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Patient Safety NUTRITION

Patient Safety NUTRITION. Presented by the Dietitians and Clinical Nutrition Nurse Specialists 2012. Objectives. To appreciate the need to complete MUST every 5-7 days. To understand the First Line Action Plan and implement appropriately at ward level.

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Patient Safety NUTRITION

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  1. Patient Safety NUTRITION Presented by the Dietitians and Clinical Nutrition Nurse Specialists • 2012

  2. Objectives • To appreciate the need to complete MUST every 5-7 days. • To understand the First Line Action Plan and implement appropriately at ward level. • To appreciate if oral intake has not improved after 5-7 days to discuss a plan of action with medical staff. • To understand the range of sip feeds available and have a basic knowledge of when each one may be used. • Have an understanding of the barriers that patients have in receiving adequate nutrition in a hospital environment and ways to minimise these.

  3. Introduction Malnutrition is everyone's responsibility!!

  4. £13 Billion Why is it important to prevent Malnutrition? Muscle wasting affecting respiratory and cardiac function Increased mortality risk

  5. Nutritional Screening – MUSTMustbe completed every 5-7d Score: 0 LOW risk = observe Score: 1 MEDIUM risk = monitor Use weight chart to monitor weight Score: 2 HIGH risk = TREAT Initiate FLAP! Completing MUST provides guidance to establish a nutritional care plan for your patient

  6. If score > 2 get in a FLAP!! Includes: • Encourage ‘H’ High Calorie Options from main menu • High Protein Diet • Trial with supplements drinks • Monitor with Food & Fluid Charts & Weight Charts Has oral intake improved? Is weight stable/increasing? If oral intake has not improved after 5-7 days – discuss plan of action with the Medical Staff. Consider additional feeding e.g. tube feeding YES NO Continue

  7. Sweet or savoury preference? What specific supplements do they like? How many can they manage? What time of day do they want them? Would they drink full fat milk between meals? Would they eat 2 puddings? Turn FLAP from an Action Plan into a Care PlanFLAP needs to be personalised for each patient From the information, make a nutrition care plan and DOCUMENT this in the nursing care plans

  8. Which of the following are available for you to order for your patients as High Protein/Energy Extra’s? ?

  9. Full fat milk Fresubin Crème/YOcreme Cheese and biscuits Additional sandwich Mars bar Build Up Soup Cornish pasty Extra puddings Ice cream Big Mac High Protein/Energy Extra’s

  10. Full fat milk Fresubin Crème/YOcreme Cheese and biscuits Additional sandwich Mars bar Build Up Soup Cornish pasty Extra puddings Ice cream Big Mac High Protein/Energy Extra’s Patient’sdo notneed to be seen by a dietitian to obtain

  11. High Protein/Energy Menu cont… • Encourage ‘H’ options from standard menu • Encourage foods naturally higher in protein and energy e.g. • Breakfast porridge, breakfast cereals with milk. • Milky puddings e.g. custard, rice, semolina etc. • Encourage nutritious snacks/drinks between meals e.g. yoghurts, milk, cakes/biscuits with drinks

  12. Nutritional supplements

  13. If a patient doesn’t like milky supplements what alternatives could you offer them?

  14. Possible Answers: • Build Up Soups • Fresubin Jucy • Fresubin Crème and YOCreme

  15. What supplements are suitable for dysphagic patients requiring thickened fluids?

  16. Possible answers: • Fresubin thickened stage I or II • Fresubin YOcrème • Fresubin Crème

  17. What supplements could be offered to a patient requiring additional protein?

  18. Possible answers: • Fresubin 2kcal • Fresubin Protein Energy

  19. Which supplement is a fat emulsion and does not provide any protein, vitamins or minerals?

  20. Answer: • Fresubin 5 kcal shot

  21. Food and fluid chartsWould you consider nutritional supplements or artificial feeding for this patient?

  22. Food and fluid chartsWould you consider nutritional supplements or artificial feeding for this patient?

  23. What if FLAP does not change anything? If oral intake has not improved after 5-7 days discuss plan of action with the Medical Staff. ? Consider additional feeding e.g. tube feeding • MONITOR • Your responsibility

  24. Red Tray • Protected Mealtimes • Patients Meal Charter Ward-Based Initiatives to Help Tackle Malnutrition?

  25. Where can I find further information? Policies Diet sheets

  26. Where can I find further information? Menus and coding Ward posters Ward Manual

  27. Key messages • If MUST score > 2 initiate First Line Action Plan at ward level • If oral intake has not improved after 5-7 days – discuss a plan of action with the Medical Staff eg to consider NG feeding. • Use the intranet site for further support

  28. Any Questions?

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