A Review of the Cup of Tea cycle... Raising the multiple issues linked to preventable dehydration in elderly care By Naomi Campbell RGN Hydration Lead (secondment) Innovator & lead of Cornwall Hydration Project A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012

Why focus on the Cup of Tea? To keep it simple! then we can ALL understand the challenges we face in tackling the problem of dehydration in elderly care Cornwall Hydration Project Supporting Oral Hydration Care Systems (SOHCS ™)

How much does a person need to drink to avoid the onset of dehydration ? Evidence from across the globe supports a minimum daily volume of 1,600mls This is the equivalent of 8 standard drinks © 2012 Naomi Campbell 'Cornwall Hydration Innovation Project' So why is that dehydration is such a huge problem? Drinks are regularly handed out!

The Tea Trolley... A familiar sight in most care settings 6 x a day 7 days a week 365 days a year A review of ‘ The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012

The Tea Trolley A review of ‘ The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Six cups of tea a day = approx 75% recommended daily intake of 1600mls needed to prevent the onset of dehydration

But how much is poured down the drain every day? & why is it poured away?

The fact is... we simply don’t know how much our patients are actually drinking! “Failure to accurately monitor how much elderly people are drinking – is a root cause of avoidable dehydration” A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012

Weakness in system processes that support effective fluid management Inadequate staff knowledge and competence in effective management of volume assessment leading to over or under hydration within the overall context of holistic clinical assessment and care of the patient Insufficient governance of the accountability for effective fluid management Adult Intelligent Fluid Management Bundle – NHS East of England 2011 Cornwall Hydration Project - Naomi Campbell © 2012

AKI can occur in all medical settings AKI affects 1:5 people admitted to hospital as an emergency & many elderly patients 1/3 rd are considered avoidable but to achieve this MONITORING of fluids must become part of regular care Cornwall Hydration Project - Naomi Campbell © 2012 Approx cost to NHS £500 million Inadequate Hydration is one of the main causes of Acute Kidney Injury (AKI) NHS Kidney Care June 2012

© 2012 Naomi Campbell 'Cornwall Hydration Innovation Project' 200 ml ml 200 ml 200 ml 200 ml 200 ml = 1200ml in most care settings patients are offered on average 6 cups of tea per day e.g. If all the cups are drunk = 75% Daily fluid intake goal The Reality is often much less... How much are our patients actually drinking? Failure to daily monitor and respond to poor fluid intake = the gradual onset of dehydration

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Existing methods of recording oral fluids is ‘notoriously inaccurate’ Finding new practical and effective monitoring systems is essential We need to think differently!

Chronic dehydration develops over time... Every day matters A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012

© 2012 Naomi Campbell 'Cornwall Hydration Innovation Project' 50 yrs on... the same amount of time is needed at the bed side

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Poor staffing levels are a known risk factor for dehydration But Little is known about how much help a vulnerable elderly person needs to drink

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 How much help is needed to drink & eat? How much time is needed to drink & eat Providing evidence to support essential basic care Improving accountability at all levels Recognising work load staffing demands Skill mix Cornwall Hydration Project - is developing a ‘Tool’ to help evidence how much help a patient needs to drink & eat

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Patient admitted No Dehydration risk assessment tool Risks not clearly identified Patient offered a cup of tea No valid ‘needs’ assessment tool to identify level of help to drink Patient May OR may not have had enough help to drink cup cleared away Who / How / When / Where? monitors how much has been drunk? Inconsistent outcome of care – risk of dehydration The cup of Tea cycle Highlights the gaps in the systems & processess gap 1 gap 2 Gap 3

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Community care Hospital care Primary care Home Where do you fit into the Cup of Tea Cycle? What is your role? How can you help to improve the systems & processes that provide our elderly with essential drinks Encouraging & helping vulnerable people to drink & eat... Is CRITICAL CARE Preventable Dehydration in Elderly Care ( = immeasurable suffering + £billions )

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Chief Exec Finance Matron Patients relatives Admin GSA House Keeper HCA OT Physio SALT Discharge Team Doctor And many others! Catering RGN We are all involved in the Cup of Tea Cycle... We all need to work together to prevent avoidable dehydration in elderly care

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Education & Training Cornwall Hydration Project is developing new innovative measures to raise the profile of this basic but complex nursing task cleaners, housekeepers... relatives & volunteers, admin staff, managers, CEOs etc ? We are ALL supposed to be part of ‘hydration’ care... How can this be achieved?

HEALTH PROMOTION Encouraging elderly people to drink is vital More needs to be done A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012

‘What goes in.... Must come out!!!’ Supporting timely toileting needs is a vital part of hydration care A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Fear of incontinence deters many elderly people drinking adequate fluids

A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012 Hydration Sociable Pleasure KindnessFamiliarNurturingRoutine Crosses all boundaries Personal Likes & dislikes... I’d prefer a coffee or water instead! ComfortingCaring The Cup of Tea... represents so many different things... At so many different times... To so many different people