managing postpartum haemorrhage | Cross-sectional | Obstetric | 45 | Standard of care criteria: fluid intake/output chart is maintained | In 13.3%, a fluid intake/output chart was maintained. |
Vincent and Mahendiran (2015); UK49 | Quality of FB monitoring | Quasi-experimental | General medicine | 147 | FBD, indication of FBD. Chart completion: boxes filled of all total boxes. Accurate totals=<10% error | Before intervention, 67% were on FBD (indicated in 53%) vs 38% after (indicated in 93%). Average chart completion rate before intervention was 50% vs 70% after. Average chart accuracy was 41% before vs 61% after. |
Wakeling (2011); UK40 | FBD and FB complications; Hydrant drinking aid | Quasi-experimental | Orthopaedic, surgery, urology | 313 | Complete FB charts (%) | Before intervention, 19%–50% of FB charts were complete vs 29–62% after. Completeness improved (5–18 percentage points). |
Walker et al. (2012); UK41 | Improve guideline adherence | Quasi-experimental | Acute wards | 101 | Completion of FB charts | Before intervention, 62.3% had FBD vs 70.8% after (p=0.36). |
Yang et al, (2019); Taiwan51 | Compliance with FB monitoring | Quasi-experimental | Congestive heart failure | 24 | FB charts used with electrolytes and physical assessment. Patients involved in FBD | Before intervention, 58% had FB charts with physical assessment vs 100% after; 42% were involved in recording before intervention vs 75% immediately after. |
Zhu et al, (2018); China50 | Non-pharmacological fever management | Quasi-experimental | Infectious disease, HIV | 60 | Formal assessment of fluid in- and output volume documented | Before intervention, 0% had fluid input/output documented vs 73% 10 days after intervention. |
*Studies addressing cumulative fluid balance.
AKI, acute kidney injury; BW, body weight; CRRT, continuous renal replacement therapy; ED, emergency department; FB, fluid balance; FBD, fluid balance documentation; ICU, intensive care unit; NHDU, neurosurgical high-dependency unit; NICU, neurosurgical ICU; PACU, postanaesthetic care unit; PPU, perforated peptic ulcer; SAH, subarachnoid haemorrhage.