Posted tagged ‘hygeine’

What CQC outcomes say about Eating and nutritional care pt 2

February 22, 2012

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