Essence of Care Food and Nutrition

1
Essence of CareFood and Nutrition

• Simon Fisher
• Rowena Chilvers
• February 2009

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Essence of Care

• The NHS Modernisation Agency (2001) produced
  patient focused benchmarks for clinical
  governance
• NICE Guidelines drawn together health care
  providers (Hospital/GP DN/OOH Ambulance etc.) via
  the Cancer networks
• Further developments from Care Quality Commission
  towards integration

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Why Food and Nutrition?

• There is no clear communications link between the
  hospice catering service / multi-disciplinary
  team in terms of the requirement for nutrition
  for patients.
• Anecdotally we know patients meals can be
  interrupted (visitors, ward rounds) it is easy
  for our patients to be put off their food.

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What we have done so far

• Obtained funding from FoNS
• Linked with Nutrition Group Help the Hospices
• Conducted an EoC Nutrition Audit
• Preliminary Literature Search
• Aims and Objectives

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The Audit

• There are 4 tools that make up the complete
  package.
• We have adapted these to our environment and
  client group.
• Information from patient records
• Nurse questionnaire
• Patient questionnaire
• Ward information

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Results conducive environment

• Patients one identified a problem (noisy
  trolley)
• Observations drug/Drs rounds/ visitors. Eating
  areas not always cleared. Wet wipes etc. not
  always available
• Toileting (?falls) not offered
• Food was always in reach, dentures sorted out,
  condiments provided and utensils appropriate.

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Results providing assistance

• There were no problems with providing assistance
• It was not clear from the nurse questionnaires
  who had responsibility for providing assistance
• Possibly volunteer/catering/nurse/HCA roles could
  be more clearly defined

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Results obtaining and providing food

• There is a long gap between the evening meal (5
  6pm) and breakfast
• Delivery of meals, snacks, drinks etc. could be
  more clearly defined
• Patients not told of availability of snacks
• Seven drinks a day one patient counted them out
  to the interviewer

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Results Presentation and food quality

• Patients pleased according to British perspective
  (1 patient from the continent gave 5/10!)
• Food temperature who does this? (one hospice
  had a hot trolley from kitchen to bedside)
• Extra meals were not at patients initiative

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Results promoting health - nutritional
assessment

• Patient interest in dietary advice minimal (none
  wanted a dietary leaflet 1/14 wanted advice)
• Food record chart and record of food consumption
  different across sites.
• Concerns are documented and supplements provided,
  preferences considered and nausea treated
• No validated Assessment form used but 3/5 in one
  hospice were informally assessed

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Implications informed by the Nutrition Group HtH

• Patients do not know they can ask for a snack
  (not in the Patient Guide)
• How do we expect patients to manage without a
  meal (or snack?) for 13 hours?
• And
• No Nutritional Policy
• No Nutritional Group

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Aims and Objectives

• To define what nutrition means to the quality
  of life of the patient.
• To provide evidence of improved quality in the
  documentation (nutrition assessment)
• To compare and identify the needs of patients at
  the end of life with those with a longer
  prognosis and consider the implications in terms
  of nutrition assessment

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What next?

• Complete a literature review
• Conduct research (Ethics approval)
• Conduct Focus Groups (as the main part of the
  research)
• Poster for National Conferences with H the H
  nutrition group?

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Acknowledgements

• Dr Eleni Tsiompanou and the Food Nutritional
  Group at Help the Hospices
• Kate Sanders and The Foundation of Nursing
  Studies
• Website www.fons.org/ahcp_funding.asp

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References

• Department of Health (2008) End of Life Care
  Strategy promoting high quality care for all
  adults at the end of life. London Department of
  Health.
• Food and Nutrition (Essence of Care) Audit Tool
  (2006). East Kent Hospitals NHS Trust.
• National Institute for Clinical Excellence (2004)
  Improving Supportive and Palliative Care for
  Adults. London Department of Health.
• National Institute for Clinical Excellence (2006)
  Nutrition support in adults London Department of
  Health