1. NURSING AUXILIARY TALK NUTRITION & DIETETICS DEPARTMENT Gartnavel Hospital Emmajane Christie

2. Outline Malnutrition in hospitals Procedure for referring patient to the Dietitian Importance of nutritional support Catering service and menu planning

3. Malnutrition in hospitals General term used to describe “poor nutrition” caused by improper or insufficient diet. Most often refers to undernutrition but can also mean overnutrition The risk of malnutrition risk has been identified in 20-60% of patients admitted to hospital If undetected and untreated can lead to delayed wound healing increased risk of pressure sores & infections muscle wasting and weakness increased risk of postoperative complications increased length of hospital admission Undernutrition has significant financial implications on the NHS Good nutritional care improves disease outcomes and patients quality of life

4. At risk patients Poor appetite – leaving majority of meals Recent weight loss – loose fitting clothes GI disturbances - Nausea, vomiting, diarrhoea Need assistance with meals – unable to handle equipment, poor eyesight Poor fitting dentures – uncomfortable, unable to chew food Swallow problems – difficult swallowing/chewing food, coughing, hoarse wet voice, drooling Chronic disease eg. Cancer Undergoing major surgery

5. REFERRAL PROCEDURE All patients should be screened for malnutrition /risk of malnutrition on admission using a validated nutritional screening tool. Recent weight loss Appetite Ability to eat and drink Skin condition Gut function Medical Condition condition Screening should be repeated weekly for inpatients Must have nutrition risk score to refer patient to the dietitian regardless of reason for referral

6. Please circle only one score in each section RESCORE Date BODY WEIGHT  Normal [no recent weight changes]  Recent unintentional weight loss [<6Kgs]  Underweight / weight loss >6Kgs 035035 035035 035035 035035 035035 APPETITE  Good – finishing three meals per day  Reduced – leaving quarter meals and fluids  Poor – leaving half meals and fluids  Little or no appetite, refusing or unable to eat/drink 02350235 02350235 02350235 02350235 02350235 ABILITY TO EAT AND DRINK  No difficulties, eating and drinking independently  Requires assistance with eating and drinking  Difficulty swallowing and/or chewing 025025 025025 025025 025025 025025 SKIN CONDITION  Healthy  Sore red pressure areas  Superficial breaks in pressure areas  Multiple deep pressure sores 02450245 02450245 02450245 02450245 02450245 GUT FUNCTION  Normal  Persistent Nausea  Nausea + / or occasional vomiting + / or some diarrhoea / constipation  Diarrhoea > 3 per day / unable to keep food or fluids down 02350235 02350235 02350235 02350235 02350235 MEDICAL CONDITION  No impairment to food intake  Minor surgery / mild infection  Major surgery [Esp. G.I. Tract] / G.I. Disease / CVA / Chronic illness  Sever infection / Sepsis / Cancer / Burns > 15% / Multiple injuries 02450245 02450245 02450245 02450245 02450245 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

7. Referral Procedure Score 0-5 (Low Risk) Encourage normal diet Check weight and re-screen weekly Re-assess if condition changes Score 6-9 (Medium Risk) Commence 3 Day Food Record Chart Check weight twice weekly Intake / weight not improving – refer to Dietitian Intake / weight improving – continue to encourage Score 10+ (High Risk) Refer to Dietitian

9. REASONS FOR REFERRALS Inpatients Nutritional Support Outpatients Weight reduction Heart disease Coeliac Disease Diabetes Food allergies/intolerances  Dietary requirements met within hospital meals.  Ward staff to liaise with catering - Dietitian doesn’t need to be involved  Dietary advice usually given as an outpatient. May be given general first line advice as an inpatient if newly diagnosed and followed up as an outpatient

10. Nutritional Support Increasing ENERGY & NUTRIENT intakes from ordinary food. Fortifying the ENERGY & NUTRIENT content of ordinary food. SIP FEEDS and other supplements. TEXTURE modified diets ENTERAL NUTRITION. PARENTERAL NUTRITION.

11. Nutritional Support Minimise weight loss/ stabilise weight Weekly weights / or more often if requested Changes in nutritional intake Food and Fluid charts Improvement s in bowel function / skin condition Observations Compliance with dietary advice Food choices / food fortification / documenting intake Monitoring Patients at Risk

12. SIP FEEDS & OTHER SUPPLEMENTS Milk Based Sip feeds -Fortisip Juice style Sip feeds – Fortijuice Yoghurt style Sip feeds – Fortifresh Energy Supplements – Calogen, Calshake Forticreme – semi solid yoghurt

13. PRACTICAL TIPS SUPPLEMENTS - between or after meals. ASSISTING with feeding. OFFER full cream milk between meals. DOCUMENT food & fluid intake. WEIGH patients weekly.

14. CATERING / MENU PLANNING New menus currently on trial (commenced Nov 07) Therapeutic menus still in development Additional Snacks can be requested by the dietitian if felt patient requires extras Specific dietary requirements out with the planned menu are available on request (Halal, Kosher, Vegan) All meals are cooked on site

15. Questions?????