From 25 November 2019 the Trust will adopt a simple, traffic light system using coloured jug lids to monitor the amount that individuals are drinking across the day. This simple visual cue is an easy way for clinicians to see a patient’s fluid intake. Nursing staff at Doncaster and Bassetlaw Teaching Hospitals (DBTH) are set to implement a number of innovative measures to help patients stay hydrated – a major challenge for health professionals. When the patient has drunk their first jug, it will be refilled with fresh water - lid changed to amber. These can range from constipation, pressure ulcers and also more serious issues such acute kidney injury, cardiac disease and venous thromboembolism (blood clot).

Simple measures: improving hydration in patients (DBTH)

A large number of relief-moulded jugs are found with no maker's mark. Some are titled, but many are completely unmarked. A selection of jugs by unknown makers can be found here. News of other interesting unmarked jugs and particularly the discovery of any marked examples of these designs would be very welcome. Storage & organisation Furniture Textiles Kitchenware & tableware Kitchens Lighting Decoration Rugs, mats & flooring Beds & mattresses Baby & children Smart home Bathroom products Laundry & cleaning Plants & plant pots Home electronics Home improvement Outdoor living Food & beverages Christmas Shop Shop by room

Project plan

Any patient tolerating less than 500ml a day orally was given a red jug and mug and patients assessed as having a poor fluid intake on admission were also considered for the project. A patient drinking preference sheet was devised so that staff knew what drinks patients liked. After four weeks, a repeat audit found: 100% of patients had fluid balance charts; and 100% had their oral fluids accurately documented. The number of patients on intravenous fluids has decreased from 66% to 25% suggesting that patients’ hydration had improved.

Coloured Jugs - Andway Healthcare - Care Home Supplies and Coloured Jugs - Andway Healthcare - Care Home Supplies and

Some of the manufacturers of relief-moulded jugs attempted to protect their designs from being copied by the use of two Acts of Parliament dating from 1798 and 1814. The system required the wares to be marked in a specific way, following a fairly standard format which was dictated by the acts. Its first use on moulded jugs came in 1834, and the latest in the 1850s. The process Before introducing the scheme, we carried out an audit of hydration and found that 80% of our patients had a fluid balance chart, 66% had intravenous fluids documented and none had their fluid balance accurately documented.

Reaching the green lid stage is significant to this as this shows the patient has drank 1500ml of water which reduces their risk of dehydration. By ensuring that inpatients drink enough throughout their time in hospital, there is an association that drinking plenty of water and fluids aids recovery. Dehydration — a condition which occurs when you don't have enough water in your body to carry out normal functions – can be the underlying cause of many common conditions which can complicate a hospital stay. It has been immensely satisfying that this scheme has been accepted in many trusts in the UK, and also has garnered interest internationally.

Colored Jugs - Colored Jugs Colored Jugs - Colored Jugs

The Malnutrition Universal Screening Tool and Waterlow pressure ulcer score were used to identify people who needed a red jug and mug as no hydration assessment tool was available. By a strange quirk of fate, in about 1982 John Steele at the Antique Collectors’ Club asked me to have a look at a manuscript about jugs he had received for possible publication. It was an interesting exercise but to cut a long story short, John and I eventually agreed that I should write a new book on jugs. That was the birth of my Relief-Moulded Jugs 1820-1900, published in 1984. I continued to collect jugs alongside blue and white wares, and these forays led to a more wide-ranging volume, An Illustrated Guide to British Jugs, published in 1997. The introduction of traffic light system is DBTH’s approach to reducing dehydration amongst patients. It’s also part of a wider ongoing project called ‘But First a Drink’ initiative, aimed at prompting health professionals to offer a drink and record patients’ fluid balances at the start and end of all their patient interactions with inpatients.

Conclusion

If nurses are concerned about patient’s water intake, such as if the red lid is still attached by the late afternoon, there are escalation processes to alert senior colleague for further action. Clinicians will also introduce a blue lid for patients with strict fluid restrictions.