Earlier today I picked up on an article on nursingtimes.net that looked at a study published in the Journal of the Royal Society of Medicine.
The study looked at the prevalence of care home residents being admitted to hospital with dehydration in comparison to those in their own home. It is not a new issue, when I was studying for my pre-registration a few years ago concerns were being identified about dehydration management.
The comparison this time around though is staggering, care home residents are up to ten times more likely to be admitted to hospital with dehydration than if they were in their own home.
The report questioned wether adequate support was being given to residents for drinking but I think this is only part of the problem. I agree that it is frontline staff that should be looking to manage dehydration through identifying key needs and level of support required and writing effective care plans to support that individual.
To tackle the whole issue of dehydration, there needs to be a multi-disciplinary approach to closely monitoring each individual and putting a plan of management in place.
At university we took a module called inter professional working, it was a mandatory module that many people did not really like, including myself. I don't think we realise until we are working as Healthcare Professionals how important inter professional working is.
In order to manage a persons hydration needs effectively, there needs to be a few people involved. At the frontline it is important to have a effective support plan and collaboration between the Nursing staff and Healthcare Assistants. At a higher level it is very important, in my own opinion, to have the GP involved in the ongoing management. There could be valid medical problems that are causing a persons to be dehydrated more than them just not drinking enough i.e. diabetes or even medication. At some point the GP may have to look at further management including Subcutaneous or Intravenous fluids and even hospitalisation if the dehydration is serious enough.
It is important for us to keep residents out of hospital though as this could cause problems in itself, especially in those with dementia. An admission can increase anxiety and act as a potential trigger for agitation and aggression, this in turn could result in unnecessary medication being prescribed as the behaviour may be out of the ordinary for the person.
In those that are at risk of dehydration or have started having low fluid intake/output its important that its closely monitored through a intake/output chart and encourage fluids as much as possible. One of the management techniques I mentioned above could be a solution to prevent hospitalisation if the person is suitable, Subcutaneous fluids. This however needs to be agreed and prescribed by the GP.
I don't want the post being incredibly long but the other two professionals you need to consider involving in management of dehydration is the dietician and Speech & Language Therapy who may be able to provide considerable input into the care of that person.
