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Inspection report

Date of Inspection: 15 March and 13 April 2011
Date of Publication: 6 June 2011
Inspection Report published 6 June 2011 PDF

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Food and drink should meet people's individual dietary needs (outcome 5)

Meeting this standard

We checked that people who use this service

  • Are supported to have adequate nutrition and hydration.

How this check was done

Our judgement

People who use services are usually well supported to have adequate nutrition and hydration. However, care plans do not always identify how risks of poor nutrition and hydration are managed and there may be a delay in obtaining specialist advice and techniques when needed, which mean that personalised care is not always provided.

User experience

Patients and relatives told us the food was usually good with plenty of choice and help with eating when needed. Some patients did not realise snacks were also available between meals, but they told us if they have to miss a meal due to tests or treatment, staff check if they would like something before the next meal.

At lunch time, food was heated up on the ward and carried on individual trays to patients by their beds, so that it was served hot. Staff told us patients have the option to eat in the dining rooms, but this only happens occasionally when relatives visit. Most patients were sitting in chairs by their beds and were offered napkins to protect their clothing. Adapted cutlery was available; some patients had plate guards, non-slip mats, or cups with lids and drinking spouts to prevent food and drink spillage. The food portions appeared appropriate and most patients seemed to enjoy their meal and ate well. People were offered alternatives if they did not like part of the meal or had little appetite.

The main course was served first and then dessert options were taken round on a trolley. We saw staff supporting people to eat and drink when needed. We observed a health care assistant feeding a patient sensitively and patiently. She used appropriate verbal and non-verbal communication, and involved the patient as much as possible. Staff were attentive to people’s needs and asked if they would like help moving into a more comfortable sitting position, or placing a napkin on their lap. We saw drinks being topped up on request. There were plenty of staff to help, for example one ward had seven staff assisting nine patients. We saw staff checking patients had eaten enough and had finished. After the meal, patients were made comfortable and helped to wipe their hands with sanitising wipes. Health care assistants checked everyone had finished and the food and fluid charts had been completed, before wiping down the tables.

Other evidence

The wards had several strategies in place to ensure patients’ nutritional needs were met. Coloured stars above patients’ beds and on wall charts identify different nutritional needs such as whether a food intake needs recording (pink star) or if the patient has diabetes (yellow star). Meals were served on red trays to patients who require assistance with feeding or who are at nutritional risk. This is a way of alerting care staff to ensure support is given and/or a food and fluid chart is completed after every meal. There were “protected meal times” at lunch and tea, which means that patients are not disturbed during their meals by unnecessary clinical and non-clinical interruptions. Care staff did not take breaks during this time and were on duty to support patients with eating and drinking, in a quiet environment. Only visitors who are assisting a relative with their meal were able to go on the ward for this purpose. We observed lunch time on two wards and saw the protected meal time and red tray policies being adhered to.

Patients were assessed on admission using the Malnutrition Universal Screening Tool (MUST). This helps identify patients who are malnourished, at risk of malnutrition or obese, and includes management guidelines that can be used to develop a care plan. It was introduced at the end of 2010 and staff told us they find it very beneficial. Doctors may also take blood tests, for example to identify dehydration or nutritional problems. A patient’s weight is recorded weekly or more frequently if requested by their doctor. Staff told us they add notes on nutritional needs to the handover sheet so that patients’ care needs are highlighted at shift handovers.

Each ward has an occupational therapist (OT) who may assist with feeding support. A physiotherapist told us she liaises with staff when a patient’s joint or balance problems, such as from arthritis or a stroke, might affect eating and drinking. Patients may be referred to Speech and Language Therapy (SALT) for swallowing assessments or Dietetics for specialist advice, both based at King’s Mill Hospital in Sutton-in-Ashfield. Several staff told us there can be unacceptable delays in accessing these services, from several days to more than a week.

The ward staff reported various training in nutrition, with link nurses and the housekeeper playing key roles in attending trust meetings and cascading information to the rest of the ward staff. The housekeeper on one ward told us she has attended training on MUST, swallowing and stroke awareness, and accesses information on the trust intranet. She has tasted all the food and supplements so that she can discuss them with patients. Trust records show that training in MUST was provided last year for five staff nurses but we do not know where in the hospital these nurses work. The trust also supplied us with information that five staff nurses received training in nasogastric feeding (in which a thin tube is passed down the nose into the stomach so that patients can be given nutritional support) during 2010. Most of the ward staff told us they had not had further training in nutritional care since induction and some felt they were not adequately trained to meet patients’ needs, especially when patients may have to wait several days for SALT or dietetics assessment and intervention.

The hospital achieved high scores in Patient Environment Action Team inspections of nutritional services in early 2010 and March 2011. Each ward has a nutrition link nurse who carries out audits of nutritional care. Recent ward audits in line with the Department of Health’s Essence of Care benchmarks for food and nutrition found appealing food, good availability of food, and nutritional screening usually in place. There were lower scores for an acceptable eating environment, planning and implementing nutritional care, and encouraging patients in healthy eating.

We looked at six patients’ case notes and found that some did not link clinical f