ABSTRACT
BACKGROUND: The accuracy of documentation of body weight and fluid balance in hospitalized patients is frequently questioned. METHODS: We conducted a survey to understand provider perceptions of the accuracy of intake, output, and weight charting in the electronic medical record. We sent a six-item questionnaire to nurses and physicians who provide inpatient service in a community-based teaching hospital of the Northeastern United States. We compared the response difference between nurses and physicians by Fisher exact test. RESULTS: One hundred eight nurses and 39 physicians participated in the survey. Both nurses and physicians responded that the accuracy of documentation is crucial. However, only 25.7% of participating physicians and 38.3% of participating nurses considered that documentation in the electronic medical record is reliable. Both physicians and nurses assumed that the nurses are too busy to collect and document the data, and the variability of non-patient weight and variations in body weight measurement under different conditions account for inaccuracies in the documented body weight. CONCLUSIONS: Assessing the accuracy of documenting intake, output, and body weight in the electronic medical record is warranted. Providers believe that educating patients about fluid balance and volume assessment help to improve the accuracy in charting intake, output, and body weight in the electronic medical record.
ABSTRACT
BACKGROUND: General risk factors for osteoporosis in men include cigarette smoking, alcohol consumption, and diseases known to affect calcium or bone turnover. The aim of this study was to determine the specific incidence and major risk factors for osteoporosis in those at high risk for falling in a Veterans Administration nursing home that included a high proportion of psychiatric patients. METHODS: We performed a cross-sectional analysis of Veterans Administration Medical Center nursing home residents with high fall risk. Thirty-nine men with a previous episode of falling or who were considered to be at high fall risk were enrolled. A review of the medical histories and pertinent hormonal and biochemical laboratory values was performed. Bone mineral density was measured by performing dual energy x-ray absorptiometry for all participants. RESULTS: We reviewed the medical records of 39 male nursing home residents with high fall risk. The patients' mean age was 74.7 +/- 6.8 years. A significant (p = 0.00045) association was found between chronic obstructive pulmonary disease and osteoporosis independent of oral corticosteroid use. Additional risk factors found to be associated with osteoporosis included hypogonadism, lower body weight, antipsychotic medication use, and smoking. CONCLUSION: In a Veterans Administration nursing home population at high risk for falls, including psychiatric patients, chronic obstructive pulmonary disease independent of the use of corticosteroids, lower body weight, hypogonadism, use of antipsychotic medications, and smoking was found to be associated with osteoporosis.
