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Nutrition - patient safety

People are at risk of malnutrition and dehydration in all care settings. These risks are widespread, have damaging consequences and need to be understood and addressed as patient safety issues.

Patient safety incidents associated with poor nutrition

We know from records maintained by the National Patient Safety Agency (NPSA) the particular kinds of patient safety incidents that are associated with the risk of malnutrition and dehydration (NPSA 2009). Some of these incidents are described below.

Nursing staff need to report these and similar issues especially availability of equipment including scales and cutlery, lack of assistance at mealtimes and lack of nutritional screening. It is important that staff are encouraged to report these issues and know how to report locally. BAPEN’s report of the fourth Nutrition Week Survey undertaken in Spring 2011 (BAPEN 2012) recommends the annual calibration of scales on all wards and in all care settings and ensuring that nutritional information identified as malnourished be included in communications on discharge from hospital and mental units.

There are tools and techniques that can be introduced to reduce the risk of poor nutrition and dehydration. Protected mealtimes and red tray initiatives are part of this approach. The active engagement of patients, families and carers increases the likelihood of nutrition related incidents being spotted and dealt with promptly (Age UK 2011).

Impact of poor oral health care 

Oral health is also an important factor in safe care. Poor mouth care and ill-fitting dentures will impact on nutritional intake and ability to eat particular types of food as well as enjoyment of food. Fundamentals of Care includes a practice indicator for oral health and hygiene (Welsh Assembly Government 2003). Audits carried out in hospital settings in Wales using this practice indicator have shown that mouth care has often not been well done. A programme for improving mouth care for adult patients in hospital has been established through the1000 Lives Plus initiative in Wales in order to address this (1000 Lives Plus 2012). 

The Guidelines and Audit Implementation Network (GAIN) in Northern Ireland has published guidelines for the oral health care of older people in care homes for similar reasons (GAIN 2012). The introduction to the guidelines also makes the point that because increasing numbers of older people now have their own teeth staff are frequently required to support dentate patients and residents in care homes. The guideline document highlights the associations between poor oral hygiene and aspiration pneumonia “which accounts for up to 48% of all chest infections in nursing home residents” (GAIN 2012, p.6).   

Case studies and good practice examples addressing some of the issues highlighted above are available at Enhancing nutritional care.

For guidance and tools to support patient safety in nutritional care see Patient safety resources.

References

These resources were last accessed on 4 December 2014. Some of them are in PDF format - see how to access PDF files.

1000 Lives Plus (2012) Programme area: Improving mouth care for adult patients in hospital. 1000 Lives Plus website.

Age UK (2011) Malnutrition in hospital: Still hungry to be heard. Age UK website.

BAPEN (2012) Nutrition screening survey in the UK and Republic of Ireland (PDF 4.55MB). Redditch: BAPEN.

GAIN (2012) Guidelines for the oral healthcare of older people living in nursing and residential homes in Northern Ireland (PDF 212.5KB). Belfast: GAIN.
 
NPSA (2009) Nutrition factsheets. 10 characteristics of good nutritonal care. Fact sheet 01: Food service and nutritional care is delivered safely. London: NPSA.

NPSA (2011) Patient safety alert: reducing the harm caused by misplaced nasogastric feeding tibes in adults, children and infants. London: NPSA.

NPSA (2012) Patient Safety Alert: Harm from flushing of nasogastric tubes before confirmation of placement. London: NPSA.

NCEPOD (2010) Parenteral nutrition: a mixed bag: an enquiry into the care of hospital patients receiving parenteral nutrition. London: NCEPOD.

Welsh Assembly Government (2003) Fundamentals of care (PDF 577KB). Cardiff: Welsh Assembly Government.
Further resources 

For guidance and tools to support patient safety in nutritional care see Patient safety resources.

See also Core nutritional care resources.