1
2
3
4
5
6
8
9
7
10
THE NURSING CARE STANDARDS
FOR PATIENT FOOD IN HOSPITAL
Body Mass Index (BMI)
Your weight in kilos
40
50
60
70
80
90
100
110
120
130
140
150
1.98
6’5
1.96
6’4
1.94
6’3
1.92
UNDERWEIGHT
6’2
OK
OVERWEIGHT
OBESE
© Crown Copyright
6’6
1.90
VERY
OBESE
1.88
6’1
1.86
6’0
1.84
1.82
5’11
1.80
5’10
1.78
1.76
5’9
1.74
5’8
1.72
1.70
5’6
1.68
5’5
1.66
1.64
5’4
1.62
5’3
1.60
5’2
1.58
1.56
5’1
1.54
5’0
1.52
4’11
1.50
1.48
4’10
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Your weight in stones
Underweight – you may need to put on weight by eating more.
OK – you are a healthy weight and should aim to stay that way.
Overweight – you need to make sure that your weight does not
continue to rise and try to lose some weight if you can.
Obese or very obese – your health is at risk and you need to
lose weight.
Your height in metres
Your height in feet and inches
5’7
Get your 10 a day!
THE NURSING CARE STANDARDS
FOR PATIENT FOOD IN HOSPITAL
Acknowledgements
Many people have contributed to Get your 10 a day! The Nursing Care Standards
For The Patient Food In Hospital. These include patient representatives, all
members of the multidisciplinary team as well as colleagues from Estates Services
and catering. Thanks also to all of those who contributed to both the initial
workshop (annex 1) and those who provided critical feedback during the
consultation phase. A particular word of thanks to Pauline Mulholland, Nutrition
and Diet Therapy Manager at the South Eastern Trust for her ongoing commitment
and support, to Margaret O’Hagan, Nursing Officer, DHSSPS, for leading on this
important piece of work and Dr Carolyn Mason, Head of Professional Development
at the RCN for coordinating the entire effort.
Foreword
Adequate food and fluids are as essential to good
care in hospital as the medicines patients are
prescribed and the treatment they receive. Simply put,
meeting patients’ nutritional requirements will help
them return to health more quickly and prevent a
whole range of complications which can delay recovery.
Patients rightly expect that during their stay in hospital they will be
provided with food that is both nutritious and appetising. As a result the
quality of food and beverages are often cited as a benchmark by which
patients and relatives judge the quality of care.
When patients are ill, there is more risk of them not eating the right
balance of nutrients which will help their recovery. The challenge for all
healthcare workers is to encourage and support patients in meeting
their nutritional needs. Responsibility for the delivery and presentation
of meals and fluids should be clearly defined, and those patients who
require help with eating or drinking clearly identified.
In Get your 10 a day! The Nursing Care Standards for Patient Food in
Hospital nurses and midwives have set out ways in which they can
improve the nutritional care and food experience of patients in hospital.
They have an important role to play in this fundamental area of
treatment and care. This initiative is an important part of an overall
strategic framework we are developing that will ensure that we can
provide nutritional hospital food that supports the delivery of high
quality health and social care. I am delighted that nurses and midwives
have put food in hospital high on their agenda and are leading the way
in improving patient care and the patient experience.
MICHAEL MCGIMPSEY
Minister for Health, Social Services and Public Safety
Introduction
Nutrition and the meal experience are of vital
importance to the patient in hospital. Not only is food
necessary for life and represents a basic human right,
but it is also a source of great pleasure, with important
social, cultural, and religious functions all of which need
consideration within a hospital setting. However as
recently highlighted by Age Concern in the Hungry to be Heard campaign
we do not always get it right.
Nurses and midwives in Northern Ireland are dedicated to providing the
best possible treatment and care to their patients. As the health workers
who have most direct contact with patients in hospital1, nurses and
midwives have huge potential to improve the patient experience in relation
to eating and drinking and nutritional care. This potential can be realised by
focusing our efforts on improving all aspects of food, fluid and nutritional
care and giving nurses2 the practical tools and support they require to
make nutrition a priority in the area where they work.
Get your 10 a day! The Nursing Care Standards for Patient Food in
Hospital has been developed as a collaboration between the DHSSPS
Directorate of Nursing and Midwifery and the Royal College of Nursing
(RCN) as a Northern Ireland response to the RCN’s national Nutrition Now
campaign.
The nursing care standards outlined in Get your 10 a day! represent the
views and experiences of a broad range of stakeholders and were informed
by an extensive evidence-base of knowledge and best practice from
throughout the United Kingdom. They are designed to provide a framework
within which patients, relatives and carers can participate in shaping the
way that food and drink is offered and taken, and to promote
1 The term hospital refers to all in-patient facilities in Health and Social Care Trusts across NI
2 Throughout this document the term Nurses refers both nurses and midwives within the hospital setting.
multidisciplinary working with nurses, healthcare assistants, dieticians,
catering staff and speech and language therapists and others working
towards the common goal of improving the patient experience of food and
mealtimes in hospitals.
MARTIN BRADLEY
Chief Nursing Officer
Contents
Background
3
The 10 Nursing Care Standards
7
Standard 1
9
Standard 2
13
Standard 3
17
Standard 4
21
Standard 5
25
Standard 6
29
Standard 7
33
Standard 8
37
Standard 9
41
Standard 10
45
What Now?
48
Annex
49
Annex 1
51
PAGE 1
Background
The provision of food, fluids and nutritional care in hospital is a
multifaceted area of service and is the responsibility of many members
of the hospital team. This is a diverse team and includes clinical staff:
doctors, nurses, midwives, dieticians, speech and language therapists,
occupational therapists and those in support roles: catering, domestic,
healthcare assistants and therapy assistants. For patients to get the
best possible service and derive maximum benefit from food, all
members of the team must work together and “do their bit” in
partnership with the patient and their relatives/carers.
The nursing service in hospital is 24/7 and as such nurses are the only
group staff who have direct contact with the patient at every mealtime
and at all times in between. Therefore, nurses play a pivotal role in
nutritional care and the meal experience of patients. The nursing
responsibility is broad ranging and includes screening, assessment,
planning, monitoring, serving, practical help with eating and drinking
and on occasion, preparation of food in the ward area. Nurses are
accountable for their practice in all aspects of the provision of food,
fluid and nutritional care and need to be able to demonstrate that
service and care are delivered to the highest standard possible. It is for
this reason that Get your 10 a day! The Nursing Care Standards for
Patient Food in Hospital have been developed for use across all
in-patient facilities in the health and social care Trusts across
Northern Ireland.
What is a standard?
A standard is a level of quality against which performance can be
measured. These standards have been written in simple language. They
are concise, clear and measurable. Each standard has a standard
statement, which explains the level of performance to be achieved. The
rationale section provides the reasons why the standard is considered
to be important and in the section headed criteria the context of the
PAGE 3
standard is explained. Finally all the standards contain examples of
how the standard can be demonstrated and monitored.
The evidence base for Get your 10 a day! The Nursing Care Standards
for Patient Food in Hospital was principally drawn from the following
source documents:
Age Concern (2006) Hungry to be Heard. The scandal of
malnourished older people in hospital. Age Concern, London
www.ageconcern.org.uk/AgeConcern/Documents/Hungry_to_be
_Heard_August_2006.pdf
Allison S. (1999). Hospital Food as Treatment: A Report by a
Working Party of BAPEN [British Association for Parenteral and
Enteral Nutrition], Maidenhead: BAPEN
www.peng.org.uk/food-as-treat.html
Kelly L, Tessier S, et al. (2000); Still Hungry in Hospital: Identifying
Malnutrition in Acute Hospital Admissions. Quarterly Journal of
Medicine 93 (2): 93-98.
McWhirter J, Pennington C. Patients (1997); Go Hungry in British
Hospitals: Malnutrition is common, unrecognised, and untreatable
in hospital patients [Letter]. British Medical Journal 314, (7082):
752.
RCN Nutrition Now Campaign: regular articles in Nursing Standard
beginning with the campaign launch reported in the issue 18 April,
2007 volume 21 no.32, and subsequent weekly articles in the
journal from 30 May, 2007 volume 21 no.38 to 17 October volume
22, no.6.
Council of Europe Resolution (2003) Food and Nutritional Care in
Hospitals How to Prevent Under-Nutrition: Report and
Recommendations of the Committee ff Experts on Nutrition, Food
Safety and Consumer Protection, Strasbourg: Council Of Europe
Publishing.
DoH (2003) Essence of Care – Patient Focused Benchmarks for
Clinical Governance - Benchmarks for Food and Nutrition. SF Taylor
&Co Ltd, Stockport
Edington J, Boorman J, et al. (2000); Prevalence of malnutrition on
admission to four hospitals in England. Clinical Nutrition 19 (3):
191-195.
European Nutrition for Health Alliance (2005) Malnutrition within an
Ageing Population: A Call to Action
bmj.com/cgi/content/full/314/7082/752
PAGE 4
PAGE 5
The 10 nursing care standards for provision of
patient food in hospital
1
1
4
41
17
47
4
7
7
2
2
5
25
8
2
8
5
10
5
10
8
8
10
1
1
1
1
9
5 9
5
5 9
5
6 9
6
6
6
7 who require nutritional intervention will have a nursing care plan
3
7
3 Patients
implemented, evaluated and renewed to reflect the patient’s
7
3 devised,
nutritional and physical care needs and which documents both the dietetic
3
plan7
and the nursing
care assessment.
4
8
10
5
3
4
8
10
3 5
8 who require
10 food and/or fluid intake to be monitored will have
5 Patients
34
4
8
10out in a way that is informative, accurate and up-to-date.
3 5 that activity carried
3
3
6
36
399
6
6
9
9
10
III
III
III
III
11
11
44
44
77
77
999 9 9
99
9
999
9
All patients admitted
9 to hospital are screened for risk of malnutrition.
9
99
999
999
99 9
9 999 9
9
9 99 9
9
9 9 999
9
9
9 by nurses, patients who are identified as malnourished
9
Following screening
999 9 9 999
9
or at risk of malnutrition
are referred for and receive a nutritional
9 9 9 99 9
assessment appropriate to their level of need.
III
III
III
III
III
III
III
III
IIII
I
IIII
IIII
IIIII
IIIII
IIIII
IIII
IIII
1
1
22 3333
22
55 6666
55
88 999
88 9
10
10
10
10
IIIIII
IIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIIII
IIIII
IIIII
IIII
IIII
III
IIII
III
IIII
III
III
III
III
III
III
III
III
II
II
III
II
III
II
9
9 99
9
99
9
9
9
9999
99999999 who require support with eating and drinking are clearly identified.
99Patients
99
9
99
9
5
5
6
6
9 99 99 99999999
9
9999999 999 9
9
9
Patients who require support with eating and drinking receive assistance
when it is required.
Patients will be served their food and allowed to eat their meals without
3
99
99 7
7
3
disruption.
1
9
5 99 9
receive their meals in a physical environment that is conducive
45
8 Patients
10
3
10
5
34
8
to enjoying their food.
6
9
1
4
7
2
5
6
8
9
9
2
9 99
IIIIIIIIIIIIIII
II II IIIIIIIIIIIIII I I I I I I I I I I I I I I II II II II II II II II II II I I I I
I II II II II II
I I I I II I I I I
IIIIIIII
IIIIIII
IIIIIII
III II
II I
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIIIII
IIIII
IIIII IIIIIIIIIIIIIIIIIIIIIIIIIIII
IIII
IIII
IIIIII
IIII
II
IIIII
I I II II I I I I I I I I
III
I
I
IIII
III
II III
III
III
I I II I I I
III
III
III
III
II
31
3
4
5
6
7
8
9
10
9
I
IIII
IIIII
I II II I
I II II I
III I
10
1
9
9
3
75
III
III
III
IIII
IIIII
I
IIIII
3
IIII
IIII
III
III
9
99
9
9
99
9
9
whatever reason and can access snacks at ward level.
9
86 10
345
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIIII
99 9 9 9
Patients are offered a replacement meal if they miss their meal for
9
The patient receives food presented in a way that is
appealing and appetising.
II
7
PAGE 7
FACT
Four out of 10
older people
1
admitted to
hospital have
malnutrition
4
on arrival.
7
STANDARD
2
3
5
6
8
9
10
1
All patients
admitted to
hospital are
screened for
risk of
malnutrition
3
5
6
7
NT
E
M ES
E
G
NA ELIN
A
M UID
G
STEP
5
ACUTE
DISEASE
EFFECT
SCORE
+ WEIGHT
LOSS
SCORE
BMI
SCORE
2
3
STE
P
STEP
OVERAL
RISK OFL
MALNUT
RITION STEP
4
1
4
7
2
1
3
All patients admitted to hospital are screened
for risk of malnutrition
5
8
10
6
Rationale
Screening is a process of identifying patients who are
already malnourished or who are at risk of becoming so. All
patients, especially those who would be more vulnerable like
older people, need to have their nutritional needs identified
and met in order to advance their recovery and/or create
optimum wellbeing, whatever their condition or level of
dependence.
9
Criteria
Incorporated in an organisational policy for food and
nutrition will be guidelines which clearly identify the process
for nutritional screening for all patients on admission to
hospital. These guidelines are implemented and monitored
within the context that:
• All staff understand the fundamental importance of
nutritional care and treatment of patients
• All staff are fully aware of the screening policy and
understand their role and responsibilities within it
• A reliable and valid tool is used to screen patients on
admission to hospital e.g. Malnutrition Universal
Screening Tool (MUST) for adults
• All staff that screen patients are trained in the use of the
specific tool used in the Trust.
3
345
How this standard can be demonstrated and monitored
• Documentation audit against all elements of the
screening tool
• Audit of staff training records
• Benchmarking activity which includes action planning for
improvement.
II
I
III
III
III
IIIII
IIIIII
IIIIIIIIIII
STEP
1
PAGE 11
IIIIIIIIIIIIIIIIIIII
IIIIII
I
1
4
2
3
1
5
6
STANDARD
FACT
9
7
Patients over the 8
age of 80 admitted
to hospital have a 10
five times higher
prevalence of
malnutrition than
those under the
age of 50.
5
6
Following screening
by nurses, patients
who are identified
as malnourished
or at risk of malnutrition
are referred for
and receive a nutritional
assessment appropriate
to their level of need
3
345
III
III
III
IIII
IIII
IIIIII
IIIIIIIIIII
IIIIIIIIIIIIIIIIIIII
IIIIII
IIIII
IIII
III
III
III
7
8
I
4
7
5
6
8
9
Following screening by nurses, patients who are
10
identified as malnourished or at risk of malnutrition
are referred for and receive a nutritional
assessment appropriate to their level of need
3
Rationale
Patients who are malnourished or are at high risk of
becoming malnourished will require referral for an in-depth
nutritional assessment. Assessment is a more detailed
process than screening, in which a range of specific methods
can be used to identify and quantify impairment of
nutritional status. Assessment is undertaken by registered
practitioners who have received the necessary education
and training and have been registered as competent to
undertake the level of assessment required e.g. dietitian.
345
Criteria
An organisational policy for food and nutrition will clearly
identify the process for nutritional assessment for patients
who are malnourished or at high risk of becoming
malnourished patients in the hospital setting. The policy will
be implemented and monitored within the context that:
• All staff understand the fundamental importance of
nutrition in the care and treatment of their patients
• Patients are referred appropriately for dietetic assessment
if required
• A reliable and valid tool is used for assessment
• The outcome of the assessment is available to the
multidisciplinary team.
I
I
III
III
III
IIII
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
How this standard can be demonstrated and monitored
• Documentation audit
• Audit of dietetic referrals
• Benchmarking activity which includes action
planning for improvement.
PAGE 15
IIIII
I
5
6
8
9
4
7
10
FACT
Six out of 10 older
people are at risk
of becoming
malnourished.
6
STANDARD
7
3
Patients who require
nutritional intervention
will have a nursing care
plan devised, implemented,
evaluated and renewed
to reflect the patient’s
nutritional and physical care
needs and which
documents
both the dietetic plan
and the nursing care
assessment.
345
III
III
III
III
III
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
III
8
3
Patients who require nutritional intervention
will have a nursing care plan devised, implemented,
evaluated and renewed to reflect the patient’s
nutritional and physical care needs and which
documents both the dietetic plan and the nursing
care assessment
345
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Rationale
Patients who require nutritional assessment and subsequent
intervention must have a nursing care plan devised,
implemented and evaluated to document and communicate
the nutritional care and treatment that is required by the
patient.
I
III
III
II
IIII
IIIII
IIIIII
Criteria
An organisational policy for food and nutrition will clearly
identify documentation to support the planning, provision
and evaluation of nursing care provided to patients requiring
nutritional intervention. These guidelines are implemented
and monitored within the context that:
• All staff understand the fundamental importance of care
planning
• A registered nurse plans and evaluates the nursing care
plan
• The nursing care plan reflects the dietetic assessment
and treatment plan
• The patient’s clinical notes reflect the monitoring,
decision-making and action/evaluation process with this
aspect of nutritional care.
How this standard can be demonstrated and monitored
• Audit of nursing notes and/or care plan
• Benchmarking activity which includes action planning for
improvement.
PAGE 19
IIIII
10
7
3
STANDARD
FACT
Patients who are
malnourished stay
in hospital for a
longer time, require
more medications,
and are more likely
to suffer from
infections.
345
III
III
III
III
III
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
III
Patients who
require food and/or
fluid intake to be
monitored will have
that activity carried out
in a way that is informative,
accurate and
up to date
8
345
II
I
III
III
III
IIIII
IIIIII
IIIIIIIIIII
Patients who require food and/or fluid intake to
be monitored will have that activity carried out in
a way that is informative, accurate and up to date
Rationale
The amount of food and fluid a patient consumes must be
known as it is a vital indicator of effective care and
treatment.
Criteria
An organisational policy for food and nutrition will clearly
reflect need for recording and monitoring food and fluid
intake. The policy will be implemented and monitored within
the context that:
• All staff understand the fundamental importance of
recording and monitoring food and fluid intake, and the
requirement to take action when there is cause for
concern
• Registered nurses take individual responsibility for
ensuring that patient’s fluid and food intake is monitored
and recorded where applicable
• The record is available to the multidisciplinary team
• There are clear indicators of when action should be taken,
what action and by whom.
How this standard can be demonstrated and monitored
• Observational audit
• Documentation audit e.g. audit of fluid balance and food
record charts
• Benchmarking activity which includes action planning for
improvement.
PAGE 23
IIIIIIIIIIIIIIIIIIII
IIIIII
IIII
STANDARD
9
9
9 9
9
FACT
3
1 It is2estimated
that
30 - 50% of
food
6
4 hospital
5is wasted.
7
8
1
5
Patients who
require support with
eating and drinking
are clearly identified
6
9
10
3
7
99
9
9
9
9
9
9
9
9
9
1
4
7
2
5
8
10
1
3
6
9
5
Patients who require support with eating and
drinking are clearly identified
6
Rationale
Many staff, some of whom may not be aware of an
individual’s needs, interact with patients before, during and
after meal times. Therefore there is a requirement for a way
in which patients that require assistance/support with eating
and drinking are easily identifed.
Criteria
Highlighted in the organisational policy for food and nutrition
will be a Trust–wide approach to identifying patients that
require support with eating and drinking. The policy will be
implemented and monitored within the context that:
• The Trust adopts a clear system of identifying patients
who require additional help with eating and drinking e.g.
coloured napkin/coloured tray
• All staff are aware of the system in place to identify
patients who require support
• Registered nurses take individual responsibility for
ensuring patients who need help are identified
• People (including relatives) with appropriate training are
available to assist patients with eating and drinking when
required.
7
3
345
8
How this standard can be demonstrated and monitored
• Observational audits
• Documentation audits
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users.
III
III
III
III
IIIII
IIIII
IIIIIIIII
IIIIIIIIIIIIIIIIIIIIIIII
IIIIII
IIII
IIII
III
III
III
I
PAGE 27
9
9
9 9
9
1
3
FACT
2The toll of
on
6
4 malnutrition
5 and health
health
care
costs
is
9
7 8
estimated to
exceed £7.3 billion
10year (much
per
more than obesity).
Over half of this
cost is expended
on people aged 65
years and above.
1
5
STANDARD
99
9
9
9
9
9
9
9
9
9
6
All patients who
require support with
eating and drinking
receive assistance
when it is required
7
3
345
III
III
II
III
IIII
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
III
8
10
4
7
5
8
10
6
9
All patients who require support with eating and
drinking receive assistance when it is required
Rationale
Patients may need assistance both prior to and when eating
and drinking. This may involve hand hygiene, positioning of
the person in preparation for mealtimes, oral hygiene or
actual ‘hands on’ assistance, as well as specific equipment
such as modified crockery, utensils etc.
7
3
when help is
needed!
Criteria
An organisational policy for food and nutrition will clearly
address providing assistance to patients who require
additional support with eating and drinking. The policy will be
implemented and monitored within the context that:
• Registered nurses take individual responsibility for
ensuring assistance/support for patients with eating and
drinking is provided
• People are available to assist patients with eating and
drinking when it is required
• People assisting patients with eating and drinking will
have received training to do so
• Patients’ dignity is never compromised
• Modified utensils and equipment, including furniture, are
available and used appropriately
• Independence is promoted.
345
III
III
III
IIII
IIII
IIIIII
IIIIIIIIIII
IIIIIIIIIIIIIIIIIIII
IIIIII
IIIII
IIII
III
III
III
8
I
How this standard can be demonstrated and monitored
• Observational audits
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users.
PAGE 31
1
4
7
1
2
5
6
8
9
5
99
9
9
9
9
9
9
9
6
10
STANDARD
“Nothing shall be
done on a ward
whilst patients are
having their meals”
7
3
Patients will be
served their food
and allowed to eat
their meals
without disruption
Florence Nightingale in 1859
345
III
III
III
IIII
IIII
IIIIII
IIIIIIIIIII
IIIIIIIIIIIIIIIIIIII
IIIIII
IIIII
IIII
III
III
III
8
I
10
7
3
Patients will be served their food and allowed to
eat their meals without disruption
Rationale
Nurses can improve the nutritional care and status of
patients by creating a protected environment that allows
patients to eat their meals without disruption.
345
8
Criteria
Integral to an organisational policy for food and nutrition will
be a protected mealtime policy for local implementation.
This policy will be implemented and monitored within the
context that:
• All staff are aware of and adhere to the protected
mealtime policy
• Non-urgent activities such as cleaning, non-priority
treatments, ward rounds, visiting etc. are designed to be
operated around and outside of pre-set meal times
• Staff and visitors respect the patients’ mealtimes as a
time focused on the patient.
III
III
III
III
III
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
III
How this standard can be demonstrated and monitored
• Multi-professional observational audits
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users
• Review and monitor lessons learned from complaints.
PAGE 35
10
7
3
FACT
Of 500 patients
admitted to an
acute hospital in
the UK, 40% were
undernourished on
admission and 75%
by the time of
discharge!
STANDARD
345
III
III
II
IIII
IIIII
IIIII
IIIIIIIIII
IIIIIIIIIIIIIIIIIIIIIII
IIIIII
IIII
IIII
III
III
III
8
I
Patients receive
their meals in a
physical environment
that is conducive
to enjoying
their food
10
345
III
III
III
III
III
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
8
III
Patients receive their meals in a physical
environment that is conducive to enjoying
their food
Rationale
The hospital ward environment, i.e. sights, sounds and
smells, and preparedness to eat can have an impact on the
individual’s desire and ability to eat and enjoy their food.
Criteria
Incorporated in an organisational policy for food and
nutrition will be an emphasis on process to ensure the ward
environment and preparedness of the patient is conducive to
eating and drinking. The policy will be implemented and
monitored within the context that:
• Consideration is given to tables, seating, utensils, adapted
utensils and washing/hygiene facilities
• Steps are taken to ensure the ward environment is
conducive to eating and drinking.
How this standard can be demonstrated and monitored
• Observational audits
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users
• Review and monitor lessons learned from complaints.
PAGE 39
STANDARD
9
9
9 9
9
“Thousands of
patients are
3
2
annually starved in
the
midst
of
plenty
6
5
from want
of attention to the
9
8
ways which make it
possible for them
10
to take food”
1
5
6
Florence Nightingale in 1859
3
7
99
9
9
9
9
9
9
9
9
Patients are
9
offered a
replacement meal
if they miss
their meal for
whatever reason
and can access snacks
at ward level
9
9
9 9
9
1
4
7
2
5
8
1
3
5
99
9
9
9
9
9
9
Patients are offered a replacement meal if they
miss their meal for whatever reason and can
access snacks at ward level
6
9
9
9
6
Rationale
Good nutrition is a cornerstone of effective care and treatment.
Access to food and drinks should match the needs of patients
and not be constrained by ward or service delivery routines.
9
Criteria
Incorporated in an organisational policy for food and nutrition will
be protocols regarding the provision of food available outside set
meal times. These protocols are implemented and monitored
within the context that:
• Registered nurses take individual responsibility for ensuring
that patients who miss a meal receive a replacement meal or
alternative food and beverage
• Individual patients are given choice to meet personal
preferences
• Food and beverage should be appropriate in respect of
religious and cultural factors, age related and special needs
• Food and beverage is served at the correct temperature for
patient preference and meets safety standards at all times
• All staff serving food will receive appropriate training to do so
• Suitable crockery and utensils are available at ward level
• Hot food and snacks are made available outside set
mealtimes.
10
7
3
345
III
III
III
IIII
IIII
IIIIII
IIIIIIIIIII
8
How this standard can be demonstrated and monitored
• Observational audits
• Audit of staff training records
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users.
IIIIIIIIIIIIIIIIIIII
IIIIII
IIIII
IIII
III
III
III
10
I
PAGE 43
10
7
3
FACT
Only 18% of
patients are
satisfied with the
overall quality of
food served.
STANDARD
345
III
III
II
III
IIII
IIIII
IIIIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
IIII
III
III
8
10
III
The patient
receives food
presented in a way
that is appealing
and appetising
345
III
III
III
I
IIII
IIII
IIIIII
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIII
IIII
III
III
III
8
10
II
The patient receives food presented in a way that
is appealing and appetising.
Rationale
To meet their nutritional needs, patients should have food
presented in a way that takes account of what appeals to them
as an individual. Food should be tastefully presented and
appealing to patients.
Criteria
Incorporated in an organisational policy for food and nutrition
will be an emphasis on the importance of food presentation.
The policy will be implemented and monitored within the context
that:
• All food, regardless of who prepares it or serves it, should be
presented to the patient in an appealing way
• Food and drink is served at the correct temperature for
patient preference and meets safety standards at all times
• All staff preparing and serving food will receive appropriate
training to do so.
How this standard can be demonstrated and monitored
• Observational audits
• Audit of staff training records
• Benchmarking activity which includes action planning for
improvement
• User satisfaction surveys
• Evaluation of stories from service users
• Review and monitor lessons learned from complaints.
PAGE 47
What Now?
Nurses have a real opportunity to improve the nutritional
care and meal experience of patients. This document has
been specifically designed so that the perforated pages can
be used as posters in the ward area to help get the message
across that nurses are serious about improving patient care
and experience in the area of food and nutrition in hospital.
This document will be distributed widely and the Directors of
Nursing in the Health & Social Care Trusts will be responsible
for implementing the standards and monitoring nursing
performance in this area. Progress of this will be kept under
review by the Chief Nursing Officer.
PAGE 48
Annex
Hospital Food
Annex 1
The top picture is an example of food patients receive in hospital. The picture
below is the same food pureed and moulded and is presented in such a way as
to resemble the pre-pureed meal.
Participants at Food Standards Workshop Royal
College of Nursing Northern Ireland 21 June 2007
NAME
ORGANISATION
Paddie Blaney
NIPEC
Ward Sisters will make sure that everyone knows the
George Boal
South
Eastern HSCT
importance of their own actions
in controlling
healthcare
June Cairns
South
Eastern
HSCT
acquired infections. They will make cleanliness standards
Jacqueline‘live’,
Clarke
Southern
HSCT
recognising achievements
and saying
thank you when
Pauline Croskery
Easternpoor
HSCT
things are done well, while alsoSouth
challenging
practice.
Changing attitudes will mean developing
pride in what
Stella Cunningham
Southern HSSC
people think of as ‘our’ ward environment,
Teresa Cushley
Belfast HSCTand adopting a
‘clean up as you go’ approach Belfast
to work.HSCT
Karen Davidson
Moira Davren
Royal College of Nursing
Governance arrangements within the Trust should support
Joanne Deery
Northern HSCT
cultural change by establishing robust accountability
Rosie Farrell
Belfastand
HSCT
arrangements. Systems of reporting
lines of
Anne Harris
Southern
HSCT
communication need to be clear.
The commitment
to
Michelle Hunt
Belfast HSCT
cleanliness is long term and induction,
ongoing training,
Liz Konya audit and dealing positively with
Northern
HSCTare examples of
complaints
actions that will strengthen theRoyal
driveCollege
to improve
the safety,
Carolyn Mason
of Nursing
orderliness
and
appearance
of
hospital
wards.
Angela McErlane
Northern HSCT
Ashleagh Millar
Belfast HSCT
Allison Mowbray
South Eastern HSCT
Useful Information
Edith Neale
The 2004 Controls Assurance Northern
Standard HSCT
on Infection Control
Adele Nichol
South
Eastern
HSCTas part of
provides a clear framework for control of infection
Suzanne O’Boyle
Belfast HSCT
the standard governance requirements
of the HPSS.
Margaret Governance
O’Hagan
DHSSPS
in HPSS, Controls Assurance Standards,
Anne Marie
Scally Control, DHSSPS 2004
South
Infection
can Eastern
be foundHSCT
at
Barbara Soye
Southern HSCT
www.dhsspsni.gov.uk/hss/governance/assurance_standards
Richard Walker
South Eastern HSCT
.asp
Fiona Watters
Belfast HSCT
Linda Wray
Belfast HSCT
PAGE 50
PAGE 51
Notes
PAGE 52
Forbidden foods by
religious group
Muslims:
Pork, non-halal meat and chicken, shellfish, alcohol
Hindu:
Beef, sometimes lamb and chicken, oily fish, sometimes
white fish, eggs, alcohol
Sikh:
Beef, sometimes all meat and fish, alcohol
Buddhist:
Chicken, lamb, pork, beef, shellfish (sometimes all fish),
alcohol
Rastafarian:
Animal products (except milk), foods that are not Ital (Ital food
is organic, not tinned or processed), added salt, alcohol, tea,
coffee
Jewish:
Pork, any meat that has not been koshered, fish without
scales and fins, shellfish. Meat and milk products served at
the same meal or cooked together.
Produced by: Department of Health,
Social Services & Public Safety
Castle Buildings, Stormont,
Belfast BT4 3SQ
Telephone: 028 9052 2593
Textphone: 028 9052 7668
www.dhsspsni.gov.uk
November 2007