Outcome 6. Safe and effective care - food, fluid and nutrition
The status of people with dementia is maintained or improved and appropriate food, fluid and nutrition is provided in a way that meets their individual needs. Ensuring the care for all people meets the NHS Quality Improvement Scotland Clinical Standards for Food, Fluid and Nutritional Care in Hospitals.
Boards are using a range of tools to assess patients' nutritional levels and needs, including the Malnutrition Universal Screening Tool (MUST), LanQIP audits for food and nutrition, and the Food, Fluid & Nutrition Clinical Quality Indicators. Fluid and nutrition charts are used as appropriate and patients' weights are regularly recorded. Dietician and speech and language therapy services are widely available, and mealtimes are monitored and protected - indeed, NHS Lanarkshire has been involved in the national Making Meals Matter programme.
An example of a comprehensive nutritional assessment process is found in NHS Grampian. All patients are assessed on admission using the MUST tool and a three-day total intake chart is commenced, allowing staff to identify appetite, food preferences and any swallowing difficulties that can be referred for speech and language therapy assessment. A food preference sheet is completed on admission, including specific dietary requirements and specialised equipment necessary to support nutritional intake. Carers may be involved in this process to ensure a comprehensive assessment is achieved, and the occupational therapist is included if any appropriate needs are identified. Personalised assessments and interventions are recorded in the nursing notes and individualised care plans are created.
MUST scores are reviewed weekly and appropriate actions taken. Patients with a high score are referred to the dietetics service and a further three-day total intake chart is commenced. Medication and general physical health is reviewed by the multidisciplinary team and care planned accordingly.
Food has always featured highly on the agenda of NHS Borders. The units in the board have a long history of supplementing foods of choice for patients: if patients do not wish food they had previously ordered, other choices, including finger-foods, are always available. As is the case across the boards, carers are encouraged to work with ward staff to maintain how patients prefer to dine, and nutrition champions or nutrition link nurses are in place. In NHS Lothian and NHS Tayside, nursing and care intentional rounding has a focus on food and fluids.
NHS Dumfries & Galloway and NHS Lothian are among the boards that provide special crockery and cutlery to aid patients and present picture menus to enhance choice. Most boards make provision for wards to be able to provide a range of food and fluids outwith mealtimes.
Each clinical area in NHS Ayrshire & Arran has been provided with a standardised nutrition folder consisting of food and fluid charts and information on required supplements and snacks, diet and fluid consistency, and type of diet required. The aim is to create an "at-a-glance" nutritional information guide for the multidisciplinary team to ensure appropriate delivery of individualised nutritional care. This is supported by information-sharing sessions with the Dementia Nurse Consultant that enable the cascade of research data and lessons learned from research projects in relation to nutritional intake for patients in the later stages of dementia. A food hygiene module is also available on LearnPro, which is completed by all inpatient staff as part of their personal development plans.
NHS Lanarkshire has taken forward work focusing on hydration, with guidance on completing fluid balance charts developed and distributed to all wards. Fluid balance charts were reviewed and updated in line with the national Hydration Framework. Flow charts that indicate the need for fluid balance monitoring have been introduced and a mental health version agreed. Visual prompts have been introduced to highlight patients on fluid balance monitoring and posters have been developed to provide information to staff on the volume of the various drinking vessels used in ward areas.
A multidisciplinary group with representation across care groups has been evaluating dysphagia management in NHS Forth Valley. The group has developed a clinical care standard, reviewed current practice and developed or updated resources, and is developing a LearnPro module plan for dysphagia management.
Overall strategic approaches to food, fluid and nutrition emerge at high levels in boards. In NHS Greater Glasgow & Clyde, for instance, the Partnership Food, Fluid and Nutrition Operational Group is chaired by the Nurse Director Partnerships. The work plan is operationalised by the Mental Health Services Food, Fluid and Nutrition Group, which is co-chaired by a senior nurse and the Lead Dietician. The other boards, including NHS Lanarkshire and NHS Forth Valley, have food, fluid and nutritional care steering groups or equivalent bodies in place, backed up by clear local policies and standards.
Email: Ian Roxburgh
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