Nutrition and Patient Safety

1. Nutrition and Patient Safety Presentation developed by Caroline Lecko Nutrition Lead National Patient Safety Agency

2. ‘ …to improve the safety of patients by promoting a culture of reporting and learning from Patient Safety Incidents affecting patients receiving NHS funded care…..’ The National Patient Safety Agency

3. Food for thought… • Up to 40% of all patients admitted to hospital are undernourished • This percentage increases once patients have been in hospital for 1 week • Malnutrition often goes unrecognised and untreated • Leading to prolonged hospital stays, worse outcomes and increased healthcare costs

4. Nutrition The patient safety issues • Choking • Dehydration • Nil by Mouth • Inappropriate diet • Artificial nutrition • Lack of assessment • Lack of assistance • Missed meals • Catering services

5. Incidents

6. The patient safety debate

7. The patient safety debate

8. Protected Mealtimes How can they help?

9. What are Protected Mealtimes? • “Protected uninterrupted time to focus on providing an environment conducive to eating” • “An uninterrupted mealtime with no clinical interventions and all staff focused on patient’s nutritional needs” • “Reduce level of non clinical activity to ensure that patients have a relaxed and leisurely mealtime in order to maximize well-being” • “Protect the patient to ensure he/she has opportunity and time and assistance to their eat meal” • “Opportunity for patients to enjoy their meals at their best and aid recovery” • “A period of uninterrupted time for patients to eat and digest their meal allowing supporting staff the time to assist the patients with their meal”

10. What are Protected Mealtimes? “A period of time when patients are allowed to eat their meals without unnecessary interruptions and when nursing staff and the ward team are able to provide safenutritional care”

11. Protected MealtimesImproving Patient Safety Activity is focused on the meal and the patient… • Making sure that the patient is ready to eat • Making sure that the environment encourages eating • Providing assistance • Observation/monitoring • Making sure that patients are eating

12. Protected MealtimesImproving Patient Safety • Making sure that the patient is ready to eat - Positioning patients - Providing appropriate equipment • Providing assistance - Ensuring adequate diet and fluid intake - Reducing the risk of malnutrition and dehydration

13. Protected Mealtimes Improving Patient Safety • Observation/monitoring - Appropriate diet and fluids - Monitoring for swallowing problems - Ensuring adequate diet and fluid intake - Reducing the risk of malnutrition and dehydration - Patients that are NBM remain NBM

14. NPSA Protected Mealtime Review • Uptake of the Protected Mealtimes initiative remains variable between hospitals and between wards within hospitals across England and Wales • There are inconsistencies around which meal time services are protected • There are inconsistencies in the type of clinical area that have introduced Protected Mealtimes

15. Protected Mealtimes Review Barriers • Ward rounds • Diagnostic tests • Visitors • Other healthcare professionals Critical Success Factors • Trust Policy related to Protected Mealtimes • Promotion of the initiative • Communication • Leadership at all levels of the organisation

16. Protected Mealtimes Review Recommendations • All NHS staff are encouraged to report patients’ missed meals to the NPSA via their Local Risk Management System • All NHS staff are encouraged to implement Protected Mealtimes to ensure their patients get the nutritional care they need • Healthcare inspectors should include the implementation of Protected Mealtimes as part of their healthcare standards

17. Protected Mealtimes Resources • Full report available http://www.npsa.nhs.uk/site/media/documents/2813_NPSA_Protected_mealtime_review1.pdf • Implementation resources available http://www.npsa.nhs.uk/npsa/display?contentId=5830