First reported 28 Aug 2013•Latest report 22 Dec 2025
Definition
What this concern includes
Includes failures of the dedicated patient fluid-balance monitoring process, including failure to initiate, assess, measure, record or maintain monitoring, and delayed or incomplete monitoring when fluid status is clinically important.
Not included
Excludes failures limited to recording fluid-balance information when monitoring itself was completed reliably.
Excludes generic clinical information, staffing or documentation deficiencies unless they directly cause failure of the patient fluid-balance monitoring process.
Excludes monitoring of other physiological measures unless the assertion specifically concerns patient fluid balance.
Excludes treatment or fluid-management decisions where no failure of fluid-balance monitoring is identified.
Reports
29
Distinct published reports
Individual concerns
34
A report can raise multiple concerns
Date range
2013–2025
First to latest report issue date
Stated actions
78
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Care Quality Commission3
Ashford and St Peter'S Hospitals NHS Foundation Trust2
Blackpool Teaching Hospitals NHS Foundation Trust2
Department of Health and Social Care2
NHS England2
Swansea Bay University Local Health Board2
University Hospitals Sussex NHS Foundation Trust2
Aneurin Bevan University LHB1
Barking, Havering and Redbridge University Hospitals NHS Trust1
Barts Health NHS Trust1
Cwm Taf Morgannwg University Local Health Board1
East Kent Hospitals University NHS Foundation Trust1
East Surrey Hospital1
Epsom Hospital1
General Medical Council1
NHS trust17
Healthcare site8
Local health board4
Nursing home4
Health and social care service regulator3
Executive non-departmental public body2
Health professional body2
Ministerial department2
Coronial office1
Health and care professional regulator1
Independent healthcare provider1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
Northamptonshire
Concerns raised1
Failure to accurately and completely record fluid and food intake
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Use electronic fluid-balance charts in Nevercentre to improve accessibility, calculation and documentation accuracy.
Stated by University Hospitals of Northamptonshire NHS GroupStated completedThe respondent said that this action was complete when they made their response on 24 February 2026.
Action
Roll out updated food-and-fluid charts across both hospitals, including prompts for chart commencement, visitor-provided food and oral nutritional supplements.
Stated by University Hospitals of Northamptonshire NHS GroupStated plannedThe respondent said that this action was planned when they made their response on 24 February 2026.
Action
Audit MUST completion and the accuracy of food-and-fluid charts through Nutrition Nurses and use findings to monitor compliance.
Stated by University Hospitals of Northamptonshire NHS GroupStated completedThe respondent said that this action was complete when they made their response on 24 February 2026.
Action
Deliver evaluated monthly nutrition and hydration training through the Clinical Skills Nursing Programme, including documentation standards.
Stated by University Hospitals of Northamptonshire NHS GroupStated in progressThe respondent said that this action was in progress when they made their response on 24 February 2026.
Blackpool and the Fylde
Concerns raised2
Ineffective monitoring of fluid balances
Absence of important information for clinical decisions about fluid balances
This report raised 1 other concern. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.6
Action
Roll out the newly developed Trust fluid-balance chart across the organisation.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 24 January 2025.
Action
Adopt the designed and tested fluid-balance escalation process.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 24 January 2025.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 24 January 2025.
Action
Establish a lead team to update the Trust fluid-balance policy using Quality Improvement recommendations.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 24 January 2025.
Action
Operate the launched Clinical Community to scale, spread and embed fluid-balance improvements across the organisation.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 24 January 2025.
Action
Introduce mandatory afternoon checks and QR-code guidance to reinforce fluid-balance policy changes.
Stated by Blackpool Teaching Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 24 January 2025.
Gwent
Concerns raised1
Failure to monitor fluid balance
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.11
Action
Complete the review of Health Board documentation, monitoring tools and relevant national guidelines to establish an evidence base for best practice.
Stated by Aneurin Bevan University LHBStated completedThe respondent said that this action was complete when they made their response on 3 February 2025.
Action
Establish and operate a multidisciplinary Fluid Balance Task and Finish Group with defined improvement objectives.
Stated by Aneurin Bevan University LHBStated completedThe respondent said that this action was complete when they made their response on 3 February 2025.
Action
Initiate a surgical-ward fluid-balance monitoring pilot incorporating staff education, information boards, data sharing and auditing.
Stated by Aneurin Bevan University LHBStated plannedThe respondent said that this action was planned when they made their response on 3 February 2025.
Action
Standardise fluid-balance monitoring documentation across the organisation.
Stated by Aneurin Bevan University LHBStatus unclearThe respondent did not make the status of this action clear when they made their response on 3 February 2025.
Action
Explore using a digital observation platform to record fluid balance.
Stated by Aneurin Bevan University LHBStatus unclearThe respondent did not make the status of this action clear when they made their response on 3 February 2025.
Action
Develop a multidisciplinary fluid-balance standard operating procedure.
Stated by Aneurin Bevan University LHBStatus unclearThe respondent did not make the status of this action clear when they made their response on 3 February 2025.
Action
Disseminate expected fluid-balance monitoring standards through feedback sessions, posters, emails, ward meetings and learning events.
Stated by Aneurin Bevan University LHBStatus unclearThe respondent did not make the status of this action clear when they made their response on 3 February 2025.
Action
Deliver strengthened multidisciplinary education and training on fluid-balance roles, responsibilities and best practice.
Stated by Aneurin Bevan University LHBStated plannedThe respondent said that this action was planned when they made their response on 3 February 2025.
Action
Engage senior medical staff to support education and establish clinical expectations for fluid-balance monitoring.
Stated by Aneurin Bevan University LHBStated plannedThe respondent said that this action was planned when they made their response on 3 February 2025.
Action
Incorporate Medical Examiner and Quality Safety Learning Forum learning into the fluid-balance improvement plan.
Stated by Aneurin Bevan University LHBStated plannedThe respondent said that this action was planned when they made their response on 3 February 2025.
Action
Use the AMAT tool to standardise fluid-balance compliance audits, conduct audits through ward accreditation and report results to the Nutrition and Hydration Committee.
Stated by Aneurin Bevan University LHBStated plannedThe respondent said that this action was planned when they made their response on 3 February 2025.
Worcestershire
Concerns raised1
Failure to properly record fluid intake and output on fluid balance charts
This report raised 3 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.3
Action
Share Trust-wide learning and required actions to improve fluid-balance documentation in the electronic patient record.
Stated by Worcestershire Acute Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 25 September 2024.
Action
Provide ward-based education on nutrition, hydration, MUST assessment and fluid-balance recording through induction, specialist training and HCA study days.
Stated by Worcestershire Acute Hospitals NHS TrustStated completedThe respondent said that this action was complete when they made their response on 25 September 2024.
Action
Develop and deliver a local training package addressing fluid-balance and electronic-record changes.
Stated by Worcestershire Acute Hospitals NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 25 September 2024.
Surrey
Concerns raised1
Inadequate recording of fluid input and output
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.9
Action
Disseminate a quick reference guide explaining how to manage parenteral nutrition entries in the electronic fluid-balance chart.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 5 August 2024.
Action
Conduct the electronic fluid-balance discovery work with subject-matter experts to define required data feeds.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 5 August 2024.
Action
Conduct a gap analysis to identify updates needed to improve fluid-balance-chart accessibility and viewing.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated plannedThe respondent said that this action was planned when they made their response on 5 August 2024.
Action
Provide fluid-balance recording training through induction, student workbooks, preceptorship, and ward-based clinical education.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 5 August 2024.
Action
Reinforce fluid-balance practice through daily safety huddles and recurring ward handover topics.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 5 August 2024.
Action
Set ward times for recording catheter, drain, and nasogastric-tube outputs and monitor chart-review compliance.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 5 August 2024.
Action
Carry out a ward quality-improvement project to improve oral hydration and fluid balance.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 5 August 2024.
Action
Provide ward-focused tea-trolley education on accurate fluid-balance recording.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated in progressThe respondent said that this action was in progress when they made their response on 5 August 2024.
Action
Review fluid-balance charts during weekly senior-nurse care rounds.
Stated by Ashford and St Peter'S Hospitals NHS Foundation TrustStated completedThe respondent said that this action was complete when they made their response on 5 August 2024.
South Wales Central
Concerns raised1
Failure to maintain fluid balance charts
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
East London
Concerns raised2
Failure to put fluid balance charts in place
Failure of consultant-led ward rounds to adequately review fluid monitoring
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Action
Conduct and continue unannounced cross-site fluid-management audits on every COTE ward, monitoring Careflow Vitals recording and appropriate follow-up.
Stated by BHRUTStated in progressThe respondent said that this action was in progress when they made their response on 24 February 2023.
Action
Conduct peer fluid-monitoring audits between COTE wards and share results through governance meetings and daily huddles.
Stated by BHRUTStated in progressThe respondent said that this action was in progress when they made their response on 24 February 2023.
Action
Provide nursing staff with Careflow Vitals training and one-to-one fluid-monitoring support.
Stated by BHRUTStated completedThe respondent said that this action was complete when they made their response on 24 February 2023.
Action
Train medical staff to access fluid balances in Careflow Vitals and discontinue completion of paper fluid charts.
Stated by BHRUTStated completedThe respondent said that this action was complete when they made their response on 24 February 2023.
Action
Carry out a clinical safety assessment to identify and mitigate hazards affecting entry or viewing of fluid-balance data.
Stated by BHRUTStated plannedThe respondent said that this action was planned when they made their response on 24 February 2023.
Action
Require consultant-led ward rounds to review fluid monitoring in Careflow Vitals and reinforce this expectation through divisional communications.
Stated by BHRUTStated completedThe respondent said that this action was complete when they made their response on 24 February 2023.
Action
Deliver a Careflow fluid-management teaching presentation at the next Clinical Review Group meeting.
Stated by BHRUTStated plannedThe respondent said that this action was planned when they made their response on 24 February 2023.
Hampshire, Portsmouth and Southampton
Concerns raised1
Failure to assign overall responsibility for monitoring adherence to hydration requirements
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Continue ward accreditation assessments, including care-plan and patient-record reviews, feedback, action planning and governance reporting.
Stated by Portsmouth Hospitals University NHS TrustStated in progressThe respondent said that this action was in progress when they made their response on 9 January 2023.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Existing multidisciplinary observation, clinical assessment and selective fluid-charting arrangements are considered sufficient to monitor patients’ hydration without one overall monitor.
Stated by Portsmouth Hospitals University NHS TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Norfolk
Concerns raised1
Reliance on estimated fluid intake and output amounts
This report raised 12 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Operate a hydration-monitoring system using first-four-week fluid charts, shift-based hydration trolleys, millilitre recording and daily senior review of charts and electronic records.
Stated by Runwood Homes PLCStated completedThe respondent said that this action was complete when they made their response on 1 December 2022.
Lincolnshire
Concerns raised1
Failure to record fluid intake accurately
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.4
Action
Maintain ongoing staff training on nutrition, hydration, and responding to declining food or fluid intake.
Stated by TanglewoodStated in progressThe respondent said that this action was in progress when they made their response on 5 October 2022.
Action
Review and amend the Nutrition and Hydration policy to cover intake recording, refusals, fluid targets, and discussions with clinicians and families.
Stated by TanglewoodStated completedThe respondent said that this action was complete when they made their response on 5 October 2022.
Action
Embed admission safeguards requiring risk assessments, daily charts, documented communications, timely referrals, and updates to residents and representatives.
Stated by TanglewoodStated in progressThe respondent said that this action was in progress when they made their response on 5 October 2022.
Action
Continue face-to-face staff training on care documentation and recording offered or declined nutrition and fluids.
Stated by TanglewoodStated in progressThe respondent said that this action was in progress when they made their response on 5 October 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Staff cannot force residents to take food or fluids when they refuse, but must record the refusal and intake.
Stated by TanglewoodUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Pin
Get email alerts
Request correction
Includes failures of the dedicated patient fluid-balance monitoring process, including failure to initiate, assess, measure, record or maintain monitoring, and delayed or incomplete monitoring when fluid status is clinically important.
