Nutrition - core nutritional care resources

This list includes key guidance and tools on nutritional care generally. Some of these tools are described in more detail within this resource, including a page dedicated to protected mealtimes.

In other sections of this resource you can also:

Core guidance and tools

These resources were last accessed on 11 February 2013. The list is arranged alphabetically by author/organisation. Some of the resources are in PDF format - see how to access PDF files.
 
Age UK (2011) Seven steps to end malnutrition in hospital
As part of their campaign ‘Still hungry to be heard’ Age UK are calling for all hospital wards to effectively implement these seven steps. These steps are also presented with practice examples in the report: Still hungry to be heard: the scandal of people in later life becoming malnourished in hospital (PDF 1.45MB) .
  
BAPEN (British Association for Parenteral and Enteral Nutrition) (2003) Malnutrition Universal Screening Tool (MUST)
'MUST' is a screening tool to identify adults who are malnourished, at risk of malnutrition or obese. It may be used in hospitals, the community and other care settings. The tool and related information including the MUST explanatory booklet are available on the BAPEN website.
Explanatory booklet.

BAPEN (British  Association for Parenteral and Enteral Nutrition (2012) Toolkit for Clinical Commissioning Groups and providers in England: Malnutrition matters: meeting quality standards in nutritional care, 2nd.ed. (PDF 4.6MB)
The BAPEN Toolkit contains guidance for commissioners and providers on defining the relevant, measurable outcomes related to nutritional care within services in order to gain value for money and includes a range of commissioning tools. It also provides recommendations based on an analysis of national nutritional care standards and guidelines.

British Dietetic Association (2012) The nutrition and hydration digest: improving outcomes through food and beverage services (PDF 2.08MB)
The nutrition and hydration digest is primarily written for those involved in food provision in care settings, particularly dietitians, dietetic support workers and caterers, but is also useful to other professionals such as nurses, speech and language therapists. The chapter on nutrition, hydration, eating and drinking discusses how to ensure optimal consumption and includes strategies for introducing protected mealtimes, providing adequate hydration and reducing unnecessary food waste. There are also chapters on food composition and menu design as well as guidance on texture modified, cultural and therapeutic diets. 

British Geriatrics Society (2009) Good practice guides: Nutritional advice in common clinical situations
Guidance on nutritional care in hospital and in relation to certain specific conditions.

British Nutrition Foundation (2009) Nutrition through life
Key points for healthy nutrition in different age groups and in pregnancy and pre-conception.

Department of Health: The eatwell plate
The eatwell plate makes healthy eating easier to understand by giving a visual representation of the types and proportions of foods needed for a healthy and well balanced diet that meets Government recommendations.

Department of Health (2012) Principles for hospital food
The Department of Health has published a set of basic principles which set out what patients can expect from good hospital food. They cover the quality of food, nutritional content and choice for patients and will be backed up by assessments led by patients. 
 
Department of Health (2011) Healthier and more sustainable catering: toolkit and supporting nutrition principles
The toolkit provides practical information for caterers and procurement managers to work towards best practice catering, improving the nutritional quality of the food provided to meet nutrient and food based standards, and reducing the environmental impact of their catering services.

Department of Health (2010) Essence of Care
The Essence of Care benchmarks aim to help practitioners take a structured approach to sharing and comparing practice. There is a benchmark for food and drink.
Benchmark for food and drink (PDF 512.9KB).

Department of Health, Social Services and Public Safety (2011) Promoting good nutrition: a strategy for good nutritional care for adults in all care settings in Northern Ireland 2011-2016
The overall vision of the strategy is to improve the quality of nutritional care of adults in Northern Ireland in health and social care, whether delivered or commissioned, through the prevention, identification, and management of malnutrition in all health and social care settings including peoples own homes.

Department of Health, Social Services and Public Safety (2007) Get your 10 a day: the nursing care standards for patient food in hospital (PDF 512.91KB) 
Nurses are accountable for their practice in all aspects of the provision of food, fluid and nutritional care. These standards have been developed for use across all in-patient facilities in health and social care trusts across Northern Ireland and can be used to demonstrate that service and care are delivered to the highest possible standards.
Guidelines and Audit Implementation Network (GAIN) have audited compliance with standards 1-7 in  to identify the percentage of participants who received care in line with that expected for each standard. Data was collected between July and October 2011 - see Get your 10 a day audit PDF (1.10MB).

H4H: online hydration for health resource
The focus of this resource is establishing healthy hydration and advice on this as an integral part of public health nutritional guidelines and as part of routine patient information. The website provides a collection of tools and publications including patient education material on healthy hydration, for example in different age groups. There is also a 'Hydration for Health Hub' intended for healthcare professionals and featuring regular blogs from experts and researchers.

Healthcare Improvement Scotland (2011) Nutritional care communication tool
Effective communication of individual needs is a vital part of transition between care home and hospital in order to ensure that individuals receive appropriate and safe nutritional care, and assistance. The tool was developed by a sub-group of the Improving Nutritional Care Programme.

Healthcare Improvement Scotland (2011) Making meals matter pack
The ‘Making Meals Matter’ resources have been developed by the sub-group of the Improving Nutritional Care Programme to support local quality improvement and monitoring. This includes principles of safe and effective nutritional care and principles of protected meal times.

National Association of Care Catering: Top tips
This section of the NACC website brings together top tips on topics such as: spotting the signs of malnutrition and deydration; dysphagia diet;  tips on aspects of hydration as part of the NACC Dehydration in Older People Awareness week.
 
National Institute for Health and Clinical Excellence (2006) Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (Clinical guideline CG32)
Recommendations in this guideline apply to all patients with malnutrition or at risk of malnutrition, whether they are in hospital or at home. Good coordination between the hospital and the home or community is needed when patients are transferred between settings.
 
National Patient Safety Agency (2009) Nutrition factsheets
These  factsheets set out the 10 key characteristics of good nutritional care in healthcare environments. See also the NPSA toolkit on protected mealtimes.

NHS Education for Scotland: Nutritional care in hospitals 
“This web resource aims to support all staff involved in nutritional care in hospitals, ensuring that they have the knowledge, skills and capabilities to optimise nutritional care as part of the patient experience. It serves to promote the development of nutritional thinking at each of the key stages in the nutritional care process”. It brings together a range of resources about nutritional care in Scotland including a Learning in nutrition toolkit and dysphagia resources.

NHS Education for Scotland (NES): Core Nutritional Pathway
The core nutrition pathway has been developed in consultation with staff from across NHSScotland, incorporating the Malnutrition Universal Screening Tool (MUST). The Core Nutrition Pathway is intended to clarify what patients should expect in terms of effective nutritional care. It identifies six key stages or critical points in the patient’s journey from Admission (Stage 1) to Discharge (Stage 6). These can be used to explore the effectiveness and patient centredness of care to determine how it measures against best practice.

NHS Kidney Care (2012) Hydration Matters
NHS Kidney Care have launched a campaign to improve inpatient hydration and to encourage staff in hospitals and nursing homes to better monitor and manage inpatients’ fluid status. Inadequate hydration is one of the main causes of acute kidney injury (AKI) and other avoidable healthcare complications. It affects around one in five people admitted to hospital as an emergency and many elderly patients, but work done by NHS Kidney Care has found that nearly a third of AKI cases are avoidable. The campaign brings together information about acute kidney injury and risk factors for this as well as resources to support improved hydration.

NHS Institute for Innovation and Improvement (2010) High Impact actions: Keeping nourished getting better
This is one of the eight High Impact Actions for Nursing and Midwifery that were developed following a ‘call for action’ which asked frontline staff to submit examples of high quality and cost effective care that, if adopted widely across the NHS, would make a transformational difference. It aims to identify an approach to nutritional care which is inclusive and joined up and which crosses pathways in both acute and community settings.

NHS Quality Improvement Scotland (2007) Caring for children and young people in the community receiving enteral tube feeding: best practice statement
This statement specifically addresses issues in nasogastric, gastrostomy and jejunal feeding. The importance of communication and sharing of information between local and regional services is key to ensuring best practice for those children and young people and this is reflected throughout the statement. This is made available on the Healthcare Improvement Scotland website.

Nursing Standard articles
The full text of these articles can be accessed via RCN e-journals.

Bloomfield J and Pegram A (2012) Improving nutrition and hydration in hospital: the nurse's responsibility. Nursing Standard 26(34) 25 April pp.52-56.

Holmes S (2012) Enteral nutrition: an overview. Nursing Standard 26(39) 30 May 2012 pp.4-42.

Ruxton C (2012) Promoting and maintaining healthy hydration in patients. Nursing Standard 26(31) 4 April pp.50-56.

Patients Association and Nursing Standard (2011) CARE campaign
The campaign is based on the four most frequent concerns that the Patients Association receive from patients, their relatives and carers. The CARE challenge is that "as a minimum, all patients should get assistance when they call for help, encouragement to eat and drink, assistance with going to the toilet, and have their pain addressed". The Care slogan acts as a checklist - Communicate with empathy and kindness; Assist with toileting promptly, ensuring dignity; Relieve pain regularly and effectively; Encourage adequate nutrition throughout the day.

Patient Safety First: Nutrition and hydration week 23-29 January 2012
The Royal College of Nursing (RCN) was a supporting partner of the nutrition and hydration week entitled “A taste of patient safety”. Details of the week's activities and recordings of the WebEx sessions held during the week are available on the Patient Safety First website. 
For details of the 2013 week to be held 18-24 March 2013 see Nutrition and hydration week 2013. 

Royal College of Nursing (2006) Malnutrition: what nurses working with children and young people need to know and do: an RCN position statement (PDF 1.22MB)
Nurses who work with children and young people have an important role in identifying whether children are at risk of malnutrition and monitoring it. This position statement is aimed at all such nurses in GP practices, outpatient departments, hospitals, health centres and schools.
 
Royal College of Nursing (2008) Nutrition Now: Enhancing nutritional care (PDF 982KB)
This publication priovides a summary of case studies which demonstrate sustainable changes to enhance people's experience of food and nutrition in health and social care.

Scottish Government (2011) Improving maternal and infant nutrition: a framework for action
The framework is aimed at a variety of organisations with a role in improving maternal and infant nutrition. It includes indicators for short, medium and long term outcomes and provides case studies of some of the good practices already in place across Scotland.

The State Hospital (NHS Scotland) (2010) Food, fluid and nutrition standards. Guidance for patients (PDF 135KB)
These six standards aim to address the risk of under-nutrition in hospitals. They are listed along with the action to be taken by the hospital and what this means for the patient.

Wales Audit Office (2012) Eating well in hospital: what you should expect (PDF 295.9KB)
This four page leaflet describes what patients should expect regarding their nutritional needs from the time they arrive in hospital.

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 (2011) Nutrition in community settings. A pathway and resource pack
This All-Wales pathway for the management of malnutrition in the community and supporting resource pack have been developed for health and social care professionals, the third sector, care home staff, relatives and carers. Its purpose is to improve standards of nutrition for people living in the community, by providing tools and best practice.

Welsh Assembly Government (2009) Free to lead free to care - All Wales food record chart and nutritional care pathway
The pathway supports and promotes the implementation of the food services aspects of the Council of Europe Resolution on food and nutritional care in hospitals.

Welsh Assembly Government (2003) Fundamentals of care
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. Eating and drinking is one of the aspects of care. Each aspect of care has practice indicators and examples of what the indicators mean in practice.

Welsh Government (2011) All Wales nutrition and catering standards for food and fluid for hospital inpatients
These standards provide technical guidance for caterers, dietitians and nursing staff responsible for meeting the nutritional needs of patients who are capable of eating and drinking. They replace the nutrition and catering framework published in 2002. All hospitals in Wales should achieve full compliance with the new standards by April 2013.
An All Wales Hospital Menu Framework has been developed that caters for all patients including those with special requirements, and supports these standards. The framework provides standardised recipes and methods which have all been nutritionally analysed. The list of menu items is available on the NHS Wales Shared Services Partnership Procurement Services website.
See also the news item on the Welsh Government website: Hospital food: Improvements on the menu.