Date of Award

Fall 2015

Project Type


College or School




Program or Major


Degree Name

Master of Science

First Advisor

Pamela P. DiNapoli


Background Information
It is important for patients with heart failure to have awareness of their intake & output to effectively manage their disease. There is evidence that tracking intake & output is a component of missed nursing care resulting in discrepancies between the actual patient intake and what is documented in the patient’s electronic health record (EHR).


The aim of this quality improvement project was to engage patients in monitoring their intake by using teach-back and patient engagement techniques to track their own oral fluid intake throughout the day.

The Plan-Do-Study-Act (PDSA) model was used as the framework for this initiative. Patients meeting inclusion criteria were given a teach-back quiz to evaluate baseline knowledge. If patients were able to pass the teach-back quiz, they were given a tracking sheet with instructions on how to use it. After a period of eight hours, the sheet was collected and fluid intake volumes were compared with those documented in the EHR. Results
Using the Wilcox on non-parametric test, the mean difference between volume tracked by patient and volume documented by clinician was significant at pConclusion & Implications for CNL Practice
Variation between oral fluid intake volume documented in the EHR and patient stated volumes indicates that EHR documentation is less reliable than records kept by adequately educated and engaged patients. Implications for CNL practice include identification of opportunities to increase patient engagement and to utilize evidence-based techniques for this purpose. The CNL should explore barriers that contribute to inaccuracy of documentation. The CNL may explore more reliable methods for determining accurate patient fluid balance for at-risk populations.

Included in

Nursing Commons