Maura Buchanan

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Maura Buchanan
President Royal College of Nursing
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Alison Kitson
Executive Director - Nursing Royal College of
Nursing
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Water for Health
Nick Ellins Facilitator of the Water for Health
Alliance Head of Consumer Strategy for Water UK
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The Water for Health Alliance

• Water UK
• Alcohol Focus Scotland
• Action on Elder Abuse
• British Medical Association
• Chartered Institute of Environmental Health
• Consumer Council for Water
• Developing Patient Partnerships
• Drinking Water Inspectorate
• Drinking Water Inspectorate - Northern Ireland
• Drinking Water Quality Regulator Scotland
• English Community Care Association
• ERIC (Enuresis Charity)
• Focus On Food
• Health Education Trust
• Healthy Schools
• Hospital Caterers Association
• Kidney Research

• Local Authority Caterers Association
• Men's Health Forum
• National Association of Care Catering
• National Care Association
• National Governors' Council
• National Heart Forum
• The National Kidney Research Fund
• Patients Association
• Royal Institute of Public Health
• Royal College of Nursing
• The Royal Society for the Promotion of Health
• Schools Health Education Unit
• Stirling University (Dementia Unit)
• TOAST (Obesity Awareness Trust)
• Unison
• United Kingdom Public Health Association
• WRVS
• WaterAid
• Waterwatch Scotland

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Water is a basic nutrient of the human body,
critical to human lifeWorld Health
Organization - Water, Sanitation and Health
Guidance
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• Thirst 4 Life
• A sister at Stoke Mandeville Hospital, AE
  Department, audited AE attendances at Stoke
  Mandeville Hospital.
• Over 30 of elderly people attending AE were
  there because of a dehydration related illness.
• Training was given to professionals caring for
  older people by Tissue Viability Nurses, District
  Nurses and allied Health Professionals.
• Additionally AE nurses used teaching techniques
  to recognise the early stages of dehydration in
  older people as well as ways to stop it
  happening.
• Training led to a 45 reduction in AE attendance
  at Wycombe General Hospital from nursing and
  residential homes between November 2004 and March
  2005.
• http//www.buckscc.gov.uk/thirst4life/project.htm

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Experience of carers to date

• Improved sleep patterns
• Increased consumption of food
• Less soiling incidents
• Reduced confusion
• More energy
• Reduced use of laxatives

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Nick Ellins nellins_at_water.org.uk Website -
www.waterforhealth.org.uk
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Nutrition and Patient Safety
Caroline Lecko Nutrition Lead National Patient
Safety Agency (NPSA)
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Patient Safety the facts

• The NPSA has identified nutrition as a patient
  safety issue
• Over 900 patient safety incidents relating to
  nutrition have been analysed
• Key themes have been identified from the analysis
• These themes have implications for all care
  settings and all patient groups

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Nutrition Patient Safety Themes

• Dehydration
• Choking
• Nil by Mouth prolonged periods of time
• Nil by Mouth patients fed

• Inappropriate diet and fluids
• Incorrect artificial nutrition
• Transfer of care
• Lack of assessment
• Lack of equipment

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Key Themes

• Dehydration
• Intravenous fluids prescribed but not
  administered
• Patients transferred from care homes
• Patients not offered or provided with hydration
  in AE
• Nil by Mouth prolonged periods of time
• Patients fasted prior to surgery/procedure
• Patients waiting for specialist review

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Key Themes

• Choking
• Patients being given inappropriate diets and
  fluids
• Lack of awareness of at risk patient groups
• Lack of assessment
• Patients nutritional status and requirements not
  assessed on admission to hospital or into
  community care
• Lack of access to specialists out of hours

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Improving Patient Safety

• - What can nurses do to improve the safety of
  their patients nutritional care?
• - 1 simple step
• Introduce the Council of Europe Alliance 10 Key
  Characteristics of good nutritional care
• The NPSA fully endorses this piece of work

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The nurses role in patient safety

• Recognise nutrition as an important part of
  clinical care
• Recognise that a missed meal is as important as
  missed medication
• Recognise that poor nutritional care has the
  potential to cause harm
• The delivery of safe nutritional care in all
  care settings has the potential to stop headlines
  like

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Thank you for listening!caroline.lecko_at_npsa.nhs.
uk
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Food For Thought
Jayne Quigley Head of Nursing Leadership
Development Raising Nutritional Awareness
St Georges NHS Healthcare
Trust
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Our Journey.

• What spurred us into action?
• What did we see?
• What did we do?
• What have we achieved?
• Lessons learned
• Next steps

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What spurred us into action.

• RCN Clinical Leadership Programme
• Observations of Care
• Patient Stories

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What did we see?

• Meal times were not treated as a priority. Wards
  busy and noisy, Drs rounds and drug rounds going
  on, people
• Patients not prepared /positioned appropriately
  prior to meal
• Ward hostesses responsible for serving food and
  removing trays, very little monitoring of intake
  by nurses. Uneaten food removed ? Supplement
  offered
• Trays placed at wrong side of patient so unable
  to reach food Nurses not available to assist
• Tray left outside curtains whilst patient on
  commode
• Toilet rolls and urinals on bed tables whilst
  patient eating
• Domestic changing bed curtains whilst patient
  eating
• Patient struggling to open a sandwich
• All courses served at once and second helpings
  were rarely offered
• Patchy completion and reviewing of Nutritional
  Screening Tool

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Our Aim

• To provide an environment that allows patients to
  eat their meals without unnecessary interruptions
  and to enable the nursing staff to focus on
  providing assistance to patients and monitor
  their food intake.

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What did we do?

• PROMT MDT Working Group, guidelines, pilot wards
  and roll out
• MDT approach Nursing, Dietetics and Facilities
• Visits to other hospitals re menu choice and food
  provision
• Recruited and trained volunteers
• Revised Nutritional Screening Tool
• Training from Dieticians
• Nutrition Strategy Group

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What have we achieved?

• Collaborative working
• PROMT policy and Trust roll out
• Reduced food wastage in fully compliant areas
• Increased understanding of benefits of PROMT
• Regular input from volunteers
• New catering contract
• Specialist diets for renal, cardiac and
  paediatrics
• 3 different textures of soft diet
• Extensive ethnic menu including 2nd generation
  Halal
• Extra snacks for the elderly
• Improved snack boxes for maternity

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Lessons Learned..

• Support from the Board and Executive Team is
  crucial. Communicate trust wide as it affects
  everybody and you need to get them on board from
  the start
• The Ward Sister/Charge Nurse is pivotal in making
  it work, modelling is very powerful
• A MDT approach is essential from the startits
  everybodys responsibility and we all have a role
  to play
• The Ward team needs regular support and feedback
  and monitoring of food wastage is a good measure
  of success
• Observations of Care pre and post implementation
  is very effective
• Catering and Facilities were included from the
  outset and are excellent champions

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Next Steps

• PROMT becomes part of every ward routine
• Improved Nutritional Screening
• Stakeholder event May 2007
• Increase number of volunteers
• Roll out to the evening meal service
• Exploring Protected Cleaning..

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And Finally

• The message were sending out across the
  organisation re the importance of Protected
  Mealtimes and promoting nutrition is
• Its not rocket science, its common sense
• Its cost neutral
• It improves patient satisfaction with their
  overall experience
• It improves nurse satisfaction i.e. its about
  being with the patient
• It really does make a difference