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Fluid monitoring must improve, CQC tells two hospitals after discovering multiple lapses

Staff frequently failed to complete fluid balance charts – even after coroner’s warning
Kent and Canterbury Hospital, part of East Kent NHS trust, where CQC found lapses in fluid monitoring

Staff frequently failed to complete fluid balance charts – even after coroner’s warning over patient’s death

A trust that was told to improve fluid monitoring by nurses after the death of a patient has been criticised for failing to make adequate changes.

Inspectors found record-keeping was incomplete during visits to medical wards at William Harvey Hospital and Kent and Canterbury Hospital , both managed by East Kent Hospitals University NHS Foundation Trust.

Fluid balance records incomplete

They found patient records that were not up to date, with important information – including details of patients’ fluid balance – missing. Inspectors did not find any complete fluid charts, although internal audits suggested up to 30% of

Staff frequently failed to complete fluid balance charts – even after coroner’s warning over patient’s death

Kent and Canterbury Hospital, part of East Kent NHS trust, where CQC found lapses in fluid monitoring
Picture: Alamy

A trust that was told to improve fluid monitoring by nurses after the death of a patient has been criticised for failing to make adequate changes.

Inspectors found record-keeping was incomplete during visits to medical wards at William Harvey Hospital and Kent and Canterbury Hospital, both managed by East Kent Hospitals University NHS Foundation Trust.

Fluid balance records incomplete

They found patient records that were not up to date, with important information – including details of patients’ fluid balance – missing. Inspectors did not find any complete fluid charts, although internal audits suggested up to 30% of fluid balance records were incomplete.

Care Quality Commission (CQC) head of hospital inspection Amanda Williams said this was particularly worrying, given fluid overload had contributed to the death of a patient.

‘Across both hospitals, our inspectors found records relating to people’s fluid balances were consistently incomplete or not completed at all,’ she said. ‘This was despite being told by the coroner in July last year that fluid balance monitoring needed to improve to prevent patient future deaths.’


William Harvey Hospital, part of East Kent NHS trust, where CQC found lapses in fluid monitoring
Picture: Alamy

Fluid overload contributed to patient’s death

A coroner’s report about the death aged 60 of Lynda Pedersen at William Harvey Hospital in September 2018 said fluid overload was a contributing factor.

Coroner Patricia Harding found fluid balance charts had not been completed correctly in the period leading to Ms Pedersen’s death, resulting in the patient experiencing significant fluid overload.

‘It was accepted at the inquest that the charts were deficient in their completion, that nursing staff had not recorded output properly or reconciled the balance as required,’ the coroner stated.

She urged the trust to improve practice to prevent further deaths.


Refresher training for nursing staff

East Kent Hospitals University NHS Foundation Trust chief executive Susan Acott said: ‘We know there is more to do to consistently provide the highest standards of care and we are urgently addressing areas highlighted for improvement.’

Since the May inspection, staff in all areas have had fluid-chart refresher training. This is in addition to training provided last summer in response to the coroner’s comments.

‘There are daily safety huddles and our teams of matrons are regularly checking that risk assessments and patients’ records are up to date,’ said a statement.

The CQC found improvements in infection control and a ‘positive culture’ at the two hospitals. It rates both as requiring improvement.

Inspectors found there were adequate nurses on duty and noted trust vacancies were falling, although staff told them cover had been a concern during the pandemic.


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