Maura Buchanan

2. Maura Buchanan President Royal College of Nursing

3. Alison Kitson Executive Director - Nursing Royal College of Nursing

4. Water for Health Nick Ellins Facilitator of the Water for Health Alliance Head of Consumer Strategy for Water UK

5. Water UK Alcohol Focus Scotland Action on Elder Abuse British Medical Association Chartered Institute of Environmental Health Consumer Council for Water Developing Patient Partnerships Drinking Water Inspectorate Drinking Water Inspectorate - Northern Ireland Drinking Water Quality Regulator Scotland English Community Care Association ERIC (Enuresis Charity) Focus On Food Health Education Trust Healthy Schools Hospital Caterers Association Kidney Research Local Authority Caterers Association Men's Health Forum National Association of Care Catering National Care Association National Governors' Council National Heart Forum The National Kidney Research Fund Patients Association Royal Institute of Public Health Royal College of Nursing The Royal Society for the Promotion of Health Schools Health Education Unit Stirling University (Dementia Unit) TOAST (Obesity Awareness Trust) Unison United Kingdom Public Health Association WRVS WaterAid Waterwatch Scotland The Water for Health Alliance

6. “Water is a basic nutrient of the human body, critical to human life”World Health Organization - Water, Sanitation and Health Guidance

8. Thirst 4 Life • A sister at Stoke Mandeville Hospital, A&E Department, audited A&E attendances at Stoke Mandeville Hospital. • Over 30% of elderly people attending A&E were there because of a dehydration related illness. • Training was given to professionals caring for older people by Tissue Viability Nurses, District Nurses and allied Health Professionals. • Additionally A&E nurses used teaching techniques to recognise the early stages of dehydration in older people as well as ways to stop it happening. • Training led to a 45% reduction in A&E attendance at Wycombe General Hospital from nursing and residential homes between November 2004 and March 2005. • http://www.buckscc.gov.uk/thirst4life/project.htm

9. Experience of carers to date • Improved sleep patterns • Increased consumption of food • Less soiling incidents • Reduced ‘confusion’ • More energy • Reduced use of laxatives

11. Nick Ellins – nellins@water.org.uk Website - www.waterforhealth.org.uk

12. Nutrition and Patient Safety Caroline Lecko – Nutrition Lead National Patient Safety Agency (NPSA)

13. Patient Safety – the facts • The NPSA has identified nutrition as a patient safety issue • Over 900 patient safety incidents relating to nutrition have been analysed • Key themes have been identified from the analysis • These themes have implications for all care settings and all patient groups

14. Dehydration Choking Nil by Mouth – prolonged periods of time Nil by Mouth – patients fed Inappropriate diet and fluids Incorrect artificial nutrition Transfer of care Lack of assessment Lack of equipment Nutrition Patient Safety Themes

15. Key Themes • Dehydration • Intravenous fluids prescribed but not administered • Patients transferred from care homes • Patients not offered or provided with hydration in A&E • Nil by Mouth – prolonged periods of time • Patients fasted prior to surgery/procedure • Patients waiting for specialist review

16. Key Themes • Choking • Patients being given inappropriate diets and fluids • Lack of awareness of ‘at risk’ patient groups • Lack of assessment • Patients’ nutritional status and requirements not assessed on admission to hospital or into community care • Lack of access to specialists out of hours

17. Improving Patient Safety - What can nurses do to improve the safety of their patients nutritional care? - 1 simple step • Introduce the Council of Europe Alliance 10 Key Characteristics of good nutritional care The NPSA fully endorses this piece of work

18. The nurse’s role in patient safety • Recognise nutrition as an important part of clinical care • Recognise that a missed meal is as important as missed medication • Recognise that poor nutritional care has the potential to cause harm The delivery of safe nutritional care in all care settings has the potential to stop headlines like…

20. Thank you for listening!caroline.lecko@npsa.nhs.uk

21. Food For Thought… Jayne Quigley Head of Nursing – Leadership Development Raising Nutritional Awareness St George’s NHS Healthcare Trust

22. Our Journey……. • What spurred us into action? • What did we see? • What did we do? • What have we achieved? • Lessons learned • Next steps

23. What spurred us into action…. • RCN Clinical Leadership Programme Observations of Care Patient Stories

24. What did we see? • Meal times were not treated as a priority. Wards busy and noisy, Dr’s rounds and drug rounds going on,++ people • Patients not prepared /positioned appropriately prior to meal • Ward hostesses responsible for serving food and removing trays, very little monitoring of intake by nurses. Uneaten food removed ? Supplement offered • Trays placed at wrong side of patient so unable to reach food Nurses not available to assist • Tray left outside curtains whilst patient on commode • Toilet rolls and urinals on bed tables whilst patient eating • Domestic changing bed curtains whilst patient eating • Patient struggling to open a sandwich • All courses served at once and second helpings were rarely offered • Patchy completion and reviewing of Nutritional Screening Tool

25. Our Aim… • To provide an environment that allows patients to eat their meals without unnecessary interruptions and to enable the nursing staff to focus on providing assistance to patients and monitor their food intake.

26. What did we do? • PROMT MDT Working Group, guidelines, pilot wards and roll out • MDT approach: Nursing, Dietetics and Facilities • Visits to other hospitals re menu choice and food provision • Recruited and trained volunteers • Revised Nutritional Screening Tool • Training from Dieticians • Nutrition Strategy Group

27. What have we achieved? • Collaborative working • PROMT policy and Trust roll out • Reduced food wastage in fully compliant areas • Increased understanding of benefits of PROMT • Regular input from volunteers • New catering contract • Specialist diets for renal, cardiac and paediatrics • 3 different textures of soft diet • Extensive ethnic menu including 2nd generation Halal • Extra snacks for the elderly • Improved snack boxes for maternity

28. Lessons Learned….. • Support from the Board and Executive Team is crucial. Communicate trust wide as it affects everybody and you need to get them on board from the start • The Ward Sister/Charge Nurse is pivotal in making it work, modelling is very powerful • A MDT approach is essential from the start…it’s everybody’s responsibility and we all have a role to play • The Ward team needs regular support and feedback and monitoring of food wastage is a good measure of success • Observations of Care pre and post implementation is very effective • Catering and Facilities were included from the outset and are excellent champions

29. Next Steps • PROMT becomes part of every ward routine • Improved Nutritional Screening • Stakeholder event May 2007 • Increase number of volunteers • Roll out to the evening meal service • Exploring Protected Cleaning..

30. And Finally… • The message we’re sending out across the organisation re the importance of Protected Mealtimes and promoting nutrition is: • It’s not rocket science, it’s common sense • It’s cost neutral • It improves patient satisfaction with their overall experience • It improves nurse satisfaction i.e. it’s about being with the patient • It really does make a difference