Food, Fluid and Nutrition. Q.I.S Q.I.S. Embraces several quality and patient focussed organisations...

Food, Fluid Food, Fluid and and

NutritionNutrition

Q.I.SQ.I.S.

• Embraces several quality and patient focussed organisations in to one

• National standards of care are set for various groups e.g. Elderly in acute care, various cancer sites, Chronic conditions e.g. Diabetes, renal.

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Boards are Boards are auditedaudited

A report is produced

• Commending good practice • Making recommendations for improvement- challenges

Standards are re -audited 2 – 3 years later to monitor compliance and improvements

Scope of standard, embraces many aspects of patient care

Patients who can eat and drink normally meeting their needs

Patients who can eat and drink but don’t meet their needs

Food, Fluid and Food, Fluid and Nutrition Nutrition StandardStandard

Patients who need supplementary drinks to meet their nutritional requirements.

Patients who need enteral tube feeding to meet their needs.

Patients who require Total Parenteral feeding as the gut is unavailable.

Organisational Policy

Care Planning

Staff Training

Support for Patient

Patient choice

Screening

Patient

Whose business is Whose business is it?it?• Caterer

• Doctor

• Dietitian

• Nurse

• Patient

• Pharmacist

• Porter

Research studies have shown that malnourished patients continue to lose weight if not identified and treated, the consequences are as follows:-• Weight loss and muscle loss

Lack of energy

Reduced immunity to infection

Poor wound healing

Longer hospital stay

• To improve the nutritional care of all patients it is essential to identify where problems exist.

• All patients should be screened as near to admission time as possible, ideally within 24 hours of admission or at the earliest opportunity.

Please circle only one score in each section RESCORE

Date

BODY WEIGHTNormal [no recent weight changes]Recent unintentional weight loss [<6Kgs]Underweight / weight loss >6Kgs

035

035

035

035

035

APPETITEGood – finishing three meals per dayReduced – leaving quarter meals and fluidsPoor – leaving half meals and fluidsLittle or no appetite, refusing or unable to eat/drink

0235

0235

0235

0235

0235

ABILITY TO EAT AND DRINKNo difficulties, eating and drinking independentlyRequires assistance with eating and drinkingDifficulty swallowing and/or chewing

025

025

025

025

025

SKIN CONDITIONHealthySore red pressure areasSuperficial breaks in pressure areasMultiple deep pressure sores

0245

0245

0245

0245

0245

GUT FUNCTIONNormalPersistent NauseaNausea + / or occasional vomiting + / or some diarrhoea / constipationDiarrhoea > 3 per day / unable to keep food or fluids down

0235

0235

0235

0235

0235

MEDICAL CONDITIONNo impairment to food intakeMinor surgery / mild infectionMajor surgery [Esp. G.I. Tract] / G.I. Disease / CVA / Chronic illnessSever infection / Sepsis / Cancer / Burns > 15% / Multiple injuries

0245

0245

0245

0245

0245

TOTAL [REFER TO ACTION PLAN* SCORE 10 + REFER TO DIETITIAN

IF YOU FEEL THAT YOUR PATIENT REQUIRES A SPECIAL DIET DESPITE THE SCORE, PLEASE CONTACT THE DIETIIAN

*during latter stages of palliative treatment weighing of patients to assess nutritional status may not be appropriate as weight loss may be as a result of the under lying disease

Date Weight Score Date seen by Dietitian Refer to Dietetic Care Plan

Beatson Oncology Centre:Refer to Medium Risk

Flow Chart

Beatson Oncology Centre:Refer to High

Risk Flow Chart

LOWRISK0 - 5

MEDIUMRISK6 - 9

HIGHRISK10+

Encourage normal dietCheck weight and re-screen weekly. Re-assess if condition changes

Commence 3 Day Food Record Chart.Check weight twice weekly.

Re-assess after 3 Days.

Intake / weight increasing Intake / weight not increasing

Continue to encourage oral diet Refer to dietitian

Refer to Dietitian and Medical Staff

Assessment Screening and Care Planning.

Screening of all patients at admission to ensure that they can eat and drink. Assessment of nutritional status of patients

• Height/Weight calculating Body Mass Index

• Weight change

• Ability to eat and drink [physical]

• Skin condition [related to pressure sore prevention]

• Gut function e.g. malabsorption, nausea, sickness, diarrhoea

• Stress from disease e.g. surgery, infection, multiple injuries,

burns

Development of action plan and multi-disciplinary care plans involving referral to specialist services e.g. Dietetics, OT, SALT, Dentist

This should identify problems.

Direct to a care plan.

Instigate a care plan .

Encourage on- going monitoring

(regular weighing)

ScreeninScreeningg

Planning and Delivery of Food and Fluids.

• Patient menus are nutritionally analysed

• Normal nutritional needs are met from the hospital

menu

• Patients are given the opportunity to choose meals*

• Set mealtimes and importance of mealtimes

• Staff are available to help patients eat

• Local arrangements in place and everyone is aware

of how to access food if a patient misses a meal

*Require interpretation at local site, as systems vary

Provision of Food and fluid to patients.

• Meal choice is available and patients given

help to choose

• Portion size

• Temperature

• Patient satisfaction

•Require interpretation at local site, as

systems vary

Communication between wards, patient and staff is essential for success.

This should be ideally available before admission or in a pack available in the ward

•How to order meals

•Meal and snack times choices available

•Out of hours meals • Food brought in

• Food storage and labels

• Special equipment

• How to comment

Education and Training for Staff.

• Specific roles e.g Diabetes, renal, Intensive care

• Screening

• PACE for Care Assistants – Nutritional care of

elderly patients

• PACE training for trained nurses Nutritional care

hospitalised patients see training notice board

• Food Handling Training

• Complex nutrition for MDT

• Nurse, Pharmacist, Dietitian and Medical staff

National training programmes are available.

• To improve nutritional care of all

patients

• Screen all patients

• Formulate care plans to meet their

nutritional needs

• Meet their nutritional needs with choice

• Improve communication

• Develop training

Aims of Standard