New Acute Fluid Management (AFM) chart - for strict input / output monitoring

What? The Daily Goal - should be clearly

identified on the ward round. Nurses - please ask for this and any special instructions, to be completed!

What? Tick the box to indicate the reason for Acute Fluid Management Why? Only a small number of patients will require strict input/output monitoring - but on those
it must be accurate and complete (Other patients may need a Food and Drink chart instead)

What? Using the guide on the back of

the AFM chart, fill in the hourly and 8 hourly urine output guide for this patient.

Why? All nurses caring for the patient then

know what they are aiming for during their shift and can escalate quickly if their patient is becoming dehydrated or overloaded not meeting the Daily Goal.

ACUTE FLUID MANAGEMENT (AFM) Chart only use this chart for strict input / output monitoring Name: Hosp no: DOB:
INPUT Please state reason for AFM: Post Operative IVI

Date:
Clinical condition

Why? You can quickly refer to

See reverse of chart for guide to urine output: Hourly urine output guide (catheterised patients):. 8hrly urine output guide (non catheterised patients):. DAILY GOAL: OUTPUT Hourly out

these tohelp assess if your patient is passing sufficient urine.

Time

Oral

IV

What? Each shift is responsible for

completing 4 hourly totals and balance, but at midnight, 24 hour totals and balance should be completed, remembering to deduct 500mls insensible loss. Transfer totals to separate Cumulative Balance Chart (old pink summary chart)

What? Do not use actual body

01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15;00 16:00 17:00 18:00 19:00 20;00 21:00 22:00 23:00 24:00

Hourly in

R/T in

Urine

Stool

R/T out

Total Balance

What? All output must be

Concerned about your patients fluid input / output? See trigger criteria Trigger criteria overleaf Please

measured in mls and pads weighed etc Do not use WET, OTT, PUD +++etc

Why? You need numbers to

add up totals and calculate an accurate fluid balance

Inform nurse in charge of any concern and document in the patients health care record

inform the Patient requires ward doctor review irrespective of other observations if: Totals (R/T) in and out 4 hourly nurse in 1. Catheterised pts: U/O < hourly reasonable urine charge output for & 2 consecutive hours (as per guide below) and calculate the balance. document 2. Non catheterised pts: U/O < 8 hourly reasonable urine output (as per guide below) in notes Inform the nurse in charge of 3. Daily goal not being achieved

What? Complete the Running

4. Nurse concern

weight for calculating urine output. Use calculated weight on reverse of AFM chart, which is based on height and ideal body weight (IBW).

Please calculated weight Total fluid in minus total fluid out = 24 hour total balance minus insensible loss use 500mls = ........ based on height shown below (Ideal Body Weight IBW)
* Yellow line reminder to calculate 4 hourly running total in / running total out / total balance ** For all patients on AFM please complete pink cumulative balance chart daily
Version 1: Kate Beaumont / S.Allaway: Approval Dec 2012: Review Dec 2013

any concern and document in the patients health care record (refer to Trigger Criteria on the back of the AFM chart). Do not use ACTUAL body weight for calculating urine output
Guide to Urine Output / hr

Height (inches)
54 - 61 62 - 67 68 - 72 73 - 77 78

Height (cm)
138 - 155 156 - 169 170 - 183 184 - 195 196

IBW (kg)
40-50 51-60 61-70 71-80 81

Hourly 20 25 30 35 40

8hrs 160 200 240 280 320

16hrs 320 400 480 560 640

24hrs 480 600 720 840 960

Note!
Only enter amounts of fluid actually taken, not offered. No lines across columns to show when IVs start and are due to finish!

Why? IBW is a safer way to estimate both IV

fluids in and urine output and helps to avoid the risk of fluid overload.

Version 1: Kate Beaumont / S.Allaway: Approval Dec 2012: Review Dec 2013