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Run: Hydration Pass Documentation Log

Log between-meal fluid passes for at-risk residents with resident-level intake, refusals, and follow-up notes in one shift record. Use it to support hydratio...

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Pass Details

Unit / Wing (required)

Select the unit where this hydration pass was conducted.

Date of Pass (required)

Shift (required)

Time Pass Conducted (required)

Record the actual start time of this hydration round.

Pass Timing (required)

Staff Member Conducting Pass (required)

Staff Title / Role (required)

Fluid Offerings

Type(s) of Fluid Offered (required)

Select all fluid types offered. Thickened liquids must match the resident's current diet order.

Standard Volume Offered Per Resident (mL) (required)

Enter the standard serving size offered to each resident in milliliters (e.g., 240 mL = 8 oz).

Total Residents on At-Risk Hydration List for This Unit (required)

Resident-Level Intake Record

Resident Fluid Intake Log (required)

Record each resident's room/bed, volume consumed, and outcome. Estimated consumption is acceptable if resident is unable to self-report; note 'estimated' in the remarks column.

Outcome Code Reference

Pass Summary

Number of Residents Offered Fluids This Pass (required)

Residents Who Consumed ≥75% of Offering (required)

Residents Who Consumed <50% of Offering (required)

These residents require charge nurse notification per facility protocol.

Number of Residents Who Refused Fluids (required)

Residents Skipped Due to NPO Order or Fluid Restriction (required)

Were any clinical concerns identified during this pass? (required)

Describe Clinical Concerns Observed

Include resident identifier, observation, and any action taken. Do not include full name if facility policy uses room/ID documentation.

Was the Charge Nurse Notified of Any Concerns?

Time Charge Nurse Was Notified

Attestation

I confirm that all residents on the at-risk hydration list were approached during this pass, or a reason for exception is documented above. (required)

Yes No N/A

I attest that the fluid volumes and outcomes recorded are accurate to the best of my observation and knowledge. (required)

Yes No N/A

Time of Submission (required)

Record the time you are completing and submitting this log.

Additional Notes for Charge Nurse or Dietitian (Optional)

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