Dehydration Risk Assessment (QMS-F080) DEHYDRATION RISK ASSESSMENT (QMS-F080) Contact Document Ref: QMS-F080 (Dehydration Risk Assessment) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Effective (Eating and Drinking) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Fluid Intake Baseline & RestrictionsIs the service user on a GP-mandated Fluid Restriction? (e.g., for Heart Failure or Oedema)- Select -Yes (Strict fluid monitoring required)No (Encourage standard healthy intake)Target / Restricted Daily Fluid IntakePreferred Drinks & TemperaturesLevel of Assistance Required to Drink- Select -Fully IndependentRequires prompting and encouragement onlyRequires drinks to be placed within reachRequires physical assistance to hold cupPEG / Enteral fluid administration onlySECTION 2 - Health & Lifestyle Risk FactorsIdentify any underlying factors that increase the risk of dehydration: History of recurrent Urinary Tract Infections (UTIs) Prescribed Diuretics (Water tablets) Dementia / Cognitive decline (Forgets to drink) Fear of incontinence (Deliberately restricting intake) Swallowing difficulties / Fear of choking Restricted mobility (Cannot independently fetch a drink) None of the aboveSECTION 3 - Observational Signs & Hydration MonitoringSECTION 3 - Observational Signs & Hydration Monitoring Dark, strong-smelling urine Dry mouth, lips, or tongue Sudden onset of confusion or delirium Dizziness or light-headedness upon standing Sunken eyes ConstipationIs a mandatory Daily Fluid Chart (Form 95) required?Mandatory if the service user scores highly on MUST, has a history of UTIs, is on a fluid restriction, or is heavily dependent on staff for fluid provision.YesNoSECTION 4 - Preventative Action Plan & Sign-offPreventative Measures to be Implemented Ensure a fresh jug of water/squash is left within reach at the end of every visit Offer high fluid-content foods (e.g., jelly, melon, soup) Use a beaker with a lid/spout to prevent spillages Prompt to take regular sips throughout the care visit Measure and record exact input/output on Fluid ChartSpecific Instructions for Care WorkersAssessor NameDate of AssessmentSave Dehydration Risk
