A Review of the
Cup of Tea
cycle...
Raising the multiple issues linked
to preventable dehydration in
elderly care
By
Naomi Campbell RGN
Hydration Lead (secondment)
Innovator & lead of
Cornwall Hydration Project
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Cornwall Hydration Project
Supporting Oral Hydration Care Systems (SOHCS ™)
Why focus on the Cup of Tea?
To keep it simple!
then we can
ALL
understand the challenges we face in
tackling the problem of dehydration in
elderly care
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
How much does a person
need to drink to avoid the
onset of dehydration ?
• Evidence from across the globe
supports a minimum daily volume
of 1,600mls
• This is the equivalent of 8
standard drinks
So why is that dehydration is such a
huge problem?
Drinks are regularly handed out!
© 2012 Naomi Campbell
'Cornwall Hydration Innovation
Project'
The Tea Trolley ... A familiar
sight in most care settings
6 x a day 7 days a week 365 days a year
A review of ‘ The 'Cup of Tea' cycle:
Cornwall Hydration Project- N Campbell
© 2012
The Tea Trolley
Six cups of tea a day
= approx 75%
recommended daily intake of
1600mls needed to prevent the
onset of dehydration
A review of ‘ The 'Cup of Tea' cycle:
Cornwall Hydration Project- N Campbell
© 2012
But how much is poured
down the drain every day?
&
why is it poured away?
The fact is... we simply don’t
know how much our
patients are actually
drinking!
“Failure to accurately monitor how
much elderly people are drinking
– is a root cause of avoidable
dehydration”
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N
Campbell © 2012
Adult Intelligent Fluid Management
Bundle
– NHS East of England 2011
Weakness in system processes that support
effective fluid
management
Inadequate staff knowledge and
competence in effective management of
volume assessment leading to over or
under hydration within the overall context
of holistic clinical assessment and care of
the patient
Insufficient governance of the accountability
for effective fluid management
Cornwall Hydration Project Naomi Campbell © 2012
NHS Kidney Care
June
2012
Inadequate
Hydration is one
of the main
causes of Acute
Kidney Injury
(AKI)
•AKI can occur in all
medical settings
•AKI affects 1:5 people
admitted to hospital
as an emergency &
many elderly patients
•1/3rd are considered
avoidable but to
achieve this
MONITORING of fluids
must become part of
regular care
Approx cost
to NHS £500
Cornwall Hydration Project - million
Naomi Campbell © 2012
How much are our patients actually
drinking?
in most care settings patients are offered on average 6 cups of tea
per day e.g.
200
ml
200
ml
200
ml
200
ml
200
ml
200
ml
= 1200ml
If all the cups are drunk = 75% Daily fluid intake goal
200
200
200
200
200
200
The Reality is often much less...
150
100
50
100
50
100
Failure to daily monitor and respond to poor fluid intake
= the gradual onset of dehydration
© 2012 Naomi Campbell 'Cornwall Hydration Innovation
Project'
Existing methods of
recording oral fluids
is ‘notoriously
inaccurate’
Finding new
practical and
effective monitoring
systems is essential
We need to
think
differently!
A review of the The 'Cup of Tea' cycle:
Cornwall Hydration Project- N Campbell ©
2012
Chronic dehydration
develops over time... Every
1600
day matters
1400
1200
Daily Fluid
Goal
1000
800
Reality
600
400
What is the
root cause for
such a deficit?
200
0
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
50 yrs on...
the same
amount of
time is
needed at
the bed
side
© 2012 Naomi Campbell
'Cornwall Hydration Innovation
Project'
Poor staffing levels are a known
risk factor for dehydration
But
Little is known about how much
help a vulnerable elderly person
needs to drink
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Cornwall Hydration Project - is developing a ‘Tool’ to help
evidence how much help a patient needs to drink & eat
How much
Providing
evidence to
support
essential
basic care
help
is needed to
drink & eat?
How much
time is
needed to drink
& eat
Improving
accountability
at all levels
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Recognising
work load
staffing
demands
Skill mix
gap
1
Patient
admitted
Inconsistent
outcome of care –
risk of dehydration
No
Dehydration
risk
assessment
tool
Who / How / When /
Where?
monitors how much
has been drunk?
cup cleared
away
Risks not clearly
identified
The cup of Tea
cycle
Highlights the
gaps in the
systems &
processess
Patient
offered a cup
of tea
Patient
May OR may not
have had enough
help to drink
No valid ‘needs’
assessment tool
to identify level
of help to drink
gap
2
A review of the The 'Cup of Tea' cycle: Cornwall
Hydration Project- N Campbell © 2012
Encouraging & helping vulnerable people
to drink & eat ... Is
CRITICAL CARE
Where do you fit into the Cup of Tea Cycle?
What is your role?
How can you help to improve the systems & processes
that provide our elderly with essential drinks
Home
Primary
care
Community
care
Hospital
care
Preventable Dehydration in Elderly Care
( = immeasurable suffering + £billions )
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
We are all involved in the
Cup of Tea Cycle ...
We all need to work together to prevent avoidable
dehydration in elderly care
RGN
Chief
Exec
Finance
Matron
Catering
And
many
others!
relatives
Doctor
Admin
Patients
Discharge
GSA
Team
OT
Physio
SALT
HCA
House
Keeper
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Education & Training
Cornwall Hydration Project is
developing new innovative
measures to raise the profile of
this basic but complex nursing
task
We are ALL
supposed
to be part
of
‘hydration’
care ...
How can
this be
achieved?
cleaners, housekeepers...
relatives & volunteers, admin staff,
managers, CEOs etc ?
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
HEALTH
PROMOTION
Encouraging
elderly people
to drink is vital
More needs to
be done
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Fear of incontinence
deters many elderly people
drinking adequate fluids
‘What goes in.... Must
come out!!!’
Supporting timely
toileting needs is a
vital part of hydration
care
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012
Hydration
Caring
Sociable
Comforting
Pleasure
Personal Likes
& dislikes... I’d
prefer a coffee
or water
instead!
Kindness
Crosses all
boundaries
Familiar
Routine
Nurturing
The Cup of Tea... represents so many
different things ... At so many different
times... To so many different people
A review of the The 'Cup of Tea'
cycle: Cornwall Hydration
Project- N Campbell © 2012