We’re
We
re passionate about
• Putting
P tti patients
ti t first
fi t
• Quality,
Q lit safety
f t and
d patient
ti t experience
i
• Transforming services to meet the health needs
of future generations
How do we meet an individual’s
individual s nutrition
and hydration needs ?
Colin Chapman
Head of Catering
Julie Higgins
Professional Lead for Nutrition and Dietetics
What is nutrition and hydration?
• E
Eating
ti and
dd
drinking
i ki
• Essential nutrients for life:
– carbohydrates,
b h d t
proteins, and fats,
vitamins minerals
vitamins,
• Good nutrition means
getting the right amount
of nutrients from foods in
the right combinations
• We are all experts in
nutrition and hydration
• In
I hospital
h
it l / unwellll
• Norms of every day
eating and drinking can
be challenging
What are our aims?
• T
To provide
id ffood
d and
d
drinks that are appetising
and nourishing
– Catering services
• T
To meett nutrition
t iti and
d
hydration needs with
support
– Dietetic services
How do we meet nutrition and
hydration needs?
Oral nutrition
support
Food first
Artificial
nutrition
support
Why is nutrition and hydration important?
Water the forgotten nutrient
nutrient…
•
Good
G
d hydration
h d ti can assist
i t iin
•
preventing or treating ailments such
as:
– Pressure ulcers
– Constipation
– Urinary
Urinar infections and incontinence
– Low blood pressure
– Diabetes (management of)
– Dizziness and confusion leading to
falls
– Poor oral health
Water
W
t is
i essential
ti l to
t health,
h lth
one of the six basic nutrients
How does malnutrition affect the
individual?
Reduced quality of life
Muscle wasting and
weakness – cardiac,
respiratory and skeletal
Impaired immune function
Poor wound healing
Longer hospital stays
Impaired recovery from
illness or surgery
g y
Increased risk of pressure
sores
Impaired ps
psycho-social
cho social
function
Benefits of good nutrition
• Reduces the risk of
malnutrition
• Improved ability to fight
infections
• Reduces the falls risk
• Helps prevent anaemia
• Minimise the development • Helps reduce constipation
of p
pressure ulcers
• Improved
p
wound healing
g
• Helps maintain good bone
health
How do we know if a p
patient is at risk of
malnutrition
•
•
•
•
•
•
Screening
S
i and
d assessmentt (NICE CG32 compliant)
li t)
Patient screened on admission to hospital and repeated during
hospital
p
stay
y
Appropriate screening for out-patients (NICE CG32 compliant)
Referral pathways for dietitians, speech therapy
Clear care pathways for ‘at risk’ patients
Documentation and communication of screening outcomes,
nutritional goals, dysphagia advice and risk management
How do we meet nutrition and hydration
y
needs at North Tees and Hartlepool NHS
Foundation Trust
The Fluid and Nutrition Group
p (FaNG)
(
)
An interdependent working group
•
•
•
•
•
Catering
Dietetics
Nursing from all directorates
Consultants from clinical
directorates
Medical and surgical staff
•
•
•
•
•
•
Community
Portering
Clinical Effectiveness
Speech and Language
Pharmacy
Patient representative
What do the Fluid and Nutrition Group
p
do
Aim
• To maintain and improve the quality of nutritional care for
allll patients
ti t and
d clients
li t visiting
i iti th
the T
Trustt
What do the Fluid and Nutrition Group
p
do
•
•
•
•
•
Fluid
Fl
id and
d nutrition
t iti policies
li i and
d guidelines
id li
Monitoring and review of artificial nutrition feeding care guidelines
on annual basis via an audit programme
p g
Monitor and act upon nutrition related; patient safety issues, patient
satisfaction, complaints and compliments
Promote n
nutrition
trition and h
hydration
dration in the Tr
Trust
st via
ia campaigns and
promotional activities
Dissemination of updates on fluid and nutrition to relevant groups
g
and forums
What does g
good nutritional care look
like?
How do we know we are delivering good/safe
nutritional
t iti
l care?
?
Compliance
p
with all legislative
g
and
regulatory requirements
•
•
•
•
•
•
•
•
Food
F
d Hygiene
H i
(E
(England)
l d) R
Regulations
l ti
Food Temperature Monitoring Regulations
Food Information Regulations EU1169/2011
The Hospital Food Standards Panel Report on standards for
Food and Drink in NHS Hospitals
Care Quality Commission Outcome 5 (Meeting Nutritional
Needs)
PLACE (patient led assessment of the care environment)
10 Key Characteristics of Good Nutritional care in Hospitals
To name but a few
How do we achieve this
•
•
•
•
•
•
Trusts Food Hygiene Policy
Trusts Catering for Patients Staff and Visitors Policy
T t Nutrition
Trusts
N t iti and
d Hydration
H d ti St
Strategy
t
Working towards compliance with the 5 required hospital food
standards from the Food Standards Panel Report
p for Food & Drink
in NHS Hospitals
Unannounced Environmental Health Office Inspections
A
Annual
lE
External
t
lF
Food
dS
Safety
f t Audits
A dit
What does g
good nutritional care look
like?
•
•
•
•
•
•
•
Range of Nutritious Appetizing Menus to meet a diverse range of
patient needs (Gluten Free, Ethnic, Children's, Elderly, Maternity,
ITU, Texture Modified
Access to food available outside of routine mealtimes 24 hrs per
day
Protected mealtimes
Red tray system (for patients who require assistance with
feeding)
Diff
Different
styles
l and
d types off crockery
k
Dementia
D
i Crockery
C k
and
d
Cutlery
Ward Hostesses ((the missing
g link))
6cs Care Compassion Commitment Communication Courage
Competence
What does g
good nutritional care look
like?
•
•
•
•
Mealtime Companions
Information available for Patients regarding Catering Services
(Bedside Menu Card)
Food Hygiene Training for meal providers
Training
g to be available to a wide range
g of staff appropriate
pp p
to their
role
Are we getting it Right?
•
•
•
•
•
•
•
Customer
C
t
S
Satisfaction
ti f ti Surveys
S
Annual Place Inspections
Monthly (Internal) Place Inspections
Monthly SPEQS Inspections (Director of Nursing Led)
National In-Patient survey results
Friends and Family Test results
Key Stakeholders Engagement