Standard 5: Comprehensive Care

Nutrition and hydration

Action 5.27

The health service organisation that admits patients overnight has systems for the preparation and distribution of food and fluids that include nutrition care plans based on current evidence and best practice

Intent

Patients’ nutrition and hydration needs are identified and documented in their comprehensive care plan.

Reflective question

How does the health service organisation ensure that the planning, preparation and distribution of food, fluids and nutritional supplements are safe and acceptable, and meet a patient’s needs?

Key task

Put in place processes for addressing patients’ nutrition and hydration needs.

Strategies for improvement

Hospitals

Food is part of the care that is provided to patients who are admitted to hospital, and should not be considered solely as part of hotel services. Malnutrition adversely affects patient outcomes, and nutrition needs to be considered as an integral part of the comprehensive care plan.

In line with the requirements in Action 5.1, ensure that the health service organisation has evidence-based nutrition policies, procedures and protocols for managing nutritional wellbeing and recovery, and malnutrition that comply with relevant legislation and state or territory requirements.

Patients should be screened for risk of malnutrition and other specific nutritional requirements.

The multidisciplinary team is responsible for implementing a food and nutrition system. To be effective, all members of the workforce involved need to understand their roles and responsibilities, as well as the role of nutrition in clinical care. Identify the clinical and non-clinical members of the workforce who need training for the best operation of the system.

In line with the requirements in Action 5.2, ensure that quality improvement processes are in place to improve the effectiveness and appropriateness of the nutritional systems. This may involve collecting and analysing data on:

  • Age, life stage, and cultural and religious background of patients
  • Organisational casemix and profile of length of stay
  • Nutrition assessments
  • Complaints and incidents.

Ensure that processes for planning, preparing and distributing food, fluids and nutritional supplements are timely, safe and appropriate to the setting of care. Ensure that ordering and delivery processes support the right foods and fluids being delivered to the right patient at the right time.

Processes for menu and meal planning should:

  • Reflect the nutritional requirements appropriate to the age and life stage of patients receiving care1
  • Reflect the special dietary needs appropriate to the organisation’s casemix2,3
  • Consider psychosocial, cultural and religious needs
  • Offer food and fluid choices that are appealing and that patients enjoy
  • Consider flexible meal timing and service arrangements
  • Be relevant to patients’ length of stay, and to patients who are admitted frequently.

Patients who are not admitted overnight may receive treatment across extended periods, such as in a day surgery unit, day obstetrics unit, renal dialysis unit, radiotherapy or chemotherapy unit, rapid assessment and planning unit, medical assessment and planning unit, short-stay ward, or emergency department. Treatment in such units may be frequent for many weeks or on a continuing basis. Consider referring these patients for nutrition assessment and including nutritional care in the patient’s comprehensive care plan.

Day Procedure Services

Most day procedure services do not admit patients overnight. However, services may care for patients who are at risk of malnutrition or undernutrition, which adversely affect patient outcomes. There may be a need to refer such patients for nutrition assessment and to consider including nutritional care in the patient’s care plan. These services, or those that admit patients overnight (for example, those with 23-hour licences), should refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

Food is part of the care that is provided to patients who are admitted to hospital, and should not be considered solely as part of hotel services. Malnutrition adversely affects patient outcomes, and nutrition needs to be considered as an integral part of the comprehensive care plan.

In line with the requirements in Action 5.1, ensure that the health service organisation has evidence-based nutrition policies, procedures and protocols for managing nutritional wellbeing and recovery, and malnutrition that comply with relevant legislation and state or territory requirements.

Patients should be screened for risk of malnutrition and other specific nutritional requirements.

To be effective, all members of the workforce involved in implementing the food and nutrition system need to understand their roles and responsibilities, as well as the role of nutrition in clinical care. Identify the clinical and non-clinical members of the workforce who need training for the best operation of the system.

In line with the requirements in Action 5.2, ensure that quality improvement processes are in place to improve the effectiveness and appropriateness of the nutritional systems. This may involve collecting and analysing data on:

  • Age, life stage, and cultural and religious background of patients
  • Organisational casemix and profile of length of stay
  • Nutrition assessments
  • Complaints and incidents.

Ensure that processes for planning, preparing and distributing food, fluids and nutritional supplements are timely, safe and appropriate to the setting of care. Ensure that ordering and delivery processes support the right foods and fluids being delivered to the right patient at the right time.

Processes for menu and meal planning should:

  • Reflect the nutritional requirements appropriate to the age and life stage of patients receiving care161
  • Reflect the special dietary needs appropriate to the organisation’s casemix162,163
  • Consider psychosocial, cultural and religious needs
  • Offer food and fluid choices that are appealing and that patients enjoy
  • Consider flexible meal timing and service arrangements
  • Be relevant to patients’ length of stay, and to patients who are admitted often.

Action 5.28

The workforce uses the systems for preparation and distribution of food and fluids to:

a. Meet patients’ nutritional needs and requirements

b. Monitor the nutritional care of patients at risk

c. Identify, and provide access to, nutritional support for patients who cannot meet their nutritional requirements with food alone

d. Support patients who require assistance with eating and drinking

Intent

The workforce ensures that the nutrition and hydration needs of patients are met.

Reflective questions

How does the health service organisation collect and report data on nutrition risk screening and assessment?

What information is reported to the executive about the nutritional care of at-risk patients?

What support is given to patients who require nutritional support or assistance with eating and drinking?

Key tasks

  • Monitor the nutritional care of patients.

  • Provide assistance to patients to ensure that their nutrition needs are met.

Strategies for improvement

Hospitals

A nutrition risk assessment is part of the organisation’s screening and assessment processes, and involves:

  • Conducting screening on admission and weekly during an episode of care if care changes or if the patient’s condition changes, or at routine review
  • Considering nutrition risk such as malnutrition and dehydration, dysphagia, special dietary needs, food intolerance or allergy
  • Documenting the results of nutrition risk screening and assessment.

Where a nutrition assessment is required, consider:

  • Weight and intake history
  • Physical assessment
  • Condition of the mouth, teeth or dentures
  • Ability to swallow safely
  • Ability to open packages
  • Ability to self-feed
  • Nutritional impact of symptoms of disease or treatment.

Monitor the nutritional care of patients at risk

Ensure that the nutrition care for each patient is planned and documented. For patients with, or at risk of, malnutrition or dehydration, increase the level of food and fluid intake, and nutritional status monitoring. Act when poor oral intake, weight loss or other change in nutritional status is detected.

Consider the role of nutrition and hydration in planning and providing end-of-life care. This includes following advance care plans for nutritional support, and recognising a drop in food and fluid intake as part of the dying process.

Monitor patients to ensure that periods of fasting before and after surgery and tests are minimised.

Identify, and provide access to, nutritional support for patients who cannot meet nutritional requirements with food alone

Consider the need for nutritional support such as oral nutrition supplements, enteral nutrition or parenteral nutrition when oral intake is inadequate or contraindicated.

Support patients who require assistance with eating and drinking

Monitor patients’ food intake and their capacity to independently eat and drink, and help when required.

Day Procedure Services

Nutrition risk screening may be required before, or on, presentation at day procedure services such as chemotherapy or dialysis units. Patients using these services may need to be referred for nutrition assessment. Consider including nutritional planning in the patient’s healthcare plan. Refer to the hospitals tab for detailed implementation strategies and examples of evidence for this action.

MPS & Small Hospitals

A nutrition risk assessment is part of the organisation’s screening and assessment processes, and involves:

  • Conducting screening on admission and weekly during an episode of care if care changes or if the patient’s condition changes, or at routine review
  • Considering nutrition risk such as malnutrition and dehydration, dysphagia, special dietary needs, food intolerance or allergy
  • Documenting the results of nutrition risk screening and assessment.

If a nutrition assessment is required, consider:

  • Weight and intake history
  • Physical assessment
  • Condition of the mouth, teeth or dentures
  • Ability to swallow safely
  • Ability to open packages
  • Ability to self-feed
  • Nutritional impact of symptoms of disease or treatment.

Monitor the nutritional care of patients at risk

Ensure that the nutritional care for each patient is planned and documented. For patients with, or at risk of, malnutrition or dehydration, increase the level of food and fluid intake, and nutritional status monitoring. Act when poor oral intake, weight loss or other change in nutritional status is detected.

Consider the role of nutrition and hydration in planning and providing end-of-life care. This includes following advance care plans for nutritional support, and recognising a drop in food and fluid intake as part of the dying process.

Monitor patients to ensure that periods of fasting before and after surgery and tests are minimised.

Identify, and provide access to, nutritional support for patients who cannot meet nutritional requirements with food alone

Consider the need for nutritional support such as oral nutrition supplements, enteral nutrition or parenteral nutrition when oral intake is inadequate or contraindicated.

Support patients who require assistance with eating and drinking

Monitor patients’ food intake and their capacity to independently eat and drink, and help when required.

Last updated 5th July, 2018 at 08:33pm
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References

National Health and Medical Research Council, Australian Government Department of Health, New Zealand Ministry of Health. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Canberra: NHMRC; 2006.

National Health and Medical Research Council. Australian dietary guidelines. Canberra: NHMRC; 2014.

Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.