1. Food, Fluid and Nutrition

2. Q.I.S Q.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.

3. CRAG CSBS NMPDU SHAS HTBS

4. Boards are audited 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

5. 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 Nutrition Standard

6. 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.

7. Patient ScreeningPatient choice Support for Patient Staff Training Organisational Policy Care Planning

8. Whose business is it? Caterer Doctor Dietitian Nurse Patient Pharmacist Porter

9. 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

10. 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.

11. 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

12. *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 DateWeightScoreDate seen by DietitianRefer to Dietetic Care Plan Beatson Oncology Centre: Refer to Medium Risk Flow Chart Beatson Oncology Centre: Refer to High Risk Flow Chart LOW RISK 0 - 5 MEDIUM RISK 6 - 9 HIGH RISK 10+ Encourage normal diet Check 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 increasingIntake / weight not increasing Continue to encourage oral diet Refer to dietitian Refer to Dietitian and Medical Staff

13. 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

14. This should identify problems. Direct to a care plan. Instigate a care plan. Encourage on- going monitoring ( regular weighing ) Screening

15. 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

16. 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

17. 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

18. 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

19. 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.

20. 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