Download Food, Fluid and Nutrition Standard

Food, Fluid
and Nutrition
Q.I.S.
• Embraces several quality and patient
focussed organisations in to one
• National standards of care are set for
various groups e.g. Elderly in acute
care, various cancer sites, Chronic
conditions e.g. Diabetes, renal.
CSBS
NMPDU
SHAS
Boards are audited
A report is produced
• Commending good practice
• Making recommendations for improvementchallenges
Standards are re -audited 2 – 3 years later
to monitor compliance and improvements
Food, Fluid and
Nutrition Standard
Scope of standard, embraces many
aspects of patient care
Patients who can eat and drink
normally meeting their needs
Patients who can eat and drink but
don’t meet their needs
Patients who need supplementary
drinks to meet their nutritional
requirements.
Patients who need enteral tube
feeding to meet their needs.
Patients who require Total
Parenteral feeding as the gut is
unavailable.
Screening
Organisational
Policy
Patient choice
Patient
Support
for Patient
Care
Planning
Staff Training
Whose business is it?
• Caterer
• Doctor
• Dietitian
• Nurse
• Patient
• Pharmacist
• Porter
Research studies have shown that
malnourished patients continue to
lose weight if not identified and
treated, the consequences are as
follows:• Weight loss and muscle loss
 Lack of energy
 Reduced immunity to infection
 Poor wound healing
 Longer hospital stay
• To improve the nutritional care of all
patients it is essential to identify where
problems exist.
• All patients should be screened as near
to admission time as possible, ideally
within 24 hours of admission or at the
earliest opportunity.
Please circle only one score in each section
RESCORE
Date
BODY WEIGHT
Normal [no recent weight changes]
Recent unintentional weight loss [<6Kgs]
Underweight / weight loss >6Kgs
0
3
5
0
3
5
0
3
5
0
3
5
0
3
5
APPETITE
Good – finishing three meals per day
Reduced – leaving quarter meals and fluids
Poor – leaving half meals and fluids
Little or no appetite, refusing or unable to eat/drink
0
2
3
5
0
2
3
5
0
2
3
5
0
2
3
5
0
2
3
5
ABILITY TO EAT AND DRINK
No difficulties, eating and drinking independently
Requires assistance with eating and drinking
Difficulty swallowing and/or chewing
0
2
5
0
2
5
0
2
5
0
2
5
0
2
5
SKIN CONDITION
Healthy
Sore red pressure areas
Superficial breaks in pressure areas
Multiple deep pressure sores
0
2
4
5
0
2
4
5
0
2
4
5
0
2
4
5
0
2
4
5
GUT FUNCTION
Normal
Persistent Nausea
Nausea + / or occasional vomiting + / or some diarrhoea / constipation
Diarrhoea > 3 per day / unable to keep food or fluids down
0
2
3
5
0
2
3
5
0
2
3
5
0
2
3
5
0
2
3
5
MEDICAL CONDITION
No impairment to food intake
Minor surgery / mild infection
Major surgery [Esp. G.I. Tract] / G.I. Disease / CVA / Chronic illness
Sever infection / Sepsis / Cancer / Burns > 15% / Multiple injuries
0
2
4
5
0
2
4
5
0
2
4
5
0
2
4
5
0
2
4
5
TOTAL [REFER TO ACTION PLAN
* SCORE 10 + REFER TO DIETITIAN
IF YOU FEEL THAT YOUR PATIENT REQUIRES A SPECIAL DIET DESPITE THE SCORE,
PLEASE CONTACT THE DIETIIAN
LOW
RISK
0-5
Encourage normal diet
Check weight and re-screen
weekly.
Re-assess if condition changes
MEDIUM
RISK
6-9
Commence 3 Day Food Record Chart.
Check weight twice weekly.
Beatson Oncology Centre:
Refer to Medium Risk
Flow Chart
Re-assess after 3 Days.
Intake / weight increasing
Intake / weight not increasing
Continue to encourage oral diet
Refer to dietitian
HIGH
RISK
10+
Refer to Dietitian and Medical Staff
Beatson Oncology Centre:
Refer to High
Risk Flow Chart
*during latter stages of palliative treatment weighing of patients to assess nutritional status
may not be appropriate as weight loss may be as a result of the under lying disease
Date
Weight
Score
Date seen by Dietitian
Refer to Dietetic Care Plan
Assessment Screening and Care Planning.
Screening of all patients at admission to ensure that they can
eat and drink. Assessment of nutritional status of patients
• Height/Weight calculating Body Mass Index
• Weight change
• Ability to eat and drink [physical]
• Skin condition [related to pressure sore prevention]
• Gut function e.g. malabsorption, nausea, sickness, diarrhoea
• Stress from disease e.g. surgery, infection, multiple injuries, burns
Development of action plan and multi-disciplinary care plans involving referral
to specialist services e.g. Dietetics, OT, SALT, Dentist
Screening
This should identify problems.
Direct to a care plan.
Instigate a care plan .
Encourage on- going monitoring
(regular weighing)
Planning and Delivery of Food and Fluids.
• Patient menus are nutritionally analysed
• Normal nutritional needs are met from the hospital
menu
• Patients are given the opportunity to choose meals*
• Set mealtimes and importance of mealtimes
• Staff are available to help patients eat
• Local arrangements in place and everyone is aware of
how to access food if a patient misses a meal
*Require interpretation at local site, as systems vary
Provision of Food and fluid to patients.
• Meal choice is available and patients given help to
choose
• Portion size
• Temperature
• Patient satisfaction
•Require interpretation at local site, as systems vary
Communication between wards,
patient and staff is essential for
success.
This should be ideally available
before admission or in a pack
available in the ward
• How to order meals
• Meal and snack times
choices available
• Out of hours meals
• Food brought in
• Food storage and
labels
• Special equipment
• How to comment
Education and Training for Staff.
• Specific roles e.g Diabetes, renal, Intensive care
•
Screening
• PACE for Care Assistants – Nutritional care of elderly patients
• PACE training for trained nurses Nutritional care hospitalised
patients see training notice board
• Food Handling Training
• Complex nutrition for MDT
• Nurse, Pharmacist, Dietitian and Medical staff National training
programmes are available.
Aims of Standard
• To improve nutritional care of all patients
• Screen all patients
• Formulate care plans to meet their
nutritional needs
• Meet their nutritional needs with choice
• Improve communication
• Develop training