Esential Standards Outcome 5c – Nutrition

Posted February 29, 2012 by TeeJay Dowe
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 Promote rights and choices

5C Where the service provides food and drink, people who use services can make decisions about their food and drink because they:

 

●● Have accessible information about meals and the arrangements for mealtimes.

 

●● Have a choice for each meal that takes account of their individual preferences and needs, including their religious and cultural requirements.

Do your menu’s offer the client a choice in meal or dictate what they will have?

Are there vegetarian, vegan or halal choices as appropriate for  someone?

Do you have clients with special diets that require them to be nut-free, gluten-free, lactose-free etc.?  

 

●● Have access to snacks and drinks throughout the day and night.

 

●● Have mealtimes that are reasonably spaced and at appropriate times, taking account of reasonable requests including their religious or cultural requirements.  

Meal times are perhaps easier to plan for and accommodate in residential and nursing care than within domicilary care. Never the less, the client should be eating at times that are reasonably spaced and should have an idea of when those times are. Particulary relevent at the moment are religious and cultural requirements as we go into a fasting time for many muslims for Ramadan. 

 

●● Have information on what constitutes a balanced diet to help them make an informed decision about the type, and amount, of food they need to address any risk of poor nutrition and/or dehydration.

 This information is equally relevent and important for the care team as well as the clients themselves. All too often we hear that carer’s preparing food for client’s that is not well balanced because they do not understand what a balanced food intake is either. 

 

Here’s some useful information about healthy eating and malnutrition taken from the leaflet produced by Leeds NHS:-

 

What is malnutrition?
Malnutrition is when a person is not eating enough of the right foods. This means they don’t get all the nutrients, such as proteins,
vitamins and minerals, they need.
Being malnourished can make you ill as your body does not work as well as usual. Being ill can also lead to malnutrition as this often
results in poor eating habits. Malnutrition is not just something which happens as you age. It is important that you don’t dismiss the signs as being a part of ‘old age’. There is much that can be done to
help prevent malnutrition. The key is to ensure that the underlying causes are assessed.


Who is at high risk?
· those with reduced mobility which affects shopping / cooking;
· if you are housebound;
· if you are living alone;
· if you are showing symptoms of depression; and
· those with dementia.


Dental / mouth problems can cause malnutrition because they can make eating difficult and painful -

Spotting the signs and symptoms:
· losing weight unintentionally;
· eating/ drinking less than usual;
· experiencing any choking or swallowing problems;
· constipation or diarrhoea;
· unable to keep warm;
· loss of muscle;
· dizziness (prone to falls);
· difficulties recovering from illness;
· pressure ulcers, dry skin;
· recurrent infections;
· difficulties chewing or swallowing; and
· sore mouth, or tongue, bleeding or swollen gums. 

 

What to do if you are concerned?
You can help prevent malnutrition in yourself or others:
· recognising the early warning signs;
· supporting access to both social and health services;
· planning visits around mealtimes to get a sense of what you / they are eating and if you / they have any difficulties eating;
· sitting down and eating socially with friends or relatives;
· having a look in the fridge or cupboards. A lackof food, too much of the same foods or foods past their sell by date may signal a problem;
· encouraging extra snacks and drinks; and
· keeping active, as it stimulates an appetite and maintains muscle mass.


How can you improve access to food?
· Sharing meals with others / going to relatives or informal carers.
· Attending local cafes / pub lunches /visiting voluntary, community or faith organisations with luncheon clubs.
· Using private shopping services and / or meal preparation services.
· Using online supermarket home delivery services (including frozen meals).

 

Well worth sharing some of this information with your care teams. Maybe copy and paste the bullet points where useful as reminders for staff. How many of thier suggestions could you  adopt or adapt to meet  the needs of the people you look after?

 

 

What CQC outcomes say about Eating and nutritional care pt 2

Posted February 22, 2012 by TeeJay Dowe
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What CQC outcomes say about Eating and nutritional care:

 

What should people who use services

experience?

 

People who use services:

  • Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:

  • Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrtion and hydration
  • Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally
    balanced and supports their health.

Prompts for all providers to consider
The following prompts relate to all registered providers where they prepare,
or support people who use services to prepare, food and drink. The term
‘provide’ means the preparation of food and drink and includes where the
service gives support to people to eat and drink. The food and drink used may
be purchased either by the provider or by the person using the service. These
prompts do not cover the administration of artificial hydration which may be
essential to maintain hydration.

Moving on this week to Outcome 5B

 

5B Where the service provides food and drink, but not when this is in the
person’s own home or Shared Lives arrangement, people have their care,
treatment and support needs met because:
●● A nutritional screening is carried out to identify where they are at risk of
poor nutrition or dehydration when they first begin to use the service and
at regular intervals.

Include nutritional screening as part of the initial assessment process, so difficulties are identified right away and support can be arranged immediately.

This idea can be used in different settings - so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice at Caterham Dene Community Hospital, where all patients are nutritionally screened on admission as part of the assessment process, using the Malnutrition Universal Screening Tool (MUST) (328kb PDF file). This was included in the newsletter Nutrition part 2

This screening immediately identifies any difficulties a patient may have so that appropriate support can be arranged through the dietitian. All meals are supervised by the nursing staff, and the hospital is due to implement protected mealtimes to ensure that mealtimes are uninterrupted and that those with specific needs are easily identified.

For further information contact Eileen Clark, Service Manager. Tel 01737 214846. Email eileen.clark@eastsurrey-pct.nhs.uk.
●● Where a full nutritional assessment is necessary because the nutritional
screening identified risk of poor nutrition and dehydration, this is carried
out by staff with the appropriate skills, qualifications and experience.
●● They have their food and drink intake monitored when they are at risk of
poor nutrition or dehydration and action is taken as necessary.
●● They are not expected to wait for the next meal if their care, treatment and
support means they missed a planned mealtime.

Motivate and encourage people to cook

Support people with gaining the skills and confidence to make simple meals for themselves.

This idea can be used in different settings - so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Leicestershire Home Care Assessment and Reablement Team (HART). This is a specialist team that undertakes a six-week assessment and reablement programme with people who are newly referred for Home Care. The assessment can include observation of nutritional wellbeing (weight/body condition), diet and cooking skills as well as all other daily living tasks.

The team has had success in motivating people to start cooking again or develop the confidence to use equipment such as microwaves. For example, an ex-miner had never made himself a cup of tea or cooked a meal. When his wife died his family thought that would be unable to cope and were considering residential care for him. The HART team went in and encouraged him to use the kettle and the microwave and to make himself simple meals – starting with beans on toast. They encouraged him to go out and he now has his main meal in a local café, he is coping well, to the surprise and delight of his family. HART withdrew as he is now independent.

For further information contact claire.harrison@royalberkshire.nhs.uk
●● The person can choose a balanced diet that is relevant to them as an
individual, taking account of their nutritional status and previous wishes.

Encourage kitchen staff to listen to people’s individual preferences

Ensure that kitchen staff and volunteers engage with people to get feedback on the quality of the food and people’s needs and choices.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

 

For example, this idea has been put into practice by the Hospice of St Francis. The aim was to deliver personalised, quality, home cooked, nutritious meals for all patients, enhancing the mealtime experience.

The chef was able to demonstrate knowledge of food relating to different illnesses such as diabetes and wheat intolerance. The chef and volunteers meet with people and meal plan to ensure that they understand people’s needs and preferences. The volunteers listen to the cues, such as ‘the meat was lovely, but slightly salty’ and feedback to the chef.

The concept of a chef leaving the kitchen to discuss food in the patient’s individual bedroom and then go back to the kitchen to prepare food caused concerns about infection control. Issues were resolved through detailed discussions and training with the infection control team.

Confidentiality was also an issue. The education team at the hospice organised a training package for the chef and the team of volunteers so that they could understand the importance of confidentiality.

 

Use pictorial menus to help communicate food choices


Use menus with photographs of the food and titles in large print. This can help people with a range of communication difficulties to understand the choices on offer. This idea can be used in different settings - so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by the Royal Berkshire Hospital, which has developed a set of pictorial menus with photographs, food symbols, and the food name written in large print. There is additional information describing special food types such as puree and easy chew diets and thickened drinks.

This resource can improve meal choices of patients with communication or sensory difficulties, dementia and people who do not speak English as a first language. Consequently, their nutritional status is improved. Staff found they had to spend less time ascertaining patient choices using the new menus and 95 per cent of patients surveyed said they found the menu helpful.

Food symbols were sourced from: www.mayer-johnson.com

For further information contact claire.harrison@royalberkshire.nhs.uk

What CQC outcomes say about Eating and nutritional care:

Posted February 15, 2012 by TeeJay Dowe
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A reminder from last time….. 

What CQC outcomes say about Eating and nutritional care:

 

What should people who use services

experience?

 

People who use services:

  • Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:

  • Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrtion and hydration
  • Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally
    balanced and supports their health.

Prompts for all providers to consider
The following prompts relate to all registered providers where they prepare,
or support people who use services to prepare, food and drink. The term
‘provide’ means the preparation of food and drink and includes where the
service gives support to people to eat and drink. The food and drink used may
be purchased either by the provider or by the person using the service. These
prompts do not cover the administration of artificial hydration which may be
essential to maintain hydration.

Outcome 5A had so much to think about we split it it down further so here is the rest of 5A to explore further…….

5A Where the service provides food and drink, people who use services
have their care, treatment and support needs met because:

●● They have food and drink that:
– are handled, stored, prepared and delivered in a way that meets the
requirements of the Food Safety Act 1990
– are presented in an appetising way to encourage enjoyment
– are provided in an environment that respects their dignity
– meet the requirements of their diverse needs
– take account of any dietary intolerances they may have.
●● They can be confident that staff will support them to meet their eating and
drinking needs with sensitivity and respect for their dignity and ability.

Here’s a suggestion from Social Care Institute for Excellence…

Use a ‘discreet sign’ for people who need assistance with meals

Use a discreet signal to indicate that someone needs assistance with eating, for example a different coloured tray. This saves people the embarrassment of having to ask, or of being asked, if they need help.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice in hospitals, where using a red tray provides an effective signal to staff without compromising the patient’s dignity. The system is being monitored and refined, but has been found helpful in promoting individual care.

A daily updated list of patients due to receive food on red trays can be included in shift handovers and provided for kitchen staff. A red tray is also a simple reminder to staff to check the patient’s notes for guidance on any specific help or nutritional needs. In several hospitals, the red tray system has been linked with protected mealtimes.
●● They are enabled to eat their food and drink as independently as possible.

There are lots of eating and drinking independent living aids available that will really support this type of independence.

●● All assistance necessary is provided to ensure they actually eat and drink,
where they want to but are unable to do so independently.

Use the ‘knife and fork’ symbol 

Placing a knife and fork symbol near someone’s bed is an easy way to help staff identify which people need support during mealtimes.

This idea can be used in different settings – so seeing how someone else has done it can be useful to you, even if they work in a different area of care.

For example, this idea has been put into practice by United Bristol Healthcare NHS Trust.
●● They have supportive equipment available to them that allows them to eat
and drink independently, wherever needed.
●● They are helped into an appropriate position that allows them to eat and
drink safely, wherever needed.
●● They are not interrupted during mealtimes unless they wish to be or an
emergency situation arises.
●● They will have any special diets or dietary supplements that their needs
require arranged on the advice of an appropriately qualified or experienced
person.
●● They have access to specialist advice and techniques for receiving nutrition
where their needs require it.
●● The service takes into account relevant guidance, including that from the
Care Quality Commission’s Schedule of Applicable Publications (see
appendix B).

Essential Standards Outcome 5 Nutritional Standards

Posted February 8, 2012 by TeeJay Dowe
Categories: achieve, actions, diet, dieting, eating, energy, essential standards, feeling, fill, food, health, nutrition, weight, weight loss

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What CQC outcomes say about Eating and nutritional care

What should people who use services

experience?

 

People who use services:

  • Are supported to have adequate nutrition and hydration.

This is because providers who comply with the regulations will:

  • Reduce the risk of poor nutrition and dehydration by encouraging and supporting people to receive adequate nutrtion and hydration
  • Provide choices of food and drink for people to meet their diverse needs, making sure the food and drink they provide is nutritionally
    balanced and supports their health.

Prompts for all providers to consider
The following prompts relate to all registered providers where they prepare,
or support people who use services to prepare, food and drink. The term
‘provide’ means the preparation of food and drink and includes where the
service gives support to people to eat and drink. The food and drink used may
be purchased either by the provider or by the person using the service. These
prompts do not cover the administration of artificial hydration which may be
essential to maintain hydration.

I thought it might be useful to go through the sections of the outcome individually over the coming weeks so here is section  5A

Ensure personalised care by providing adequate nutrition,
hydration and support

5A Where the service provides food and drink, people who use services
have their care, treatment and support needs met because:

  • Staff identify where the person who uses services is at risk of poor nutrition, dehydration or has swallowing difficulties, when they first begin
    to use the service and as their needs change.

  • Action is taken where any risk of poor nutrition or dehydration is identified
    including any difficulty in swallowing or the impact of any medicines, and a
    referral is made to appropriate services.
  • They know that their medical dietary and hydration requirements are identified and reviewed.
  • Their plan of care includes how any identified risks will be managed.
  • Relevant staff know what a balanced diet is.

 

All the food we eat can be divided into five groups. In a healthy diet you eat the right balance of these groups.

They are:

  • Fruit and vegetables.
  • Starchy foods, such as rice, pasta, bread and potatoes. Choose wholegrain varieties whenever you can.
  • Meat, fish, eggs and beans.
  • Milk and dairy foods.
  • Foods containing fat and sugar.

Most people in the UK eat too much fat, sugar and salt, and not enough fruit, vegetables and fibre.

To maintain a healthy diet, the eatwell plate shows you how much of what you eat should come from each food group.

Posted February 3, 2012 by TeeJay Dowe
Categories: actions, actionsresults, dieting, energy, feeling, habit, health, mood, practice, weight loss

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What CQC outcomes say about Eating and nutritional careselection of fruit

The outcome that relates to eating and nutritional care is:

Outcome 5: Meeting nutritional needs - Requires services that provide food to ensure:

  • a choice of suitable and nutritious food and hydration, in sufficient quantities to meet people’s needs
  • food and hydration provision meets any reasonable requirements arising from a person’s religious or cultural background
  • support, where necessary, for the purposes of enabling people to eat and drink sufficient amounts for their needs.

Regulation 14 of the Health and Social Care Act 2008

So here are some interesting facts from the Social Care Institute for Excellence

Eating and nutritional care and dignity – key points from policy and research

  • Food, nutrition and mealtimes are a high priority for older people and a top priority for older people from black and minority ethnic groups (PRIAE/Help the Aged, 2001).
  • Malnutrition affects over 10 per cent of older people (British Association for Parenteral and Enteral Nutrition, 2006).
  • Between 19 and 30 per cent of all people admitted to hospitals, care homes or mental health units are at risk of malnutrition (British Association for Parenteral and Enteral Nutrition 2007).
  • The UK Home Care Association estimates that up to 90,000 people who receive home care services could be at risk of malnutrition (Grove, 2008).
  • Public expenditure on disease-related malnutrition in the UK in 2007 has been estimated at in excess of £13 billion per annum (Elia.M, Russell, C.A. Combating Malnutrition – Recommendations for Action BAPEN 2009)
  • Malnourished patients stay in hospital longer, are three times as likely to develop complications during surgery, and have a higher mortality rate (Age Concern, 2006; BBC, 2006).
  • The needs of people from black and minority ethnic groups, including ‘basics such as food’ are not always met by mainstream services (PRIAE/Help the Aged, 2001; Afshar et al, 2002).
  • Key points in bringing about a culture change in food, nutrition and mealtimes are: good leadership, staff induction and training and adequate staffing levels (Commission for Social Care Inspection, 2006).
  • The NHS Standards for Better Health requires healthcare organisations to ensure that patients have a choice of food that is prepared safely and provides a balanced diet; and that ‘individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day’ (Department of Health, 2004e).
  • In February 2006 the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care launched clinical guidance to help the NHS identify patients who are malnourished or at risk of malnutrition.
  • The NHS Essence of Care benchmarks for food and nutrition include attention to nutritional assessment, the environment, presentation of food and appropriate assistance (Department of Health, 2003c). These can be used by care homes, as well as healthcare providers, to benchmark services.

Hydration

  • The evidence suggests that good hydration can help prevent falls, constipation, pressure sores, kidney stones, blood pressure problems and headaches (Ellins, 2006).
  • Poor hydration has been shown to contribute to obesity, depression, inactivity and fatigue and to prolong healing and recovery (Ellins, 2006).
  • There is some evidence to suggest that dehydration can increase mortality in stroke patients and prolong hospital stays for patients with community-acquired pneumonia (Water UK, 2005).
  • For some older people the sensation of feeling thirsty may be impaired and may not be an accurate indicator for good hydration (Kenney et al, 2001; Caroline Walker Trust Expert Working Group on Nutritional Guidelines for Food Prepared for Older People, 2004) particularly for people who have had a stroke and those with dementia (Albert et al, 1994; Water UK, 2005).
  • Following a study of four care homes, Anglian Water has launched the Health on Tap campaign (Anglian Water, 2008) to improve hydration for older people in care homes. The key findings of the study were:
    • Availability, visibility and reminders were some of the key factors to drinking more water.
    • After a regime was introduced and a water cooler installed, anecdotal evidence from one home reported: a 50 per cent reduction in falls; a greater than 50 per cent reduction in the number of residents taking laxatives; and a decrease in GP call-outs and urinary infections.
    • There were language barriers for some staff, with 50 per cent not having English as a first language.
    • Hydration does not feature as a specific training topic in its own right.
    • Residents’ fear of increased toilet trips was the main barrier to drinking more water (the report states: ‘Once the bladder had adjusted and was able to hold more volume, toilet trips soon settled down to pre-trial levels.’)
    • Peer-to-peer learning, rather than formal training, plays a large role in the knowledge and working habits of staff.
    • Knowledgeable and committed managers generate positive results.
    • Visual and mental impairments were a problem for many residents, with a high dependency on care staff to instigate water intake.
    • Staff said they would like promotional materials for themselves, residents and their families, to remind them of the importance of hydration.
    • The ability to spread and share good practice was seen as very important
      (Anglian Water, 2008).

Who can do that for you?

Posted December 4, 2009 by TeeJay Dowe
Categories: achieve, achievement, actions, feeling, goal setting, goals, stuff, think

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Here’s a little observation….and I think that it’s more noticable at this time of year as we rush into the busy festive season.

We get so caught up in what we have to accomplish today,we write the list and never seem to get to the bottom of it cos we keep thinking of stuff to add on :-P and we never seem to have a minute to spare or a minute to think……chance woud be a fine thing! Some days we feel as though we hardly get a moment to breathe let alone anything else.

And then there are those of us who, as if we didn’t have enough to do, we go and set goals……dream bigger dreams….and so we should….and now we have to fit those into the plan for today too. And as if that’s not enough….well it’s coming up to Christmas and there’s dinners to go to and parties to attend and there’s presents to think about and then to shop for…and we need to plan who’s going where this year and is it my turn to entertan…what will we eat? drink? do?????

Phew! There’s such a lot to get done and so little time.

And then the feeling of overwhelm sets in….followed by panic…..followed by stress and fatigue and when the Day finally arrives you’re too exhausted to enjoy it….or you get the dreaded bug!

Blast!

How would it be if you could just stop…..just for a moment or two….and re-think this whole thing?

Ask a better question……

Who else could help me with this?

Just because they are you To Do’s or Goals…..doesn’t mean that YOU have to be the one who does everything to make them happen. If there was someone else who could do that thing for you…who would it be? How would I ask…..do I have to go shopping or could I do it on-line and have it delivered?

Hmm……You still get to enjoy the achievement – without the stress?

How would that feel differently?

So go through your list and delegate or find another way that would save you running around like mad……ask a better question :-)

You’ll be glad that you did!

What is Confidence?

Posted August 6, 2009 by TeeJay Dowe
Categories: achieve, actions, body language, business, career, communication, confidence, create, dreams, empowering, feeling, goals, grow, imagine, learning, relationship, results

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How would that extra confidence feel?

How would that extra confidence feel?

Confidence, we all talk about it, we all have it and we all generally would like more of at certain times in our lives, but what actually is it?

Quite simply, confidence is just a set of skills that can be learned by anyone to give them the feeling that they can succeed in any given situation or circumstance.  That’s Great News!  Why? Because it means that we can all learn to have more whenever we need it, it’s not genetic, it’s nothing to do with how much money we have, it’s nothing to do with upbringing, it’s not for a select group – it’s there for us all!!! Hooray!!

Very often we are confident in some areas of our lives and not others for example you might be confident at home with your family but not so confident in meetings with those above you at work, you might be confident in your job but not good at making friends easily, you may be confident with your friends but not in dealing with children.  In order to learn the skills we need it’s useful to identify which specific areas do you lack confidence and why and how would life be different if you had more confidence in this area? So go ahead and answer these questions for yourself right now.

What areas of my life do I lack confidence in?

Why?

How would it be different if I had more confidence in this area of my life?

Congratulations! You have just begun the process of being more confident by taking the first steps in identifying what can be improved and importantly why you want to improve it.  So for your chosen situation can you think of someone that you know or have seen who has the kind of confidence that you would like in that situation? Write down their name andCB022665 then list what you admire about them in that situation? How do they walk, stand, breathe, speak, what is their body language, what questions do they ask, what sort of words do they use? Imagine what it’s like to be them. If you have the opportunity, why not ask them? One of the best things to do to learn to be confident is to model someone who is already great at it. Ask them if they are always confident, chances are they feel a little nervous at times too, they just do it anyway and that’s the key. Confident people still feel a bit scared – they are just prepared to give it a go anyway.  That’s good news for the rest of us J We’ll look at some of the other ways to help us just do it anyway in future articles. For now, just take the actions above and you’re well on your way to a more confident you.


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