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Tue 18th Oct 2011

Six Ways to Improve the Nutrition in Your Setting; help patients to eat themselves better.


Enabling patients to have a positive mealtime experience reduces bed blocking, improves nutritional profiles and speeds recovery. Can we afford to ignore the nutritional benefits?


1  Preferences, Choices and Communication


It sounds the easiest thing in the world doesnt it? Yes of course the patient has been offered the menu, made a choice and the menu has been sent back. However, it is easy for this process to go wrong for a number of reasons. Where menu choices are available in care or hospital setting sometimes the individual can mistake what is on offer or prefer to have a slightly different make up of the meal. 


It should be possible for patients to request no gravy or no custard or on a really fundamental level no gluten. These are basic rights. Many coeliacs have no separate facilities on wards for their gluten free bakery products to be prepared, toasted or sliced using separate equipment, therefore jeopardising the patients well being and exposing them to products which may have been contaminated with gluten. It does make a difference when the patient is confident that their specialist products have been protected. 


It may also be that some diners would prefer to eat away or with other diners and as far as possible this should be accommodated as it may effect their ability to eat.


Another example of miscommunication is what the dish actually contains. A meal of ham and eggs is different depending in which part of the country you are dining. In the south this would normally mean a meal of cold ham with fried egg. In the north this would normally mean a slice of hot bacon or gammon with eggs. This makes for a very different meal!


Discussing food choices and having a clear menu gives everyone the opportunity to realise their expectations and encourages eating which in turn enhances the patients nutritional profile.


Ensure all parties are involved with the food requirements from chef through to the medical practioners and always conduct an assessment of nutritional needs for each individual on arrival. It doesnt need to be complicated, but an assessment tool should always be used.



2  Assistance


To eat a meal without difficulty when unwell or unable to perform certain functions effectively can be tricky. Patients often need some assistance and this should be factored into staffing levels. Beds will be emptied faster where good nutrition is practiced; slow recovery is symptomatic of poor nutrition.



3  Protected Mealtimes


If anyone was to be subjected to an examination by medical staff during a meal it would be hard to expect this not to effect appetite when the patient is allowed to return to the plate. This is a basic right to receive and eat a meal without unnecessary interruption regardless of the seniority of the medical staff.


4  Hydration


Much has been discussed on this subject in many types of settings, but it seems there is still the need for this to be a priority everywhere. Good hydration is a requirement for all patients and it should be a priority to enable warm and cold drinks to be consumed at a level which promotes health.  Fresh water should always be available and within reach of a patient. Without adequate hydration health and mental acuity suffer making the patient suffer unnecessarily and causing additional and serious problems for the carers and nurses.


5  Glycaemic Index (GI)


Much has been reported and written about this subject, but it is still underused and sometimes little understood for patients and clients. The use of diabetic products is still quite widespread often hand in hand with high glycaemic foods which have such a big impact on blood sugar levels, particularly for diabetics in care who may be given mashed potato which is high GI or dried fruit in cereals, but then supplied with diabetic puddings. Diabetic products such as chocolate often have high levels of artificial sweeteners which can have a detrimental effect on the digestive system causing diarrhoea. Small portions of normal puddings as part of a balanced diet with unprocessed foods and vegetables are usually fine and without the side effects found with diabetic foods.



6  Monitoring


Finally all well and good designing the perfect menu and delivery of food in your setting, but what has the patient actually eaten and drunk and has the patient had an effective nutritional assessment on arrival before anything is planned? Assessments should be ongoing and enable further routine discussions to ensure the patient is comfortable and happy with the diet and food on offer.


Keeping tabs of food and drink consumed is basic and can help to alleviate any difficulties before they turn into real problems.