1. The Importance of Nutrition Department of Nutrition and Dietetics Laura Haigh

2. Aims of the presentation Help your understanding of: Malnutrition and its consequences Factors that influence nutritional needs The role of the dietitian Ward level activities to improve nutritional intake Importance of monitoring nutritional parameters e.g. weight

3. Malnutrition? What is malnutrition? Malnutrition = imbalance between nutritional intake and nutritional requirements. Malnutrition in the UK costs in excess of 7.3 billion Who is at risk of malnutrition? A malnourished patient can  their length of stay in hospital by 50% 75% of patients may  weight during admission A large proportion of patients are at risk Auxiliary nurses play a very important role in the provision of nutritional care

4. Why might patients become undernourished? Decreased food intake Increased nutritional/energy requirements Decreased nutrient absorption (diseases affecting the gastro-intestinal tract)

5. What are the consequences of malnutrition? → Illness → Reduced food intake → Reduced muscle strength → Decreased mobility → Impaired immunity → Susceptibility to wound/chest infection → Apathy → Depression

6. Identifying patients at nutritional risk Nutritional screening Identifies patients who are or at risk of becoming undernourished Action plan 1. identifies appropriate strategies of care 2. identifies responsibilities for care Not all patients identified as being at risk require being seen by a dietitian

7. Role of the dietitian The dietitian is an expert in nutrition Assess more high risk patients Assess nutritional status (ABCD) Estimate nutritional requirements Give appropriate nutritional advice Request prescription products if appropriate Discuss care plans with multi disciplinary teams to ensure implementation

8. Catering system Dietitians will inform nursing staff of specific dietary requirements Speech and Language Therapist will inform nursing staff on appropriate texture modified diet All meals are ordered by nursing staff Fortified foods and additional snacks can be arranged via the dietitian

9. Benefits of Nutritional Support Patient Benefits ↓ Length of stay ↓ Rehab time ↓ Mortality ↑ Quality of life NHS Benefits Cost savings

10. Your role in preventing undernutrition Think about your job – how much time do you spend doing food related activities? Request Nursing Staff complete Nutritional Screening Tool Weighing patients Completing menu cards Food record charts Advising on appropriate food choices Food fortifying Meal Provision

11. Why weigh? Weight is an essential component of assessing nutritional status Weight history highlights changes of significance Unexplained weight loss should be investigated

12. How should weights should be obtained? Weekly weights (unless otherwise instructed) Obtain using the same scales preferably Ensure patient wearing similar clothing Weights should be recorded in the nursing or medical notes If weight has significantly changed Re-check the weight Inform the named nurse if concerned

13. Completing menu cards Are menu choices appropriate? Clarify likes/dislikes Observe physical limitations which may impact intake Offer assistance if required Offer encouragement

14. How to Complete Food Record Charts BreakfastMid- morning LunchMid- afternoon Evening meal Supper Ideal way ½ bowl porridge Full cup of orange juice All Fortisip All tea biscuit All soup ½ portion of mince & potatoes Glass of milk ¼ Fortisip Refused tea biscuit Refused main meal Ate full high protein custard ¾ glass of milk Cup of tea 1 slice of toast Wrong way Some porridge BiscuitSoup Main meal EnliveCustardTea Toast

15. Methods of providing Nutritional Support Appropriate food choices/↑ no. of meals/snacks Fortify foods to ↑ their nutritional value Provide supplement drinks Enteral nutrition Parenteral nutrition

16. Appropriate food choices British Nutrition Foundation (2007)

17. Food Fortification Full fat or sugar products Add extra butter, cheese, full cream milk, cream Add sugar or preserves Food fortification with Procal, Build Up, Calogen, Fortisip or Fortijuice

18. Nutritional Supplements Some can not meet their nutritional needs through oral diet alone Supplement drinks may be indicated Prescription products should only be given to patients as directed by medical or dietetic staff

19. Nutritional Supplements Always check the best before date Offer between or after meals Offer chilled or at room temperature Ask about flavour preference Offer encouragement

20. Nutrition Support cont.. Some can not meet nutritional requirements  enteral or parenteral feeding may be initiated Provision of these forms of nutrition are carried out by trained nursing staff

21. Check List Request Nursing Staff complete Nutritional Screening Tool Weighing patients Appropriate meal provision 1. Completing menu cards 2. Supervising on appropriate food choices 3. Food fortifying 4. Assistance offered if required 5. Suitable position for food consumption 6. Appropriate cutlery Food record charts

22. Thank you Any Questions? Any Questions? Any Questions?