Page 140 - Hospital Authority Convention 2018

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2018

F4.6 Clinical Safety and Quality Services II 16:15 Room 421

Is Prevention of Dehydration in Elderly Patients Who Undergoing Orthopaedics Operation Far Away from Us?
Lau MY, Wan MF, Wong PH, Cheng YC, Mok LC
Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
Introduction
Older people are vulnerable to dehydration due to age-related changes. It is also found that dehydration is significantly
associated with the occurrence of postoperative complications related to respiratory, gastrointestinal and hematological.
However, there is lack of standardised method assessing the hydration status of elderly patients during perioperative period.

Objectives
(1) To reduce dehydration rate among elderly patients undergoing orthopaedics operation; (2) to facilitate nurses for early
identification of dehydrated patients perioperatively; and (3) to prevent postoperative complications associated with
dehydration.

Methodology
The programme on “Prevention of Dehydration” in elderly patients undergoing orthopaedics operation was launched
Monday, 7 May 2018 dehydrated and appropriate dehydration preventive measures, such as increasing fluid intake, would be implemented. The
since 2015. Patients who aged 65 or above, and admitted to orthopaedics wards for operation were recruited. Patients
were screened for risks of dehydration by checking (1) blood urea nitrogen (BUN)/creatinine (Cr) level; (2) clinical signs and
symptoms of dehydration. Either BUN/Cr level ≥ 25 or with clinical features of dehydration, patients would be treated as

progress of hydration status was closely monitored. In order to understand how well nurses comply with implementation of
the programme, a staff compliance prospective audit was conducted in September 2017 in a snap shot way. All patients in
the programme were included in the audit.

Results
From September 2015 to December 2017, a total of 2,413 patients were recruited and 681 (28.2%) were identified as
dehydrated perioperatively. After implementing the dehydration preventive measures to those dehydrated patients, nearly
50% of the patients had improvement in dehydration status. For the audit, 37 cases were reviewed and the overall staff
compliance rate was 97.5%.

Discussion
The burden on managing elderly orthopaedics patients is huge. The elderly is vulnerable to dehydration, especially during
perioperative stage. The programme not only provides a standardised assessment for early detection of dehydration among
patients perioperatively, but also improves their dehydration status. Ultimately, the programme can reduce overall medical
burden and enhance patient recovery after operations. Last but not least, staff compliance to the management protocol is
one of the key elements for the success of the programme.

Conclusion
We believe what we have done is minor but important, simple but valuable, easy but effective.

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