Provide fluids consistently throughout the day | Bak, Wilson, Tsiami, & Loveday, 2018; Bunn et al., 2015; Ferry, 2005; Hodgkinson, Evans, & Wood, 2003; Jimoh et al., 2015; Jimo et al., 2019; Oats & Price, 2017; Mentes, Chang, & Morris, 2006; Robinson & Rosher, 2002; Simmons, Alessi, & Schnelle, 2001; Volkert et al., 2018 | A1 |
Specific Effective Strategies | | |
Plan fluid intake as follows: 75–80% delivered at meals, and 20–25% delivered during non-mealtimes such as medication times and planned nourishment times. | Zembrzuski, 1997; Volkert et al., 2018 | D |
Offer a variety of fluids keeping in mind the individual's previous intake pattern | Bunn et al., 2015; Godfrey et al., 2012; Schnelle et al., 2010; Simmons, Alessi, & Schnelle, 2001; Volkert et al., 2018; Wilson et al., 2018: Zembrzuski, 1997 | C1 |
Integrate fluid rounds mid-morning and late afternoon, where caregiver provides additional fluids | Spangler, Risley, & Bilyew, 1984 | B2 |
Standardize fluid with medication administrations to a prescribed amount; e.g. 180mL (6oz.) per administration time. | Jimoh et al., 2019; Mentes & Culp, 2003 | B2 |
Provide 2- 8 oz. glasses of fluid in AM and PM | Robinson & Rosher, 2002 | B2 |
If taking thickened liquids encourage intake (as intake reported as lower than if taking thin liquids) | McGrail & Kelchner, 2012; McGrail & Kelchner, 2015; Painter et al., 2017 | C1 |
Select between-meal snacks that will increase water intake | Marra et al., 2016 | C1 |
Make Drinking Opportunity a Pleasurable and Social Experience | Abdelhamid et al., 2016; Godfrey, Cloete, Dymond, & Long, 2012 | C1 |
Specific Effective Strategies | | |
“Happy Hours” in the afternoon, where residents can gather together for additional fluids and socialization | Mentes, Chang, & Morris, 2006; Munsson et al., 1990 | C1 |
“Tea Time” in the afternoon, where residents come together for fluids, nourishment and socialization | Mueller & Boisen, 1989 | D |
Encourage resident to have meals in the dining room | Reed, Zimmerman, Sloane, Williams, & Boustani, 2005; Volkert et al., 2018 | C1 |
Create a non-institutional dining experience | Reed et al., 2005; Volkert et al., 2018 | C1 |
Ensure utensils are resident centered | | |
Specific Effective Strategies | | |
Use of modified fluid containers based on resident's intake behaviors (e.g. ability to hold cup, to swallow) | Bak et al., 2018; Mueller & Boisen, 1989; Reedy, 1988 | D |
Use high contrast tableware during meals for residents with dementia | Dunne, Neargarder, Cipolloni, & Cronin-Golomb, 2004 | D |
Encourage on-going intake of fluids throughout the day | Bunn et al., 2015; Mentes, Chang, & Morris, 2006; Robinson & Rosher, 2002; Simmons, Alessi, & Schnelle, 2001 | C1 |
Provide reminders/prompts to drink fluids | Bak et al., 2018; Bunn et al., 2015; Godfrey et al., 2012; Oats & Price 2016 | C1 |
Provide the appropriate level of assistance to enhance intake | Bunn et al., 2015; Godfrey et al., 2012; Marra et al., 2016 | C1 |
Offer a variety of fluids with consideration for residents' preference | Godfrey et al., 2012; Mentes, Chang, & Morris, 2006; Oates & Price, 2017; Robinson & Rosher, 2002; Schnelle et al., 2010; Simmons, Alessi, & Schnelle, 2001; Wilson et al., 2018 | C1 |
Increase toileting routine (in combination with other strategies) | Bunn et al. 2015; Schnelle et al., 2010; Spangler et al., 1984; Tanka et al., 2009; Zembrzuski, 2006 | C1 |
Provide staff with education on hydration management (in combination with other strategies) | Beattie, O'Reilly, Strange, Franklin, & Isenring,2014; Greene et al., 2018; Oats & Price, 2017; Volkert et al., 2018; Zembrzuski, 2006 | C1 |
Coordinate staff communication about hydration such as certified nursing assistant (CNA) handoff reports or documentation in nursing care plan. | Mentes, Chang, & Morris, 2006; Ullrich, & McCutcheon, 2008 | C1 |
Provide a staffing ratio that allows the needs of the residents to be met | Namasivayam-MacDonald et al, 2018; Reed et al., 2005 | C1 |
Encourage family involvement and support | Mentes, Chang, & Morris, 2006 | C1 |
Promote Self-Management of Hydration | | C1 |
Provide education to improve their hydration health literacy | Bhanu et al. 2019; Picetti et al., 2017 | |
Individuals who are cognitively intact and physically capable can be taught to use the Drinks Diary to self-monitor their fluid intake. | Jimoh et al., 2015 | C1 |
Assist to establish their fluid intake goal based on the calculated fluid recommendation. | Volkert et al., 2018 | |
Individuals who are cognitively intact and visually capable can be taught how to note changes in their level of hydration through the use of a color chart (See Appendix A.4 for description in full guideline), to compare to the color of their urine The chart is most accurate in individuals with better renal function. | Armstrong et al., 1994, 1998;Mentes, Wakefield & Culp, 2006 | C1 |
Fluid Regulation and documentation | | |
Note: Frequency of documentation of fluid intake will vary from setting to setting and is dependent on an individual's condition. | | |
Document a complete intake recording including hydration habits | Mentes & IVANRC, 2000 | D |
Create fluid volume list of each utensil to accurately calculate fluid consumption | Burns, 1992; Hart & Adamek, 1984 | C1 |