Our simple, low-cost system to keep patients hydrated

A team of students devised a way to easily identify patients at risk of dehydration or on fluid restriction

• Dehydration can cause kidney injury and lead to acute kidney failure
• The Team Hydr8 innovation uses yellow lids on water jug to identify patients at risk
• The initiative is being taken up by hospitals in Sheffield and Jersey

Dehydration was a factor in the deaths of 429 hospital patients in England and Wales, according to latest figures. Acute kidney injury, which can be caused by severe dehydration, is associated with around 100,000 deaths a year in the UK – the equivalent to ten people every hour.

This costs the NHS between £434 million and £620 million per year, which is more than the costs associated with breast cancer, or lung and skin cancer combined.

As nursing students at the University of South Wales, we were tasked with identifying an area of clinical practice for improvement. A look at the statistics made it clear that the hydration of patients urgently needed improving.

How to track fluid intake

We knew it was important to remember that some people have their fluids restricted for clinical reasons. But how do nurses know whether patients are sticking to their restrictions if fluid balance charts are not being completed accurately? We decided to look at what was happening clinically. 

Staff only know if someone is on a fluid balance chart or fluid restriction if they read their handover sheet or there is a board indicating this above the patient’s bed. We were unsure if this was clear enough and created an online poll with the question:

Can you be confident that you know which of your patients need their fluid recorded or restricted during a shift?

The results were shocking – only 24% of the 405 nursing students, healthcare support workers and nurses who took part were confident that they knew. More than three quarters could not quickly and accurately identify which patients were at risk of dehydration or on a fluid balance chart, without checking the paperwork.

A visual clue

It was time for a change. We decided that a yellow jug lid – which would be cost-effective and simple to install – could be used as a clear visual clue. We chose yellow as it is a colour often used for aids for people with dementia or with visual impairment.

We contacted the manufacturers of the hospitals’ existing water jug lids and persuaded them the idea warranted support. They created lids for us to use in the trial at the Royal Glamorgan Hospital, free of charge.

In an initial poll of 108 people at the hospital, including nurses, doctors, healthcare support workers and relatives, 96% said the yellow lids would help patients on the wards meet their hydration needs.

A second, larger survey drew responses from 607 healthcare professionals. We asked them: If there were yellow lids on the jugs of patients who were on a fluid balance chart or fluid restriction, would you be able to safely, quickly and accurately identify them without looking at handover sheets or notes? Again the response was overwhelmingly positive.

• RELATED: Improving nutrition and hydration in hospital: the nurse’s responsibility

We felt a huge sense of achievement when Cwm Taf Morgannwg University Health Board, which provides primary, community, hospital and mental health services, become the first health board in Wales to fund yellow lids for every one of its hospitals and care homes. The lids came into use in March and the initiative will reach almost 600,000 people.

Social media proved vital in spreading the word. In ten days we reached 156,000 people on Facebook and we also created a Twitter page to gain attention, and followed some of the most influential people in healthcare. We have enjoyed daily recognition from new sources and health boards excited about our ideas.

Team Hydr8 also featured on BBC Wales evening news and on BBC Radio Wales, and we were the top feature on the BBC interactive red button on International Nurses Day.

Sheffield Teaching Hospitals NHS Foundation Trust contacted us via Twitter. They have bought yellow lids and are currently trying them out. The results so far are positive, with hydration levels rising by 400%.

Drive to change practice continues

Southampton General Hospital has purchased 200 lids to begin a trial and we have been approached by Jersey General Hospital, the only hospital on the island of Jersey. We like to think that the whole island will be better off because of Team Hydr8.

• RELATED: Think Drink hydration campaign helping patients recover faster from surgery side effects

We are proud that our efforts have been recognised nationally and internationally. We were finalists in the student category of the 2019 RCNi Nurse Awards, and have had our project discussed at conferences as far afield as Canada and the US.

Our drive to change practice continues. We are applying for an all Wales policy to make all fluid-related paperwork yellow to match the lids and provide a consistent approach to patient care.

Simple but effective

We continue to attend meetings with health boards, and make presentations at conferences all over the UK promoting our simple but effective, low-cost idea.

Now registered practitioners, we want to ensure that we inspire the next wave of students. Our initiative is presented to hundreds of students in Sheffield every term, and we have gone back to the university to speak to other cohorts, explaining to them that if you have an idea and are passionate about it you can make a difference.

• RELATED: Dehydrated nurses in hot weather are a patient safety issue, RCN warns

We are so proud that we have created an energy and excitement that has inspired others and a change in practice that will save lives.

Donna Walker is an emergency department nurse at the Royal Glamorgan Hospital 

Find out more

Team Hydr8 on Twitter: #PutALidOnIt #CheckYourJugs

The Andrew Parker Student Nurse Award is sponsored by the RCN