How to improve nutrition and hydration
The CQC’s Dignity and nutrition inspection programme: national overview (1) identifies three key points:
- the role of leadership throughout an organisation in creating a culture that prioritises dignity and nutrition and supports staff to deliver care that meets the expected standard
- the importance of staff attitudes in preserving, or diminishing, dignity.
- the risks associated with under-resourcing that make poor care more likely.
Concerns identified in the report:
- patients not given the help they needed to eat, meaning they struggled to eat or could not eat
- patients being interrupted during meals and having to leave their food unfinished
- patients' needs not being properly assessed, meaning they didn’t always get the care they needed – for example, specialist diets
- records of food and drink not being kept accurately, so progress was not monitored
- patients not being able to clean their hands before meals.
What organisations can do
To raise the standard of nutritional care, organisations must make sure (2):
- malnutrition is actively identified through screening and assessment
- malnourished patients and those at risk of malnutrition have appropriate care pathways
- frontline staff in all care settings receive appropriate training on the importance of good nutritional care
- management structures are in place to ensure best nutritional practice.
Many trusts have done one or more of these but have not achieved sustainable improvement across all four areas. A strength in one area (good screening rates consistently achieved) can mask a deficit in another (failures in delivering the care plan that is required for patients identified at risk).
According to the British Association for Parenteral and Enteral Nutrition (BAPEN) (3) and the National Patient Safety Agency (NPSA) organisations should:
- appoint a clinical lead with responsibility for nutrition supported by a senior manager
- encourage patients and carers to help design nutrition services
- form dedicated teams to carry out improvement programmes
- secure top level backing for improvement programmes to help spread best practice
- create educational opportunities around nutritional care and set related appraisal objectives.