issue 2 Nutrition News: The quarterly newsletter for care homes and care at home services across the Highlands Produced by Evelyn Newman, Nutrition and Dietetic Advisor for Care Homes. Designed by Medical illustration, Raigmore Hospital, Inverness Winter edition 2017 in this edition A review of texture modification study day in Thurso Care home food, fluid and nutrition group Learning and development news Nutricia nurses: here to help. Kayren Milne Homeward nurse An inspector calls Chris Tweddle from the Care inspectorate talks about her role in relation to care home food, fluid and nutritional care New Year s resolutions... I wonder how many of you have made it to this point in the year with your New Year s resolutions still intact?... Don t worry: there s still plenty of time to plan ahead into 2017. Have you got your local hydration challenge off to a flying start? If you haven t already taken the challenge please look back at the autumn edition for a bit more guidance. A good fluid intake is vital in preventing headaches, irritation, UTIs, confusion, falls, constipation and tiredness (to list a few). For more details of the importance of hydration look at the fluid fact sheet on www.bda.uk.com Well, we finally managed to deliver a full day of texture modification training in The Horizons centre, Thurso at the end of 2016. It was a great event with a wide range of care home participants and speakers including: oral health educators, speech therapy, OT and me from dietetics. Chef George inspired everyone with his wide variety of colourful, easy to make textured meals and puddings. The feedback was excellent so we hope to be able to see more of you again in 2017. I m always looking for examples of what you ve done differently to improve mealtimes for residents needing a modified texture. Some may have reviewed menus, offered more choices, purchased new equipment or involved local OTs and Speech therapists more often... Please email me with any more of your stories or examples at evelyn.newman@nhs.net A great day out in Thurso Nutrition News is a quarterly publication, which is developed with and for social care staff working in the Highlands to understand and improve nutrition and hydration for service users. Please pass it onto any colleagues who may find the information helpful.
Food, fluid and nutrition care group: a novel MDT approach Staff at An Acarsaid care home, in Broadford, Skye..... Food memories The next important date on the calendar is Easter. Will you be doing anything special on this special weekend? What do you or your service users remember about this time of year? Maybe you have great memories of decorating and rolling hard boiled eggs, a special family lunch and maybe even a chocolate egg! Whatever they are, why not try and build a special event or afternoon social around it with relatives/carers? You ll find out lots more about people than just favourite foods etc and create lots of discussion and laughter as well, no doubt. I d love to hear more about anything you have planned and if you have photos to share, please pass them onto me. have been meeting every couple of months with local dietitian, Kathryn Isles, along with members of the catering team at The MacKinnon hospital. As residents meals have been produced at the hospital over the past 18 months, this helps to make sure that everyone is involved in discussing the choice and nutritional quality of meals as well as trouble shooting any problems together. At a recent meeting, OT Julia Rudrum spent time discussing and demonstrating aids and adaptations to support residents, with physical or practical difficulties, to eat as independently as possible. Catherine Smith, manager of An Acarsaid, said We find it really helpful, to involve external staff so that we can take time to discuss food, fluid and nutrition and to review the care plans for any particular residents that we have nutritional concerns about. It s also a great opportunity to receive relevant updates and refreshers about topics linked to delivering good nutritional care. I would encourage other care homes to consider trying this multi disciplinary approach too. 2
Learning and development news MUST training is available to all areas of The Highlands all year round. Contact me or one of the Nutricia nurses (see article by Karen Milne) for more details. New! I have now taken delivery of the brand new Hydration game from Focus Active, which I helped to develop in partnership with NHS England, the University of East Anglia and others. I was able to test out a prototype with a few Highland care homes last Autumn but it is suitable for all settings: for staff and service users old and young. If you would like to learn more about it please take a look on the company website: (www.focusactive.com) or the twitter account on: @HydrationGame If you d like to borrow it (or any of the other Focus games), please let me know. Hydration game : Texture modification training: 4th May 2017: Smithton Church, Inverness. 23rd August 2017: Glenmorriston hall 22nd November 2017: Strathpeffar community centre 23rd November 2017: Smithton Church, Inverness More details will follow to book places, nearer the time. For access to the MUST calculator or App for your smartphone/ tablet please look on www.bapen.org.uk where you can also print off posters, leaflets and details on estimating BMI and Height. 3
Nutricia Enteral Nurse Specialist Role (ENS) The role of the Nutricia nurse within NHS Highland is very varied, like our weather; there are no two days the same! The nursing service forms part of the current 4 year enteral feeding contract, between NHS Highland, Highland Council and Nutricia Advanced Medical Nutrition. The nursing service offers training and support in the community for individuals, families, care homes, schools, basically anybody involved in caring for anyone who is receiving enteral feeding. There are currently two nurses in Highland, Peter Berrie and Kayren Milne. They are supported by the wider team of 10 throughout Scotland including two senior nurses and one clinical manager. Kayren says: I enjoy the diversity of the role along with seeing the patient journey from hospital through discharge and beyond. Individuals are generally referred to the nurse service by the managing dietitian. Peter or Kayren will typically see someone prior to discharge from hospital and demonstrate how to care for whichever type of tube is in situ; the surrounding skin; hand washing; positioning; flushing the tube; unblocking the tube; how to give medications; and how to set up pump if appropriate. The nurses will see the individual and/ or families as necessary and will then arrange a further contact or visit when they are discharged home, to ensure there are no concerns. There is also an out of hours number available twenty fours a day to support them with any problems that arise out with normal working hours (Monday to Thursday 9-5, Friday 9-4). Peter and Kayren also ensure that individuals and/or their carer is aware of how to look after the equipment, how to clean the pump and store the feed safely. All supplies are delivered to the person s home address if they are agreeable to this and the nurses will ensure they are informed of how the delivery service works and who to call if any issues. Peter and Kayren may also change feeding tubes but their primary role is to train and support people being fed, their carers, and the community staff. The nurses are also involved in delivering training to Care Homes and a range of healthcare professionals on all aspects of enteral feeding including MUST training. If you would like to discuss any aspect of someone s home enteral feed or arrange staff training please contact Peter or Kayren on 08452501078. The out of hours number for help and advice is 08457623636. 4
Nutrition An inspector calls News Article Chris Tweddle My name is Chris Tweddle, I am an inspector of older people s services and have been working for the Care Inspectorate for over 12 years. Prior to this I managed a care service that supported people who lived with dementia. I currently work within a team of nine dedicated colleagues. We cover a range of both residential and day care services for adults and older people across the Highlands and Islands. Food is very important to me and my dining table is where I show my love for the people that are in my life. Older people have a wealth of life experience that we can all learn from. I enjoy sitting and chatting with people hearing about their past lives and how this has shaped them as individuals and this simply is why I chose to work in this particular area of care. As part of the inspection process we look at how services provide good nutritional support. The basis of which should stem from a policy and procedure that makes clear the arrangements for; assessment and care planning including communication issues and any assistance needed to eat. The dining room environment and menu planning are also important aspects that need consideration and careful planning. Care services face the challenges of supporting people with their healthcare and dietary needs. As a nation we are living longer and with advancing age comes frailty. In addition dementia care is high on the health care improvement agenda in Scotland and as such present staff with a myriad of challenges. It goes without saying, therefore that staff working in services need to be skilled in recognizing and dealing with specific nutritional problems associated with frail older people. Other aspects for staff to consider are that mealtimes are often viewed as a communal activity in most care homes and as such may be quite alien to individuals. A person centred approach to the planning of care enables staff to ensure that there is sufficient detail with regard to people s physical, social and cultural and spiritual needs. This promotes opportunities to be involved with decisions and experiences. The management of mealtimes needs to be driven by the people who live in the service, be flexible and not based on our preferences, or for ease of management. Allied healthcare professionals provide invaluable support and guidance for staff. Such as helping services with menu planning, developing the dining experience and supporting individuals with eating and drinking issues. NHS Highland staff in dietetics, occupational health, dental and speech and language therapy work closely with all care homes. They have provided comprehensive resource folders, can lend equipment and have arranged various training sessions to educate and support staff with their practice. Good nutrition not only plays a part in one enjoying mealtimes but can also have a positive outcome in terms of reducing the likelihood of falls and infections and avoiding delirium and depression. In the words of Virginia Woolf One cannot think well, love well, sleep well, if one has not dined well (A Room of Ones Own, 1928). Raigmore Hospital Inverness Feb 2017