Download Nutrition Policy Adults - Portsmouth Hospitals NHS Trust

Nutrition Policy ADULTS
Version
5
Name of responsible (ratifying) committee
Nursing & Midwifery Advisory Committee
Date ratified
December 2009 / January 2013
Document Manager (job title)
Head of Nutrition and Dietetics
Date issued
05 February 2013
Review date
December 2015
Electronic location
Clinical Policies
Related Procedural Documents
Key Words (to aid with searching)
Nutrition; obesity; food service; Malnutrition; Diet;
Patient care; Patient feeding; Nurses; Health service
staff
Nutrition Policy Issue 5
(Review: December 2015)
Page 1 of 32
CONTENTS
1.
2.
3.
4.
5.
6.
7.
8.
9.
QUICK REFERENCE GUIDE....................................................................................................... 3
INTRODUCTION.......................................................................................................................... 4
PURPOSE ................................................................................................................................... 4
SCOPE ........................................................................................................................................ 4
DEFINITIONS .............................................................................................................................. 5
DUTIES AND RESPONSIBILITIES .............................................................................................. 5
PROCESS ................................................................................................................................. 10
TRAINING REQUIREMENTS .................................................................................................... 10
REFERENCES AND ASSOCIATED DOCUMENTATION .......................................................... 11
MONITORING COMPLIANCE WITH, AND THE EFFECTIVENESS OF, PROCEDURAL
DOCUMENTS ............................................................................................................................ 11
APPENDICES:
Appendix A: Membership of the Hospital Food Group
Appendix B: Nursing competency
Appendix C: Guidelines for Food Service at Ward Level
Appendix D: Protected Mealtime guideline
Appendix E: Screening tools: Malnutrition Universal Screening Tool (MUST), Wessex Renal &
Transplant Service Nutrition Screening Tool (NST), First Line Action Plan (FLAP)
Appendix F: Guideline for Mealtime volunteers
Appendix G: Guideline for use of Red Tray
Appendix H: Other supporting policies: POLICY FOR THE PROVISION AND MANAGEMENT OF
PARENTERAL NUTRITION IN ADULTS IN HOSPITAL; PHT POLICY FOR THE INSERTION AND
MAINTENANCE OF FINE BORE NASO-GASTRIC FEEDING TUBES IN ADULTS; Enteral Tube Administration
Policy (Adults): Refeeding Guidelines; Provision of parenteral nutrition when pharmacy is closed
Appendix I: What foods may I bring in to hospital?
Nutrition Policy
(Review date December 2015)
Page 2 of 32
QUICK REFERENCE GUIDE
For quick reference the guide below is a summary of actions required. This does not negate the need
for the document author and others involved in the process to be aware of and follow the detail of this
policy.
1.
Portsmouth Hospitals Trust has a responsibility to ensure patients receive adequate nutrition
to meet their needs.
2. All patients (adults) should be screened for the presence of malnutrition on admission and
their status reviewed regularly throughout their stay.
3. Nutritional care is a multi- disciplinary responsibility. Consideration should be given to dietary
preferences and cultures. Where oral nutrition is compromised consideration should be
placed on the use of nutritional support.
4. All patients should have a nutrition care plan documented following their nutrition screening.
5. Patients requiring a special therapeutic diet, diet of ethnic requirement, altered texture diet or
dietary supplements should have their requirements noted on the care planning document.
6.
Provision of a balanced diet including specialised and ethnic diets is the responsibility of
Carillion, under the guidance of the Trust’s dietitians.
7. The use of protected mealtimes, red tray use and assistance of mealtime helpers are there to
support patient’s nutritional intake.
8. Training opportunities will be made available for all staff responsible for providing patient care
(nursing staff, support staff, medical staff, allied health professionals, soft FM provision,
volunteers)
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(Review date December 2015)
Page 3 of 32
INTRODUCTION
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In England the NHS Plan states that by 2004 all hospitals will have a ’hospital nutrition policy
to improve the outcome of care for patients’.
Nationally approximately 40% of adults and 15% of children admitted to hospital are
undernourished and many others become so during their stay (Stratton et al., 2007; RCP
2002; McWhirter and Pennington 1994, Pirlich et al., 2003).
Malnutrition is a potentially serious complication of illness, which is associated with increased
morbidity, mortality and length of stay in hospitals (Norman et al., 2008)
The importance of eating well and good nutritional support cannot be overestimated.
Delivering food in an appetising manner, at the correct temperature and of an appropriate
consistency, is important.
For people with swallowing difficulties there may also be issues of safety related to eating and
drinking (BAPEN 1994, Espen, 2006, Royal College of Physicians 2002, Edington et al.
2000).
This policy was developed from a need to address the issues of nourishing patients in
hospital, addressing Care Quality Commission, Standards for Better Health, the NHS Plan
and national research.
Estimates of a saving of £26,095 per 100,000 head of population are quoted from the
introduction of screening and treatment of malnourished patients (HSJ, Dec. 09)
1. PURPOSE
1.1 The purpose of this policy is to ensure that all people in hospital or Trust residential settings
receive appropriate nutrition in a form that is acceptable to the individual and meets their nutritional
needs. It is intended to reinforce the importance of nutrition to the health of all patients and staff.
1.2 Nutritional care is a significant factor in the prevention of disease as well as its treatment DoH
(1999); NSF For Older Persons (DoH,2001); Cancer Plan (DoH, 2000); Essence of Care (DoH,
2001); Hungry to be Heard Campaign from Age Concern (2006); Combating Malnutrition BAPEN
(2009) Malnutrition in Community and Hospital Settings (Patients Association, 2011).
1.3 A healthy diet has to fulfill two objectives: it must provide sufficient energy and nutrients to
maintain normal physiological functions, permitting growth and replacement of body tissues; it must
offer the best protection against the risk of or further risk of disease; the maintenance of a healthy
weight and reduce the adverse clinical impact of malnourishment on patients.
2. SCOPE
This policy applies to the nutritional needs of all in-patients within the Trust. It will be followed
by all members of staff involved at any stage of the food chain.
Nutrition is managed at Portsmouth Hospitals through the following structure
Nutrition Policy
(Review date December 2015)
Page 4 of 32
Trust Board
Governance and Quality
Committee
Patient Experience Steering
Group
Nutrition
Group
Steering
Hospital Food Group
‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises
that it may not be possible to adhere to all aspects of this document. In such circumstances,
staff should take advice from their manager and all possible action must be taken to
maintain ongoing patient and staff safety’
3. DEFINITIONS
Nutrition is the supplying or receiving of nourishment
Malnutrition is the broad term used to describe under or over nutrition, dietary imbalance or
nutritional deficiencies.
MUST is the Malnutrition Universal Screening Tool used throughout the Trust to screen for
malnutrition.
CNNs are the clinical nutrition nurses.
SALTs are the speech and language therapists
4. DUTIES AND RESPONSIBILITIES
The executive committee of the Trust is responsible for ensuring delivery of a safe and
nutritious catering service.
The Hospital Food Group and Nutrition Steering Group will provide a report to the patient safety
committee quarterly. The hospital food group will also report to the patient environment and
partnership group monthly, regarding matters pertaining to food service and delivery.
.
Oral Nutrition - General
All health care professionals have a duty to ensure that patients are fed a diet to meet their
nutritional requirements. As such mealtimes should be conducive to eating and appropriate
food provided for individuals. All staff should assist patients in choosing an appropriate diet to
meet their needs (nutritional, behavioural and cultural).
All healthcare professionals have a duty to screen for and treat malnutrition and ensure that the
patient’s basic nutritional needs are met. Once started nutritional treatment should be regularly
reviewed to determine whether it remains appropriate. All healthcare professionals should
assess patients’ dietary preferences and ensure that any special requirements, whether
through food choice, equipment or ability to self feed, are acknowledged and addressed.
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(Review date December 2015)
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Artificial nutrition should not be used in circumstances where life is prolonged only to maintain
an unacceptable quality of life. The decision to commence artificial nutrition should be multi
professional in consultation with the patient and family. Where there is doubt referral to the
Trust’s ethics committee should be considered.
The decision made should take into consideration that artificial nutrition is legally classified as
medical intervention and can therefore be withdrawn (BMA 2000). The outcome of any decision
must be documented in the medical and nursing notes.
Nutritional care is a multi disciplinary responsibility (BAPEN 1994). There is an advisory group
within the Trust who have the responsibility for the development, implementation and reviewing
of standards of nutritional care. This is the Hospital Food Group. Composition of the Hospital
Food Group is set out in Appendix A
Nutrition Support
Nutrition support should be considered in patients who have:
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eaten little or nothing for more than five days or longer or
have a poor absorptive capacity and/or
high nutrient losses and/or
increased nutritional needs from causes such as catabolism
A MUST score of ≥2
All healthcare professionals directly involved in patient care should receive education and training on
nutrition, appropriate to their role at the start of their employment and thereafter in yearly updates.
Nutritional care provided to patients should ensure the provision of:
 adequate quantity and quality of food and fluid in a conducive environment (NICE
2006, Care Quality Commission, 2010)
 appropriate support e.g. modified eating aids, assistance to eat (NICE 2006)
Portsmouth Hospitals Trust adheres to the standards set out in:
 Annual PLACE audit (DoH, 2012)
 CQC outcome 5 (CQC, 2010)
MEDICAL RESPONSIBILITIES
Medical staff are responsible for the diagnosis and management of malnutrition and for the referral
on to other professions. Doctors should lead the team regarding decisions on appropriate feeding,
investigations according to diagnosis and prescription of fluids. Consideration should be placed on
the ethical issues regarding the provision of food and fluid to all patients. In the case of fluids see the
section below under nursing responsibilities.
NURSING RESPONSIBILITIES
ORAL NUTRITION
The responsibility of registered nurses is listed in the nutrition competency listed in Appendix B.
All registered nurses should complete this competency.
Food service should adhere to the guidelines set out in guidelines for food service at ward level listed
in appendix C.
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(Review date December 2015)
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The Trust supports the use of protected mealtimes and the use of red trays in assisting patients to
eat their meals. See Appendix D and G.
Volunteers are trained for the role of mealtime assistants and their tasks are set out in Appendix F.
HYDRATION
All patients will be adequately hydrated. It is the responsibility of the registered nurse and medical
practitioner to:

Ensure that patients are receiving an adequate amount of fluid to maintain hydration.
This may be in the region of 2 litres per day for adults. Requirements may differ
according to height, weight, medical condition and ambient temperature. A minimum
of 7 drinks should be provided daily (6 via soft FM and 1 via nursing staff).

Sufficient oral fluids are placed within reach of the patient
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Ensure drinks are of a suitable temperature i.e. a cup of tea is hot, a supplement drink
is chilled and are in a suitable drinking vessel that the patient is able to manage e.g.
patients with CVA, dementia.

Open tops of bottles etc., and assist the patient in drinking fluids as required.
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Maintain a fluid chart if fluid intake is of concern and report to the nurse in charge.
Ensure measurable amounts are recorded clearly and regularly. Record both intake
and output. Information on the quantity of fluid in various drinking vessels is available
via the dietitian’s intranet page.
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If the patient has swallowing difficulties ensure SALT (Speech & Language Therapy)
recommendations regarding thickened fluids are followed. If the patient declines to
drink thickened fluid this must be recorded in the patient notes. Ensure all staff are
aware of patient needs.

If the medical team are concerned about the patients fluid intake then a red lid can be
applied to the patient’s water jug to alert staff to the need to address fluid intake for
that patient. Each specialty has there own guidelines for the use of red lids on jugs.

It is the responsibility of the nurse to highlight to the medical team the patient who is
unable to take sufficient levels of oral fluids to maintain their hydration or who is NBM
so that alternative methods of fluid administration must be sought and the direction of
the medical team by naso-gastric tube, intravenous fluids or subcutaneous fluids.
Fasting prior to surgery or other intervention / investigation.
The intake of oral fluids during a restricted fasting period
 Intake of water up to two hours before induction of anaesthesia for elective surgery is safe in
healthy adults, and improves patient wellbeing. Other clear fluid (that allows newsprint to be
read through the drink); clear tea and black coffee (without milk) can be taken up to two hours
before induction of anaesthesia in healthy adults.
 Tea and coffee with milk are acceptable up to six hours before induction of anaesthesia.
 The volume of administered fluids does not appear to have an impact on patients’ residual
gastric volume and gastric pH, when compared to a standard fasting regimen. Therefore,
patients may have unlimited amounts of water and other clear fluid up to two hours before
induction of anaesthesia.
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(Review date December 2015)
Page 7 of 32
The intake of solid food during a restricted fasting period.
 A minimum preoperative fasting time of six hours is recommended for food (solids and milk).
Confectionary and sweets are solid food.
Delayed operations
 If an elective operation is delayed, consideration should be given to giving the patient a drink
of water to prevent excessive thirst and dehydration. The two hour rule still applies after this
drink.
 Should an operation or procedure be delayed for 6 hours then the patient should be allowed
at eat and the fasting period recommenced 6 hours before the time of the allotted
intervention. If a meal is not available at that time, then the housekeeper should be asked to
provide a meal or contact the Carillion helpdesk.
 Remember two consecutive days of fasting can mean a patient has missed 5 out of 6 meals.
Emergency surgery/ procedures
Adults undergoing emergency surgery should be treated as if they have a full stomach. If possible,
the patient should follow normal fasting guidance to allow gastric emptying.
Postoperative resumption of oral intake in healthy adults
When ready to drink, patients should be encouraged to do so, providing there are no medical,
surgical or nursing contraindications. Oral food should be provided as appropriate. In between meal
service time contact the ward housekeeper for food provision.
CATERING SERVICE
Responsibilities of the Catering Service (Soft FM services)
Better Hospital Foods Programme (2001), Nuffield Trust Series (1999) and New Principles for
Hospital Food (DoH, 2012) set out the criteria for catering provision for patients. To meet the
requirements of these initiatives the catering department are responsible for ensuring that provision is
made to address the nutritional, social, cultural and religious needs of all patients.
Soft FM provider:
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Will work with Trust health professionals to ensure the provision of appropriate
nutrition for hospital in-patients.
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Are responsible for providing patient meals via a cook-chill meal service.
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Are responsible for ensuring that patients are able to select from a wide choice of
menu items at breakfast, lunch and evening meal services. They must provide a
choice of portion size and meals suitable for all dietary needs, including food of
modified consistency for patients with swallowing difficulties and ethnic meal
requirements.
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Are responsible for ensuring that “Snack bag” meals are available for patients who
miss a meal due to late admission, diagnostic treatment, etc. The snack box will
comprise of a sandwich, fruit, ambient yogurt and biscuit/cake. Out of hours the
sandwich will be replaced by a savoury biscuit and soup sachet.

Ensure temperature of drinks is tolerable and provide 6 drinks per day plus extra
drinks as required.
Nutrition Policy
(Review date December 2015)
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THE DIETETIC SERVICE
Responsibilities of the dietetic service
The dietitian will:
 Respond to appropriate written/electronic referrals where nursing staff have
nutritionally screened and followed the appropriate action plan. Where possible
appropriate urgent referrals will be seen in one working day and routine/non urgent
referrals within 3 working days
 Review and monitor patients and adjust the therapeutic nutritional advice accordingly.
Dietitians will liaise with their community counterparts when patients are to be
discharged, ensuring a seamless service.
 Document an action plan and liaise with other multidisciplinary staff as appropriate.
 Check menus devised by Soft FM services to ensure they meet nutritional needs of
patients, needs of those on special diets etc. Dietitians will work with Soft FM services
on the production of special diet menus specific to individual needs to patients.
 Train staff in the nutritional screening of patients, basic nutrition and the use of special
dietary products.
 Chair the hospital food group and attend the nutrition steering group.
OTHER STAFF GROUPS
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Hospital Food Group - is accountable to the Patient Safety Working Group and the
Patient Environment Partnership Group. The group supports the ‘Hospital Food Chain’
including people, processes and departments throughout the hospital in getting food to
patients. The group works collaboratively with Carillion on matters of food service and acts
in the interests of nutrition from a clinical and an environmental angle.
Nutrition Steering Group– is a management body attended by representatives of
interested parties and members of the nutrition support team. It oversees policies and
guidelines relating to artificial nutrition and is responsible for the development and coordination of nutrition support services working to the Hospital Food Group.
Ward Team – work together to support patient’s nutritional status by highlighting issues
regarding feeding and hydration in relation to the patient’s diagnosis. Should ask the
patient what they would like for their next meal (one meal prior to that meal) and make
sure patients are happy with their meal service. Specialist equipment such as large
handled cutlery, non slip mats, feeder cups should be purchased and provided by the
ward team.
Clinical Nutrition Nurse Specialists – are responsible following a referral for selecting
the most appropriate route of feeding and management of the chosen route. They provide
training to nursing staff on the use of MUST, artificial nutrition and are the liaison between
the hospital food group and the nutrition champions at ward/ unit level. They work closely
with the dietetic service.
Speech and Language Therapists – are responsible following a referral for assessing
oro-motor and pharyngeal musculature and for advising on appropriate food and fluid
textures to ensure the safest possible swallow.
Pharmacists – are responsible for supplying and advising on parenteral nutrition and for
advising on any interactions between nutrients and drugs.
Catering Staff – are responsible for ensuring that balanced meals and special diets are
available to meet patient’s clinical requirements and needs.
Mealtime volunteers – should assist patients who require help in selecting their preferred
meal, cut food and assist in helping people to eat. They should receive training before
beginning this role and regular updates whilst undertaking this role (Appendix F)
Housekeepers - the housekeeper is the conduit between Carillion food delivery and
patients’ food service. They will ensure that orders for special diets, dietary products are
sent to the catering department by 9am each day. They will provide snack bags and /or
toast when patients have missed a meal. Should the food available at meal times not be
suitable for the patient then the housekeeper will find an alternative. Orders for red trays,
Nutrition Policy
(Review date December 2015)
Page 9 of 32
red lids for jugs etc., should be put through the housekeeper. In the absence of the
housekeeper contact should be made through the Carillion helpdesk on:6321
All staff listed, but especially Dietitians, Speech and Language Therapists, Clinical
Nutrition Nurse Specialists have a responsibility to provide education and training to others to
assist all staff to fulfill their role in the provision of good nutrition and the prevention of
malnutrition.
5. PROCESS
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An individual patient assessment of dietary preferences/requirements will take place on
admission and be reviewed every 5 days during the patient’s length of stay.
All patients should be screened on admission for the presence or likelihood of malnutrition
using MUST (adult general wards), Wessex Regional Renal screening tool (Wessex regional
renal unit) or through BMI calculation through pregnancy (maternity).
All patients should be weighed within 24 hours of admission and thereafter every 5 days. If
weighing is not possible a reason must be documented in the notes or an alternate
assessment using mid upper arm circumference can be made to provide a BMI assessment.
The weight should be documented in the medical notes or on Vital Pac.
All patients will be screened for their malnutrition risk score using the MUST screening tool as
part of the nursing documentation within 24 hours of admission or if available the MUST
score should be calculated on the Vital Pac screening page. This should be repeated every 5
days, or as the Vital Pac system dictates. (See Appendix E).
A nutritional care plan will be devised based on the MUST score, using guidance listed on
the screening tool/ Vital Pac. Following screening a care plan should be drawn up using
FLAP (see Appendix E)
If the patient is deteriorating and not responding to the action plan then referral should be
made to the dietitians.
Patients requiring a special therapeutic diet, diet of ethnic requirement, altered texture diet or
dietary supplements should have their requirements noted on the care planning document.
Specific orders for dietary items and special diets etc. should be given to the housekeeper 24
hours in advance wherever possible. These requests should be delivered by the
housekeeper to the catering department daily. Out of hours requests should be made via the
Carillion helpdesk.
Patients will be provided with the necessary equipment and assistance in accordance with
information set out in this policy (see appendix C and D), to ensure that they can receive
adequate nutrition.
Patients requiring artificial feeding including parenteral nutrition will be fed according to the
Trust guidelines (Appendix H)
Patients on the Wessex Regional Renal unit will be screened using the specific screening
tool to highlight malnutrition in their care group. See Appendix E. A nutrition care plan will
be drawn up as directed.
All patients that require assistance with eating should be served their food on a red tray, and
receiving help from clinical staff or trained voluntary staff. (Appendix G)
Patients wishing to have food brought in from their home should be given a copy of ‘Bringing
Food into Hospital’ (Appendix I) in accordance with Appendix C.
6. TRAINING REQUIREMENTS
Training opportunities will be made available for all staff responsible for providing patient care
(nursing staff, support staff, medical staff, allied health professionals, soft FM provision,
volunteers) to include:
Nursing staff and HCSW’s
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(Review date December 2015)
Page 10 of 32
As part of Patient Safety Day, nutrition champion study days, RN induction programme,
preceptorship courses.
Mealtime Volunteers
Specific training provided by dietitians and speech and language therapists.
Medical staff
As part of their induction programme.
7. REFERENCES AND ASSOCIATED DOCUMENTATION
Age Concern (2006) Hungry 2 be heard
(http://www.ageconcern.org.uk/AgeConcern/hungry2bheard_overview.asp)
BAPEN (1994) Nutritional Support in Hospitals (1994). British Association for Parenteral and
Enteral Nutrition. British Association of Parenteral and Enteral Nutrition
BAPEN (2009) Combating Malnutrition: recommendation for action. British Association of
Parenteral and Enteral Nutrition
British Medical Association (2000) Withdrawing and Withholding Life Prolonging Treatment:
Guidance
for
Decision
Making,
2nd
Edition
BMJ
Books
London
(www.bmjpg.com/withwith/ww.htm)
Care Quality Commission (2010) National Standards. http://www.cqc.org.uk/public/nationalstandards
DoH(1999) Not Because They Are Old’ – Health Advisory Service. Department of Health
DoH (2000) NHS Plan, A Plan for Investment, a Plan for Reform. Department of Health
DoH (2000) The NHS Cancer Plan. Department of Health
DoH (2001) Essence of Care, Patient Focused Benchmarking for Health Care Professionals.
Department of Health
DoH(2001) National Service Framework for Older People – Department of Health
DoH
(2012)
New
Principles
for
Hospital
Food
–
Department
of
Health
www.dh.gov.uk/health/2012/10/hospital-food/
Edington J et al (2000) Prevalence of Malnutrition to Four Hospitals in England Clinical
Nutrition (2000) 19(3):191-195
ESPEN. (2006) Dysphagia and Nutritional Management Clin Nutr 25:330-360.
Health Service Journal (2009) Malnutrition costs
McWhirter JP and Pennington CR (1994) Incidence and Recognition of Malnutrition in
Hospital British Medical Journal 308 945-58
NICE (2006) National Institute for Health and Clinical Excellence. Nutrition support in adults:
oral nutrition support, enteral feeding and parenteral nutrition Clinical guideline 32
Norman K et al (2008) Prognositic Impact of Disease–related Malnutrition. Clin. Nutr, 27, 5 15
Nutrition Policy
(Review date December 2015)
Page 11 of 32
Nuffield Trust Series (1999) Managing Nutrition in Hospitals: A Recipe for Quality’ – Nuffield
Trust Series 8
Patients Association (2011) Malnutrition in community and hospital settings
Pirlich M et al. (2003) Prevalence of malnutrition in hospitalized medical patients: impact of
underlying disease Dig Dis. 21, 245- 251.
RCP (2002) Nutrition and Patients A Doctor’s Responsibility. Royal College of Physicians
Stratton RJ., et al. (2007) Malnutrition in Hospital inpatients and outpatients. British Journal of
Nutrition.
Downloadable information.
Essence of Care – Nutrition Available at:
www.cgsupport.nhs.uk/downloads/Essence_of_Care/Evidence_Sources_Nutrition.pdf
Nutrition Support in Adults (NICE guidance) – Available at:
http://www.nice.org.uk/CG32
MUST screening tool Available at:
www.bapen.org.uk/must_tool.html
8. MONITORING COMPLIANCE
PROCEDURAL DOCUMENTS
WITH,
AND
THE
EFFECTIVENESS
OF,
Nutrition screening:
 Monitored by Nutrition champions at ward and unit level. Results held by Clinical
Nutrition Nurse Team.
 Vital Pac nutrition screening held by dietetics and clinical nutrition nurse specialists.
Red Tray monitoring:
 Audit completed yearly
Protected Mealtimes:
 Audit completed yearly
Food hygiene and safety:
 Annual review by Portsmouth City Council Environmental Health
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(Review date December 2015)
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Appendix A
Composition of the Hospital Food Group
Dietetics (chair)
Nursing representatives from all Clinical Service Centres
Provider of soft FM services
Voluntary services
Clinical Nutrition Nurse Specialist
Speech and Language Therapy
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(Review date December 2015)
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Appendix B Nursing Competency
Name:
Competency Statement: Competency Statement: Care of a patients Oral Nutrition
Competency
Indicators
1st Level
After
obtaining
consent from the
patient
(as
appropriate)
a) Understand importance
of and correctly
undertake MUST*
nutrition screening
 Weight
 Height
 BMI
b) Inform HCP of patients’
MUST* score.
c) Provide information to
patients, relatives and
significant others
regarding nutritional
care provided
d) Record information/
intervention accurately
in patients record to
include:
- MUST* score
- Nutrition care
plan
- Food and fluid
charts
Nutrition Policy Issue 5
(Review: December 2015)
Achieved
Assessor
Signature
a)
b)
c)
d)
Competency
Indicators
2nd Level
After
obtaining
consent from the
patient
(as
appropriate)
Level 1+
Interpret information
from MUST* score and
nursing and medical
assessment identifying
risk factors and
nutritional needs in
collaboration with the
relevant HCP
Implement and evaluate
local MUST*
management guidelines
eg First Line Action Plan
(FLAP).
Identifies patients
requiring special and
modified diets,
contributing to ensure
patients needs are met.
Able to provide patient
with appropriate written
resources e.g diet
sheets, special diet
menus.
Page 14 of 32
Achieved
Assessor
Signature
a)
b)
c)
d)
e)
Competency
Indicators
3rd level
After
obtaining
consent from the
patient
(as
appropriate)
Level 1 and 2+
Ensure that all
patients have MUST*
completed and that an
appropriate plan of
care is provided by the
relevant HCP
Ensure that PHT
policies, guidelines
and procedures are
adhered to by staff.
Facilitate MUST*
screening and audit;
develop and
implement action
plans to improve
compliance
Ensure clinical area
has appropriate
resources/equipment
to undertake screening
e.g scales, height
chart.
Ensure clinical area
Achieved
Assessor
Signature
a)
b)
c)
d)
e)
Competency
Indicators
4th level
In collaboration with
other HCP’s i.e
Dietitians, Speech
Therapists, Catering
Undertake and
facilitate audit, set
Trust wide standards,
policies and
procedures for oral
nutrition, based on
expert knowledge,
relevant research and
experience.
Dissemination of
changes in response
to national and
organisational
strategies/priorities.
Lead regular reviews
of equipment in use
and update as required
Act as an expert
resource advising,
teaching and
supporting members of
the Portsmouth NHS
Trust.
Provide formal and
Achieved
Assessor
Signature
- Weight charts
e) Able to order meals,
snacks, beverages,
special diets,
supplements, resources
e.g, special diet menus.
f) Assist in meal provision,
working collaboratively
with ward hostess.
Identify patients
requiring greater
assistance e.g
use of
red tray.
g) Understands the
importance of and
supports the ward with
the implementation of
protected mealtimes :
environment is
conducive to eating and
patient is ready to eat,
e.g handwashing
offered, patient
positioned correctly.,
appropriate utensils
available.
h) Report significant
changes and refer to
relevant HCP.
i) Understands Nutrition
Champion role and is
able to identify Nutrition
Champion, working
proactively to support
Nutrition.
j) Adheres to PHT
policies/guidelines and
procedures relating to
Nutrition Policy
(Review date December 2015)
Involve patient, relative
and significant other,
informing them of plan
and potential outcomes.
f) Recognise when
patients require referral
onto other HCP
including Dietitian,
Speech and Language
Therapist, Diabetes
Nurse Specialist. Able
to action referral
correctly.
g) Participate in multidisciplinary discussion
involving patient,
relative and significant
others, in the ethical
issues regarding
patients nutrition
h) Contributes to discharge
planning process in
relation to patients oral
nutrition.
e)
Optional
i)
Undertake Nutrition
Champion role acting as
ward lead for Nutrition,
representing ward and
disseminating
information to
colleagues, undertake
audit and attend study
days.
Page 15 of 32
has Nutrition
Champions and that
time and resources
are allocated for this
role.
f) Lead multi-disciplinary
discussion involving
patient, relative and
significant others, in
the ethical issues
regarding patients
nutrition.
g) Ensures ward
resources pertaining to
nutrition are available
and up to date.
h) Facilitate learning and
practice development
within clinical area and
ensure staff receive
essential training in
nutrition
i) Raise any issues
relating to oral nutrition
to the Hospital Food
Group via the
appropriate
representative or
attend Hospital Food
Group representing
clinical area.
informal training to
Trust staff .
f) Coordinate and
facilitate the Nutrition
Champion Role
g) Representation on
Hospital Food Group
Nutrition and attends
essential training in
Nutrition.
Optional
k) Undertake Nutrition
Champion role in
association with level 2
Nutrition Champion
* Renal Unit do not use
MUST – substitute with
renal screening tool
MUST – Malnutrition
Universal
Screening
Tool
HCP – Health Care
Professional
Education resources to support your development
1.NHS Core Learning Unit – Food,
Nutrition and Health – accessible
via Moodle
2.Ward Nutrition Champions
3.Nutrition Nurses and Dietitans
4.E.U.P – mandatory training
5.Bi-annual Nutrition Champion
study day
Author: Lesley Gregory/Jo Pratt
Nutrition Policy
(Review date December 2015)
Department: Dietetics/Nutrition Nurses
Page 16 of 32
Review Date: Sept 2013
Record of Achievement.
To verify competence please ensure that you have the appropriate level signed as a record of your achievement in the boxes below.
Level 1
Level 2
Level 3
Level 4
Date
Date
Date
Date
Signature of Educator/ Trainer
Signature of Educator/ Trainer
Signature of Educator/ Trainer
Signature of Educator/ Trainer
Date:
Date:
Date:
Date:
Signature of Assessor
Signature of Assessor
Signature of Assessor
Signature of Assessor
References to Support Competency
1.
2.
3.
4.
5.
6.
7.
8.
Age Concern. (2006).Hungry to be Heard. London.
Council of Europe. (2003). Food and Nutritional Care in Hospitals. (Resolution 12/11/2003).
Great Britain. Department of Health (2004) Standards for Better Health. London.
Great Britain. Department of Health (2001) Essence of Care Benchmarks for Food and Nutrition. London.
Great Britain. Department of Health (2007).Improving Nutritional Care. London
Great Britain. National Institute for Health and Clinical Excellence (2006). Nutrition Support in Adults (Clinical Guideline 32) London : NICE
Great Britain. National Patient Safety Agency. (2007B). Nutritional Screening-Structured Investigation Project. London
Royal College of Nursing. (2007).Nutrition Now. Principles for nutrition and hydration. London.
Nutrition Policy
(Review date December 2015)
Page 17 of 32
Appendix C
Guidelines for Food Service at Ward Level
This policy applies to all staff (all disciplines, job roles) caring for
inpatients within Portsmouth Hospitals Trust
Food hygiene regulations are laid down in the NHS executives ‘Hospital Catering Delivery’ and
conform to statutory regulations.
All staff working in a ward or clinical area involved in provision of any food, drink or dietary
supplement will be classed as food handlers
Access to ward kitchens:
The regeneration kitchen on each ward is an area supervised by Carillion FM services and
access for ward staff is at the discretion of Carillion FM services.
The pantry kitchen in ward areas should allow no access to patients or their visitors.
Food handling:
All staff taking food to a patient should have washed their hands and have clothing protected by
a blue plastic apron.
Beverage production:
Should be undertaken by ward staff when patients have missed routine beverage times or the
late night beverage. Hands should be washed and clothing covered by a plastic apron.
Special Dietary Products:
Should be checked by a trained member of staff, and if the product needs to be decanted,
administered in any way then hands should be washed and clothing covered by a plastic apron.
Food brought in by patients, visitors and staff:
Should be labelled with the name of the recipient and date the food was brought in. Food
should be stored in the refrigerator and discarded after 24 hours. Bringing Food Into Hospital is
a leaflet which sets out guidelines for patients and their relatives. Only low risk foods (biscuits,
sweets) should be kept in the bedside locker.
Refrigerators:
Refrigerators in the beverage area should be checked DAILY by the nurse in charge for
maintenance, temperature, cleanliness and stock rotation. All food dated over 24 hours should
be discarded. All open food should be covered and discarded after 24 hours. Long-life foods
should be discarded at the sell by date. Temperatures of the refrigerator should be listed on
the log sheet and maintained for all staff to see.
Volunteers:
Those helping with food service and assistance in feeding should have received training in food
service/hygiene. Rules of hand-washing and clothing covering still apply.
Meal Distribution:
Carillion staff will inform ward staff when food is ready for service. This will be at the same time
every day. Each ward has a specific time allocated.
Carillion staff will check the temperature of food prior to service and record this temperature.
They will have laid trays with cutlery, napkin etc.
Food will be served from the trolley in a discrete area of the ward by a member of the patients
services team (Carillion). Each patient’s meal request will be provided from the nursing team
and the food plated up accordingly. Where possible the food will be given to the patient
immediately and the patient will be ready for their meal.
Where patients require assistance in feeding foods will be cut up, food delivery etc will be
undertaken.
No meals should be ‘put by’ for patients who are off the ward or unable to eat their meal at the
food service time. Any food not consumed within one hour of meal service should be
discarded.
Nutrition Policy Issue 5
(Review: December 2015)
Page 18 of 32
Snack bags are provided for patients who miss their meals. If a snack bag is unacceptable
(due to texture etc.) the housekeeper will obtain a meal replacement from the catering
department.
Disposal of waste food will be undertaken by the Carillion staff. Out of hours waste food should
be discarded in a black plastic bag.
Food trolleys, beverage trolleys etc should be cleaned by Carillion staff.
Nutrition Policy
(Review date December 2015)
Page 19 of 32
Appendix D
Protected Mealtimes: Guideline
Protected Mealtimes are a period of time over breakfast, lunch and supper when all nonurgent clinical activity stops. All essential and urgent activity will be met.
This guideline is for all staff both ward based and those visiting wards. It should be the
aim of all nursing, support staff and housekeeping staff to ensure the ward is ready for
mealtimes.
Core aims:
 To encourage anything that supports and assists patients to eat.

To plan activities to ensure that nursing and support staff are available to assist at
mealtimes.

To ensure that patients eat their meal is the responsibility of the whole healthcare
team.

To discourage anything that interferes with the meal time.

As such each ward area should:
Establish changes in practices e.g. times of ward rounds, visiting times, etc.

Obtain agreement with all regular ward visitors e.g. allied health professionals, porters,
etc., that interruptions will be minimal at mealtimes

Agree a start date when the ward will observe a protected mealtime policy

Provide information for patients, relatives, staff and other departments

Patient Area:
Remind visitors and healthcare staff that patients are easily distracted from their meal and
find being watched whilst eating off-putting. Those patients where visitors, carers are
available at mealtimes they should support the patient in finishing their meal.

A quiet and relaxed atmosphere should be created by closing the ward entrance doors and
the door to the day room. If patients are using the day room to eat their meal then ensure the
room is welcoming, clean and tidy.

Reduce the noise from any unnecessary equipment e.g. cleaning equipment, radio and
television.

Ensure notices are displayed to inform everyone visiting the ward of the protected mealtime
policy and the time of the main meals.

To ensure that patients needs are met, staff should organise themselves at the beginning of
the mealtime to establish who will answer patient call buttons, telephones and assist in food
service.

Make sure that the patient is ready to eat, offer the patient the opportunity to use the toilet
before eating and washing hands in preparation for eating and remember to repeat the
process after meals.

Make sure that the environment encourages eating, clearing the bed tray to make space for
the patient’s meal, removing items to prevent distraction.
Nutrition Policy
(Review date December 2015)
Page 20 of 32

Providing assistance in cutting food, pouring drinks, removing wrappers etc.

For those patients who require help in eating this should be undertaken by a qualified
member of staff.

Patients who are eating poorly, who require help in eating, cutting food etc., should have their
meals placed on a red tray.

All staff should make sure that patients are able to consume their meal.
Provision of food:

Housekeeping staff should inform nursing staff when they are ready to serve meals.

Nursing staff should be available at the meal trolley to accept food for individual patients

Use of the red tray should be dictated by nursing staff

Discourage visiting during mealtimes unless visitors are able to help patients eat their meals.
Nutrition Policy
(Review date December 2015)
Page 21 of 32
Appendix E
Screening Tools
MUST (Screening Tool) see page 23 & 24. MUST is also available on Vital Pac for those areas that use it.
Wessex Renal and Transplant Service Nutrition Screening Tool see page 25.
First Line Action Plan (FLAP) – Nutrition care plan see page 27.
Nutrition Policy Issue 5
(Review: December 2015)
Page 22 of 32
Nutrition Policy
(Review date December 2015)
Page 23 of 32
Nutrition Policy Issue 5
(Review: December 2015)
Page 24 of 32
WESSEX RENAL & TRANSPLANT SERVICE NUTRITION SCREENING TOOL
(NST)
Nutritional Screening should be completed for all patients, on admission to
hospital and then every five days.
Please score your patient (from 1-4) according to each of the following criteria and total. Depending
on the score your patient will be classified as having low, medium or high risk of malnutrition. Once
you have classified your patient you should follow the recommendations on the following page to
ensure their nutritional needs are being met.
Date and Time of Completion: / / ……
Date Re-screening Due:
/
/
Medical Condition
Score
Post major surgery (including post transplant surgery), severe infection,
multiple injuries, burns >15%, pressure sores, ulcers, delayed wound healing,
severe pain
Cancer, gastrointestinal disease, unstable dialysis patients, conditions
affecting food intake, long bone fractures, burns<15%, numerous
periods/greater than 24 hours NBM, acute renal failure
Post minor surgery, moderate infection e.g. UTI, chest infection, unstable
diabetes, stable dialysis patients.
Non-dialysis patients with uncomplicated medical conditions e.g. asthma, MI,
CVA with no interruption in food intake.
4
3
2
1
Dietary Intake
TPN, enteral feeding such as NG/NJ/PEG, nil by mouth, refuses meals and/or
drinks
Leaves most meals, reluctant to drink
Eats only small meals/snacks, modified consistency
Eats most meals
4
3
2
1
Ability to Eat
Unable to take food and/or fluids orally
Chewing and swallowing difficulties
Requires help to be fed, cutting & transferring food to mouth (e.g. poor
eyesight)
Able to eat and/or drink independently
4
3
2
1
Gut Function
Severe diarrhoea over previous 48 hours (more than 4 episodes/day)
and/or vomiting, gut not functioning
Diarrhoea over previous 48 hours (4 or less episodes/day) and/or vomiting,
constipation or impaction
Feels nauseous
Normal gut functioning
4
3
2
1
Mental Condition
4
3
2
1
Comatose
Confused, depressed, uncooperative with eating
Apathetic, mildly confused
Alert, orientated, cooperative
Weight
Emaciated
Underweight, dehydrated, oedematous, flesh weight loss of more than 3.5kg in
last 2 months
Flesh weight loss of less than 3.5kg in last 2 months
Usual weight and stable
Name:
Signature:
Designation:
Score:
Please circle the relevant classification from the options below:
Nutrition Policy
(Review date December 2015)
Page 25 of 32
Total
4
3
2
1
Low Risk = 6-7












Moderate risk = 8-12
High risk = 13+
Once you have scored your patient you should follow the relevant care plan
detailed below:
LOW RISK
Monitor weight.
Provide appropriate menus dependent on dietary requirements, e.g.
diabetic, low potassium if level >5.5 or usually follows, high protein
etc.
Monitor oral intake and any reasons this may be limited.
Re-screen in five days.
MODERATE RISK
Monitor weight.
Provide appropriate menus dependent on dietary requirements as
per ‘low risk’.
Ensure food record charts are accurately completed including
quantities of meals eaten.
Provide assistance with menu completion and encourage between
meals snacks.
Provide help with eating and drinking as required.
Ensure dentures are used if applicable.
If patient is not finishing meals please offer two supplement drinks
per day – Fresubin Energy, ProvideXtra, Fortisip Yogurt-style,
hospital milkshakes. This applies to all patients (ARF/HD/PD/Tx)
except pre-dialysis – please discuss these with the Dietitian.
Re-screen in five days.
HIGH RISK
 Follow the steps for moderate risk.
 Refer to Dietitian – details as below.
 Re-screen in five days.





Flap
The following patients should be referred to the Dietitian
regardless of Nutrition Screening Score:
Patients requiring enteral feeding – NG/NJ/PEG etc.
Patients requiring parenteral feeding – TPN etc.
New HD/PD/Tx patients.
Pre-dialysis patients requiring specialised supplementation or advice.
Patients who require supplements or dietary advice for home.
Referral to the Dietitians:
Please leave a message with patient details and reason for
referral on ext. 1014 or bleep your allocated ward Dietitian.
Please note this tool is adapted from the Frimley Park NHS Trust Nutrition Screening Tool.
Nutrition Policy
(Review date December 2015)
Page 26 of 32
First Line Action Plan advice from Dietitian
Please document receipt of this fax in your medical notes entry and file this faxed
record in the patient’s medical notes/bed end notes
Patient Name:
Number:
DOB:
Hospital
The above patient was referred to a dietitian on ________and on discussion with a staff nurse over
the telephone, the following advice was deemed appropriate. Please convert advice into a Care
Plan for Patient.
NOTE: The advice given below is general as the Dietitian has not reviewed the patient’s
medical notes.
 Commence Food & Fluid Charts
(Please use a Red Tray for this patient at mealtimes).
 Encourage high energy ‘H’ options from the menu
 Offer High Protein Diet



2 x puddings with meals

Additional sandwiches with meals

Build-Up Soup at lunchtime
Fresubin Cremes x2 per day
1 pint Full Fat Milk Daily
 Offer patient’s nutritional supplements if deemed appropriate
by patients medical team (see ward poster)
 Weigh patient and complete ‘MUST’ every 5-7 days
Current weight:
__Current MUST Score:
_
 If patient has history of poor intake/severe weight loss/weighs <40kg
please refer to PHT Refeeding Syndrome Guidelines (see pharmacy
intranet home page  medicines information 
Follow up:
Drug therapy guidelines)
 Unless re-referred for tube feeding/further advice, this patient will
NOT be followed up by the Dietitians
Appendix F
Nutrition Policy
(Review date December 2015)
Page 27 of 32
Guideline for mealtime volunteers











Any patient requiring assistance in selecting food, cutting up, unwrapping food, loading
forks or spoons and helping to transfer food and drink to the mouth will be identified by
the Nurse in Charge at each visit. Any special instructions will be given with an
opportunity for the Volunteer to clarify ie if the patient is on a food and fluid chart or
requires a special therapeutic diet.
Exclusions :- Patients with high risk of choking
Patients being nursed in a side room or any patient being barrier nursed
The patient should be introduced and verbally consent to being helped to eat by a
volunteer ensuring that the concepts of dignity and privacy are maintained at all times.
If the patient lacks ability to verbally consent, then other means should be sought by the
registered nurse to ensure that they are aware that they are to receive assistance with
their food as it is in their best interests to receive nutrition.
The volunteer when attending the ward at mealtimes must wear a specific tabard with
‘Mealtime Volunteer’ embroidered upon and cover with a blue plastic apron as per Trust
infection control policy. Patients will be offered hand washing and volunteers will meet
food and hand hygiene regulations throughout their visit.
The volunteer will introduce themselves, ask the patient if they would like to wash their
hands prior to their meal, or assist in providing a hand wipe for this purpose.
The volunteer will check that the patients has dentures in place and is wearing glasses
and hearing aid if appropriate.
The volunteer will receive the meal from the nursing staff for the patient then sit on a
chair beside the patient to be assisted and discuss the patients preferences for eating
prior to starting, including whether to use a fork or spoon, plastic or metal, use of
condiments etc.
The assistance can be in the form of preparing food to eat, cutting up, uncovering food
plates as well as physically feeding the patient, as some patients prefer to actually feed
themselves if they are able. Offering fluids as required. To assist at a level deemed
appropriate. Older patients with delirium and dementia should be offered fluids in a cup
rather than a beaker with a spout, as this will assist their recall of the mechanism of
drinking. However, they should not be left alone with hot drinks in case of spillage. Some
people with delirium and dementia may find it difficult to remember what to do with
utensils and may prefer ‘finger foods’
Assistance with completion of their menu may also be helpful.
Give verbal handover to Nurse in Charge on completion of the meal. To ensure that the
nursing staff are aware of the dietary intake of the patient involved, in addition to
recording on intake sheet if required.
Nutrition Policy
(Review date December 2015)
Page 28 of 32
Appendix G
Red trays are a means to highlight patient’s who either need help with managing their diet, or who are not eating
well and their total food intake needs to be monitored.
RED TRAY GUIDELINES
Patient admitted/change in condition
↓
Consider if red tray is appropriate?
Food Record Chart
Patient unable to feed themselves/reduced ability to eat
Risk of malnutrition (MUST>2)
↓
Patient and relatives informed if patient falls into a high nutritional risk category
↓
Identify those patients requiring a red tray according to ward’s protocol
(For example red square/T on ward notice board)
↓
Nursing staff checks the whiteboard to see who requires a red tray and ticks box on patient
selection form
↓
Suitable meal served on red tray
↓
Those with red trays will
a) Require assistance with feeding
b) Will require monitoring of intake
↓
Check to see if food record chart completed before removing red tray
↓
Red tray status reviewed daily
MUST score <2
Food Record Chart discontinued
Patient able to feed themselves
↓
On discharge if still at risk notify dietitians for follow up at home
Nutrition Policy
(Review date December 2015)
Page 29 of 32
Appendix H
Clinical policies aligned to this policy:
Available in the Clinical Policies section of the Intranet:

POLICY FOR THE PROVISION AND MANAGEMENT OF PARENTERAL NUTRITION IN ADULTS IN
HOSPITAL

PHT POLICY FOR THE INSERTION AND MAINTENANCE OF FINE BORE NASO-GASTRIC
FEEDING TUBES IN ADULTS

ENTERAL TUBE ADMINISTRATION POLICY (ADULTS)
Within the Pharmacy homepage guidelines on the management of re-feeding syndrome
http://pharmweb/publications/guidelines/Refeeding%20Syndrome%20Guideline.pdf
And the management of parenteral nutrition when pharmacy is closed
http://pharmweb/publications/parenteralnutritionguidelines.pdf
Nutrition Policy
(Review date December 2015)
Page 30 of 32
Appendix I
List of suitable foods to bring into
hospital
Squash, fizzy drinks, bottled water,
fruit juice, milk shakes.
Yoghurt style drinks (bring in
individual container to be consumed
immediately during your visit)
Drinks not routinely stocked on ward e.g.,
favourite bedtime drink, Bovril, Marmite, Cupa-Soup, Hot soup (brought in a vacuum flask
for immediate consumption)
Do not bring to
hospital the
following
Chilled
drinks
requiring refrigeration,
unless
previously
agreed with ward
nursing staff. Chilled
drinks
can
be
purchased from the
hospital
vending
machines and cafes.
What foods may I bring in?
Fresh fruit (washed)
Biscuits, cakes, crackers, savoury
biscuits, crisps and other snacks
Cereal bars, instant noodle pots,
sweets, and chocolate – all should
be kept in a lidded container or
individually packaged.
Individual
long-life
desserts/yoghurts/
milk
puddings/custard/jelly
e.g. Ambrosia, supermarket own
brand, Hartley’s, Dole, individual
ring-pull cans of tinned fruit e.g. Del
Monte Fruitini, Dole fruit parfait
Savoury snacks e.g. sandwiches,
sausage rolls, Scotch egg – should
all be individually wrapped and
consumed straight away.
Nutrition Policy Issue 5
(Review: December 2015)
Page 31 of 32
Loose items of fruit in
bags, uncovered fruit
bowls
Loose and unwrapped
biscuits,
cakes,
sweets etc – on locker
in open packets.
Chilled
snacks
requiring refrigeration,
unless
previously
agreed with ward
nursing staff*.
Specialist Support
If you require this leaflet in another language, large print or
another format, please contact the Health Information Centre
Tel: (023) 9228 6757, who will advise you.
Everybody likes having snacks and drinks available to them when
they are in hospital. This advice sheet aims to give you ideas on
which are the ‘safest foods’ to bring into a hospital ward
environment.
When you are unwell your ability to fight infection is reduced and it
is especially important that the foods you eat as a patient in
hospital are safe. In order to reduce these risks, it is essential that
all foods consumed on the ward are eaten as soon as possible or
are stored safely as well as bringing pleasure to you as a patient to
help your treatment and recovery.
Generally, foods, which can be stored at room temperature
and do not require refrigeration, are the best option.
Perishable foods e.g. sandwiches or chilled desserts that
need to be stored in a fridge,
should be consumed
straight away or taken away with your visitor.





All foods kept in the bedside locker should be stored in an airtight
container such as a lidded plastic box or biscuit tin e.g. fruit,
biscuits, sweets. Food items that are already in a sealed package
are a good idea, as they are safe in the ward environment. For
example:
Individual packs of biscuits
Wrapped chocolate biscuits
Individually wrapped cakes
Sealed bags of prepared fruit
Long-life yogurts and desserts
The following foods are high risk and particularly prone to
food spoilage and contamination. Please do not bring these
and other similar foods in:
 Home-cooked meals and takeaway meals kept warm during
transit, or requiring reheating on the ward
 Items containing high-risk foods such as, shellfish, lightly cooked
egg, un-pasteurised cheese.
Nutrition Policy
(Review date December 2015)
Page 32 of 32
Hot meals, prepared at home, and take-away meals, cannot be
safely re-heated on the ward. It is also unwise to try to keep a hot
meal warm during the journey to hospital, as they are unlikely to be
maintained at a sufficiently high temperature to avoid bacteria
multiplying. Hot soup may be brought in, in a vacuum flask for
immediate consumption during your visit. It should be consumed
within 4 hours. Please take away flasks and containers with you at
the end of your visit.
If you wish to bring in chilled foods that require refrigeration on the
ward, you must discuss this first with the nursing staff. Staff are not
allowed to heat food in the microwave.
Any items requiring refrigeration need to be labelled with the
patient’s name and date by the nursing staff before being stored in
the ward fridge. The nursing staff will also take responsibility to
check use-by dates and discard any that are out of date or
damaged.
* Items that have been agreed with the nursing staff and are held in
the ward refrigerator will be labelled with the individuals name and
date the item was brought in. Please note that all items will be
destroyed after 24 hours.
Probiotic Drinks
These small often yogurt based drinks should be taken with caution
whilst you are in hospital. If you regularly take them whilst at
home, you should check with your ward staff as to your suitability
for them when on certain medications and treatments. They
require refrigeration and as such should only be brought in to the
hospital in agreement with ward staff.
How to comment about the hospital
We aim to provide the best possible service and staff will be happy
to answer your questions. However, if you have any concerns you
can also contact the Patient Experience Service on 0800 917 6039
or E-mail [email protected]
Author: Members of the Hospital Food Committee: Reviewed: 2011/12
Review: August 2013: Ref: HFC/01: MPI ref: 07/1274
Portsmouth Hospitals NHS Trust