Nutrition - patient safety resources
This list signposts guidance and tools which are particularly relevant to patient safety in nutritional care.
These resources were last accessed on 11 February 2013. Some of them are in PDF format - see how to access PDF files.
BAPEN et al (2011) British Consensus guidelines on intravenous fluid therapy for adult surgical
patients
Core members of a steering committee came together to establish consensus for good perioperative fluid prescribing. Concern had arisen from a high incidence of postoperative sodium and water overload, and evidence to suggest that preventing or treating this, by more accurate fluid therapy, would improve outcome. Recommendations are given for: assessment of fluid requirements; preoperative fluid management; intra operative fluid management and postoperative fluid management.
BAPEN (2004) Administering drugs via enteral feeding tubes (PDF 63.3KB)
A poster intended for wards and clinics which provides, in a flow diagram, a step by step guide for safe drug administration via this route. It also includes basic information on legal implications, health and safety and drug interactions.
Department of Health (2010) Essence of Care: Benchmarks for food and drink (PDF 153KB)
Essence of Care contains 12 benchmarks, including food and drink. It aims to support localised quality improvement, by providing a set of established and refreshed benchmarks supporting front line care across care settings at a local level. This benchmark has 10 factors. Factor 7 looks at nutritional screening and assessment. For all the benchmarks see Essence of care 2010.
Guidelines and Audit Implementation Network (GAIN) (2012) Guidelines for the oral healthcare of older people living in nursing and residential homes in Northern Ireland (PDF 212.5KB). This guidelines was developed for a context in which increasing numbers of older people now have their own teeth and how this impacts on the delivery of oral health care in care homes. It also aims to address reports of poor oral health for residents in care homes. The document sets out a best practice model.
International Dysphagia Diet Standardisation Initiative (IDDSI)
The IDDSI aims to develop global standardised terminology and definitions for texture modified foods and thickened liquids for individuals with dysphagia of all ages, in all care settings, and all cultures. The website provides more details about what the challenge involves and describes the four stages of the initiative from December 2012 to December 2014. You can register to receive information about progress of the initiative.
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2010) A mixed bag: an enquiry into the care of hospital patients receiving parenteral nutrition
This NCEPOD report highlights the process of care of patients who receive Parenteral Nutrition. These are patients with a compromised nutritional status, where oral or enteral feeding is not an option. The report takes a critical look at areas where the care of patients might have been improved. Remediable factors have been identified in the clinical and the organisational care of these patients. A parenteral nutrition toolkit is also available.
National Patient Safety Agency (NPSA): Alerts
These include Rapid Response Reports, Patient Safety Alerts and Safer Practice Notices and are developed by the National Reporting and Learning Service (NRLS) through analysis of patient safety incidents and safety information from other sources.
- NPSA (2012) Patient Safety Alert: Harm from flushing of nasogastric tubes before confirmation of placement
The NPSA is aware of a number of patient deaths where staff had flushed nasogastric tubes with water before initial placement had been confirmed. This alert underlines the importance of establishing confirmation of placement before any flushing is done. - NPSA (2011) Patient Safety Alert: Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants
This Alert updates and strengthens Patient Safety Alert 05 (Reducing the harm caused by misplaced nasogastric feeding tubes) and is based on national learning since then. - NPSA (2011) The risk of harm from children and neonates entangled in lines
This Signal looks at the risk of harm to children and neonates from entanglement in lines or tubes. - NPSA (2010) Safety Alert: Early detection of complications after gastrostomy
Gastrostomies are small stomas created between the stomach and the skin of the abdomen to insert a feeding tube in adults and children. As with other interventional procedure, "there is potential for complications (including chemical peritonitis, infection, bowel perforation, haemorrhage, and aspiration pneumonia) but prompt recognition of these complications with early action reduces the risk of serious harm or death". This alert highlights what all NHS organisation providing care in the period up to 72 hours (three days) post-gastrostomy should do. - NPSA (2011) Signal: Risk of harm to patients who are nil by mouth
Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA. This Signal is about the risk of harm to patients who are kept unintentionally nil by mouth (NBM) for a prolonged period of time.
NPSA (2009) Quarterly Data Summary Issue 12: Learning from reporting - is nutrition a patient safety problem?
This learning from reporting section concludes that nutrition‑related patient safety incidents can occur at any stage in the patients’ journey. Key contributing factors for nutrition‑related patient safety incidents include poor communication, staffing issues and unreliable application of protocols and systems.
NPSA (2009) Nutrition factsheets
This series of factsheets sets out the 10 key characteristics of good nutritional care in healthcare environments.
NPSA (2007) Ensuring safer practice for adults with learning disabilities who have dysphagia
This guidance highlights best practice and provides resource materials to give practical help. The tools can be adapted for local use and for any adult who has dysphagia.
NPSA: Protected mealtimes and patient safety (PDF 40KB)
“Right meal, right time, right help” - this one page document supported the Protected Mealtimes Initiative can be downloaded from the RCN website.
NHS Education for Scotland (NES) (2011) Dysphagia DVD
This is an online version of a DVD which explains how to prepare everyday meals and drinks for people with swallowing difficulties. The videos are on food textures, drinks, and there are interviews with carers and practitioners.
Nursing Standard article:
Holmes S (2012) Enteral nutrition: an overview. Nursing Standard 26(39) 30 May 2012 pp.41-46.
You can access the full text through the RCN e-Library at e-journals.
Royal College of Nursing: Perioperative fasting
This RCN resource has been developed to support the implementation of the RCN guideline on perioperative fasting in adults and children published in 2005. It brings together what is known from the evidence on this topic, highlights the recommendations and includes guidance on how to put this knowledge into practice.
Royal College of Nursing (2012) Essential practice for infection prevention and control: guidance for nursing staff (PDF 669.4KB)
This guidance document, which highlights essential elements of good infection prevention and control practice, includes a section on nutrition and hydration underlining why this is an important complementary component in infection prevention. "Although not always directly associated with infection prevention strategies, malnutrition and dehydration can compromise patients and contribute to infection prevention challenges. Malnutrition predisposes patients to delays in recovery from illness, and adversely affects body function, wellbeing and clinical outcome".
Royal College of Nursing (2010) Principles of Nursing Practice: Principle C
The Principles describe what everyone can expect from nursing practice, whether colleagues, patients, their families or carers. Principle C focuses on the safety of all people (patients, visitors and staff), the environment, organisational health and safety, management of risk, and clinical safety.
Water UK, RCN and NPSA (2007) Water for Health. Hydration Best Practice Toolkit for Hospitals and Healthcare
This toolkit was created within the Royal College of Nursing Nutrition Now campaign – for nurses, healthcare workers, caterers and other service providers. It aims to assist nurses, healthcare workers, caterers and other service providers to introduce good hydration and to implement the health benefits of drinking enough water.
Welsh Assembly Government (2003) Fundamentals of care (PDF 577KB)
The guidance in this document aims to help improve the quality of twelve aspects of health and social care for adults and reduce inconsistencies in quality. Practice indicators and examples of what the indicators mean in practice are provided. Practice indicator 10 is on oral health and hygiene and includes care of the mouth and teeth (including dentures). Oral health is necessary for eating and drinking. People who are unable to eat and drink normally, who are severely debilitated or unconscious, or who are receiving certain therapies e.g. radiotherapy, or certain drugs are especially vulnerable.