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).
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