Royal Surrey County Hospital NHS Foundation Trust - this article appeared recently in the Surrey AdvertiserBy Mary B
The importance of nutrition in aiding patients’ recovery is now very much in the spotlight and this week the National Patient Safety Agency are raising the profile further with a week focused on nutrition and hydration – ‘A Taste of Patient Safety’.
At the Royal Surrey County Hospital there has been a continued focus on ensuring that the nutritional needs of patients are one of the top priorities as Head of Nursing Ellen Bull explains:
“At any one time we are looking after around 100 patients who require help with direct feeding or assistance with feeding. That accounts for almost 20% of our inpatients and requires a huge team effort from staff across all disciplines. There is a nutrition action group that takes responsibility for ensuring that we meet the nutritional needs of all our patients and the group will also tackle any issues that come to light.
“We undertake comprehensive assessments of patients nutritional and hydration needs when they are admitted and we are continually building a team of volunteers to help patients who have difficulty feeding themselves.”
That team of volunteers now includes 90 A-Level students from in and around Guildford who give up their time to come in and help to feed patients during supper time. One of the team is Liam Naybour aged 17 from Bookham, who attends The Howard of Effingham School. Liam has been volunteering on Ewhurst Ward for the last few months and comes in once a week to help feed patients at supper time.
Liam says: “I want to study medicine after my A-Levels and I wanted some experience of working in a hospital. I find helping the patients, particularly the more vulnerable patients with dementia, extremely satisfying and I am pleased to be able to offer them some comfort and support. It has also been very useful to be exposed to working in a hospital environment.”
Family members and friends of patients who need help are also invited and encouraged to come in and support their relatives during mealtimes.
To ensure that the patients who need help are easily identified and prioritised, the meals for these patients are served on a red tray and this is also indicated to catering staff on the menu cards. The red trays were adopted following recommendations from Age Concern and they make the patients easily identifiable to ward staff and volunteers who are helping them.
To help ensure that there is enough time dedicated to feeding and nutrition on the wards, Protected mealtimes are in on all wards. During this period routine visiting and ward rounds are minimised, which allows the ward team to focus on ensuring that the patients are all adequately fed.
Making sure patients are well fed and hydrated plays a hugely significant part in their recovery and there is a huge team dedicated to this.
The team includes nurses, doctors, dieticians, speech and language therapists, nutrition specialist nurses, catering, pharmacy, receptionists, healthcare assistants, housekeeping, occupational therapists and physiotherapists. To complement this, the Trust has invested in a Nutrition Specialist nurse Service and Speech and Language Therapy team which provide services to patients who cannot eat normally and require specialist intervention and assessment.
A focus on hydration involves monitoring and offering drinks throughout the day using a newly developed chart. Drinks are offered in mugs or cups and jugs with red lids are used to indicate when someone needs help with drinking.
Assisting with feeding more than 100 patients a day across the hospital is a large scale logistical effort and involves the production of huge quantities of food on site. Every year the hospital provides around 570,000 meals for patients, which equates to more than 10,000 loaves of bread, 157,000 pints of milk, 73,000 portions of orange juice, 14,600 tubs of yoghurt and 10,500kg of meat.
The menu is very varied and runs across a 28 day cycle to ensure there is limited repetition for inpatients.
The menu covers the requirements of a range of diets including gluten free, vegetarian, diabetic and halal and there are also soft and puree foods available. The specialist meals are produced by our catering team working closely with the dieticians and speech and language therapists.
To ensure the distribution of meals runs smoothly, there is a daily catering operations meeting and the food is tasted and checked every day by the team before going up to the wards. The catering team and all other staff involved with the food provided for patients work very hard to ensure that they can still meet the needs of all individual patients and will do all they can to meet special requests.
The Royal Surrey’s approach to nutrition was assessed as part of a series of spot checks carried out by the Care Quality Commission in 2011. The CQC inspectors and an experienced nurse found the Trust to be compliant with meeting the nutritional needs of elderly patients. Patients and family members spoken to by the CQC team were complimentary of the meals offered to patients, stating that the food was good quality and good sized servings.
But the team at the Royal Surrey are not complacent and are always looking for feedback from patients on the quality of food and whether it met the needs of patients.
Ellen Bull continues:
“To help track the success of the nutrition and hydration initiatives questions are included in our patient e-survey and this, and information reported to PALS and Complaints, is reported to the Board.
“We also held the first of a series of Patient Experience workshops in November and invited patients who had experienced the food or had a particular interest in nutrition and food to participate. We went through the system for assessing the nutritional needs of patients, how the menu is devised and invited the attendees to feedback their experiences and suggest improvements and ideas.
“The attendees were also invited to taste our winter menu and the catering team received some useful comments and suggestions. The Nutrition Group are now working through the ideas from the workshop and have drawn up an action plan to implement the changes.
“We are always happy, and in fact want, to hear from patients and their families about the food, our approach to nutrition and what they feel we can improve as it helps us to ensure that we get it right and meet the needs of our patients.”