1. Nutrition and Patient Safety Presentation developed by Caroline Lecko Nutrition Lead National Patient Safety Agency

2. The National Patient Safety Agency …to improve the safety of patients by promoting a culture of reporting and learning from Patient Safety Incidents affecting patients receiving NHS funded care…..

3. Food for thought… Up to 40% of all patients admitted to hospital are undernourished This percentage increases once patients have been in hospital for 1 week Malnutrition often goes unrecognised and untreated Leading to prolonged hospital stays, worse outcomes and increased healthcare costs

4. Nutrition The patient safety issues Choking Dehydration Nil by Mouth Inappropriate diet Artificial nutrition Lack of assessment Lack of assistance Missed meals Catering services

5. Incidents Incident typeNumber of incidents% Lack of equipment10.2 Oral care10.2 Over hydration20.5 Missed meals40.9 Poor documentation51.2 Lack of assistance61.4 Transfer of care102.4 Lack of assessment235.4 Pressure sores286.6 Nil By Mouth - patient fed327.6 Dehydration4610.9 Choking4711.1 Artificial nutrition6515.4 Provision of food service at ward level7618.0 Nil By Mouth - prolonged7718.2 Total423100

6. The patient safety debate ThemeExamples DehydrationPatients transferred from care homes to acute care dehydrated. Delays in commencing intravenous fluid. ChokingPatients witnessed choking whilst eating a meal Inappropriate dietPatients receiving normal when requiring textured modified diet. Incorrect artificial feed Wrong dose of enteral feed given. Wrong TPN given Nil by Mouth - prolonged Patient nil by mouth for 14 days

7. The patient safety debate ThemeExample Nil by Mouth – patient fed Patient given breakfast and theatre cancelled Catering servicesInadequate supplies Unable to supply appropriate meals Missed mealsPatient declined breakfast so was not given lunch Transfer of CarePoor communication between different care settings, both verbal and written Pressure soresNutritional status identified as a contributing factor in pressure sore development

8. Protected Mealtimes How can they help?

9. What are Protected Mealtimes? Protected uninterrupted time to focus on providing an environment conducive to eating An uninterrupted mealtime with no clinical interventions and all staff focused on patients nutritional needs Reduce level of non clinical activity to ensure that patients have a relaxed and leisurely mealtime in order to maximize well-being Protect the patient to ensure he/she has opportunity and time and assistance to their eat meal Opportunity for patients to enjoy their meals at their best and aid recovery A period of uninterrupted time for patients to eat and digest their meal allowing supporting staff the time to assist the patients with their meal

10. What are Protected Mealtimes? A period of time when patients are allowed to eat their meals without unnecessary interruptions and when nursing staff and the ward team are able to provide safe nutritional care

11. Protected Mealtimes Improving Patient Safety Activity is focused on the meal and the patient… Making sure that the patient is ready to eat Making sure that the environment encourages eating Providing assistance Observation/monitoring Making sure that patients are eating

12. Protected Mealtimes Improving Patient Safety Making sure that the patient is ready to eat - Positioning patients - Providing appropriate equipment Providing assistance - Ensuring adequate diet and fluid intake - Reducing the risk of malnutrition and dehydration

13. Protected Mealtimes Improving Patient Safety Observation/monitoring - Appropriate diet and fluids - Monitoring for swallowing problems - Ensuring adequate diet and fluid intake - Reducing the risk of malnutrition and dehydration - Patients that are NBM remain NBM

14. NPSA Protected Mealtime Review Uptake of the Protected Mealtimes initiative remains variable between hospitals and between wards within hospitals across England and Wales There are inconsistencies around which meal time services are protected There are inconsistencies in the type of clinical area that have introduced Protected Mealtimes

15. Protected Mealtimes Review Barriers Ward rounds Diagnostic tests Visitors Other healthcare professionals Critical Success Factors Trust Policy related to Protected Mealtimes Promotion of the initiative Communication Leadership at all levels of the organisation

16. Protected Mealtimes Review Recommendations All NHS staff are encouraged to report patients missed meals to the NPSA via their Local Risk Management System All NHS staff are encouraged to implement Protected Mealtimes to ensure their patients get the nutritional care they need Healthcare inspectors should include the implementation of Protected Mealtimes as part of their healthcare standards

17. Protected Mealtimes Resources Full report available http://www.npsa.nhs.uk/site/media/documents/281 3_NPSA_Protected_mealtime_review1.pdf Implementation resources available http://www.npsa.nhs.uk/npsa/display?contentId=58 30