TITLE:
Application of the Quality Control Circle to Improve the Recording Accuracy of Fluid Intake and Output in Patients with Chronic Heart Failure
AUTHORS:
Yayun Bao, Chunming Lin, Yingying Zhan, Yeling Zhu, Tianxia Huang, Chao Wang
KEYWORDS:
Quality Control Circle, Heart Failure, Fluid Intake and Output, Nursing Quality, Continuous Improvement
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.16 No.6,
June
12,
2026
ABSTRACT: Volume management is a core component of clinical diagnosis and treatment in patients with heart failure. Accurate recording of fluid intake and output serves as a critical foundation for condition assessment and treatment planning. However, in clinical practice, the recording accuracy is often low due to problems such as inconsistent tools, nonstandard procedures and inadequate education, and there is a risk of misdiagnosis and treatment deviation. The purpose of this study is to systematically improve the accuracy of fluid intake and output records of hospitalized patients with heart failure through Quality Control Circle (QCC) activities. The Quality Control Circle (QCC), named the “resultant force circle”, operated following the PDCA cycle and goes through ten steps, including theme selection, current situation investigation, goal setting, root cause analysis, countermeasure implementation and effect evaluation. According to the baseline survey, the accuracy of recording the fluid intake and output of patients with heart failure in April 2024 was 66.7%. Through Pareto analysis, the three main causes of “Information dependent on family memory”, “Inconsistent measuring tools” and “Nurses’ education is not in place” were identified, and 12 root causes were confirmed by fishbone diagram and true cause verification table. Aiming at the real cause, the team implemented comprehensive intervention from three aspects: process optimization, tool equipment and education and training. After the improvement, the sampling data shows that the accuracy rate is increased to 92%, the target achievement rate is 106%, and the progress rate is 38%. Intangible results show that the soft power of circle members’ sense of responsibility, team spirit and self-confidence has been significantly enhanced. In addition, the project has realized the establishment of the standardized flow of fluid intake and output records, and has applied for an invention patent on intelligent metering drinking water control. The research shows that quality control circle activities can effectively improve nursing quality, and its multi-dimensional collaborative improvement model has good sustainability and promotion value.