Posted tagged ‘social’

Esential Standards Outcome 5c – Nutrition

February 29, 2012

 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?

 

 

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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

What CQC outcomes say about Eating and nutritional care:

February 15, 2012

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).