Thursday 6 August 2009

NHS Food and Baby Care

An NHS Tayside roadshow highlighting the importance of food, drink and nutrition to clinical care was launched at Ninewells Hospital, Dundee this week. It is estimated that between 15% and 40% of patients who are admitted to UK hospitals are at risk of malnutrition. Ninewells is playing a significant role.

Dietetic consultant Joyce Thompson said "We're invested a lot of time in training staff to carry out assessments with patients. To begin with we have a discussion with the patient, then we weigh them and work out their body mass index to find out if they're already suffering from malnutrition, or if they're at risk. Patients are involved at every stage from menu to recipe development. There's been a lot of enthusiasm and positive vibes from the wards and the kitchen. At the end of the day, food and drink matters and it's something the patients talk about - they care."

To be honest, if you're in hospital food becomes the highlight of the day for most, or at least mealtime does. To think that between 15% and 40% of patients are at risk is a vast amount. A more interesting analysis would be to see how these percentages relate to age groups, although it is admitted the elderly are more vulnerable.

Now NHS Tayside is offering individual menus to patients, perhaps they can get around to ensuring every patient is able to feed themselves. Just the other week a friend mentioned when visiting her mother, she complained of hunger. It appears she couldn't reach her lunch tray and nobody offered help. Did my friend complain? No, she thought it would be a waste of time with endless letters going back and forth.

I wonder if this has extended to Scottish maternity units? In recent years Bounty, best known for providing "goodie bags" to mothers, have started to take photographs if newborn babies in increasing numbers of hospitals in England, signing separate contracts with trusts in which it agrees to pay out about £1.50 per picture taken.

It's staff - who are allowed to park free on hospital sites while patients and relatives are forced to pay - tour maternity wards with laptops and cameras and after a new mother arrives from the delivery suite they ask to take photos of the new child. If the mother signs up she is charged for the prints.

Surely this is an invasion of privacy - perhaps not legally but certainly morally. Childbirth is stressful enough without worrying about a complete stranger thrusting a camera into your baby's face then charging you for the privilege.


McGonagall said...

Not many people without a digital camera these days Subrosa - so no need for this "service".

subrosa said...

Exactly scunnert. But of course it makes money for the Trusts and Bounty so the mother and baby are really enablers rather than customers.

Ought to be banned, right now.

Anonymous said...

"It is estimated that between 15% and 40% of patients who are admitted to UK hospitals are at risk of malnutrition"
Between 15% and 40% ? Its a huge varience, very weak figures..

As for the happy snappers, well to right they mothers should be charged, have you seen what some of they new born bairns look like ?

subrosa said...

Damn, I left the info link out Spook, thanks for reminding me. The figures were quoted in the Courier yesterday.

Every new born baby looks divine to their parents let me tell you. :)

Clarinda said...

AMW - I agree that the statistics given here are far too variable to make a definative impact on imlementing any solution - but there is already good specific evidence that could be implemented to target this mainly preventable circumstance.

For my sins, since the mid 70s, the perilous state of patient nutrition was one of my necessary interests as a Senior Critical Care Charge Nurse, where nutrition was a high priority. Through my teaching career I made particular reference to this but was usually met with the inexcusable excuse of lack of staff and time! It was, and probably still is the case, that almost all patients are at risk due to the eye-watering revellation that being ill usually means there is a dietry deficit or difficulty. This is now made worse by the relinquishing/minimising of the responsibility, by senior clinical nursing staff, to ensure that patients eat adequately by delegating the practical skills needed to junior staff... and checking up on them! It is time consuming fundamental practice, too often regarded as a 'non-nursing' or menial task, but it's the patient who needs to consume.
Surgical patients are more generally at risk of "iatrogenic"(induced by clinical circumstances)malnutrition rather than others, with those suffering from multiple trauma, burns, infection and chronic disease being at the highest risk.

It's bad enough in adult nursing and I cannot speak for paediatrics except to say from the personal experience of having a very ill child for a number of years, the food supplied was horrendous in type, nutritional content and appearance in a particular hospital - he refused to eat any of it and I wasn't surprised. For over three years I brought in home-cooked food without which iatrogenic malnutrition would have been inevitable and even fatal. I gather from colleagues it hasn't improved much since.

Nurses must take back full responsibilty to coax and assist patients to eat adequately in order for all medical/surgical therapies (and even survival) to have the best chance of success.

Dieticians are thin on the ground (no pun intended, but they cannot be responsible for physically feeding patients)), a dismal nurse leadership and supervision at ward level, the removal of the old ward kitchens ('elf'n safety) and early discharge added to a general indifference to patients diets - unless malnutrition is blatantly obvious - make for the likelihood of medical complications, prolonged healing of wounds, readmission and sadly the inevitability of many deaths at tragic cost to the patient and remarkable financial cost to the NHS.

This is NOT a new phenomenon - what is still lacking is the resolve to act on the mass of good evidence, stretching back 40 years, particularly at the clinical work-face of the nursing 'profession'. End of rant.

subrosa said...

Ah Clarinda, I just knew this post would be right up your street!

Thank you so much for your comment. Excellent as usual.

As I said, the NHS can have all the dieticians and boxes to tick that they wish, but still some patients are not even being encouraged to eat.

During my spells in hospital a couple of years ago not once did I see a patient being given assistance with eating and there were two in my ward who just left each tray untouched. No questions asked of course.

Unknown said...

Don't get me started on the whole Bounty bag process. I haven't seen a recent one, but I know that in the not so distant past, the stuff that they give out sails pretty close to the wind on the Infant Feeding Regulations and in some cases is in direct contravention of Government guidelines.

The moment families get back from the delivery suite is private and special. I'm not impressed to think it could be interfered with by an intrusive camera wielding member of staff. I hope that at the very least they would approach people in a sensitive manner.

I'm not convinced that all staff get to park for free all the time at hospitals, either. It certainly didn't used to be the case. Having said that, I don't see why they shouldn't. Nursing shifts begin and end at very unsocial hours, for much of the year in darkness. I think providing staff with a free parking space is a good thing.

subrosa said...

I think it's worse than that Caron. The Bounty camera wavers aren't NHS stuff, it seems to be a private business, but they're allowed the run of the maternity units by the sound of it.

As for infection control...

Anonymous said...

Subrosa & Clarinda

I wasn't disputing the figures, just that huge variance seems to me that they can collect info properly.

Even at 15%, this is to hight.

Heathpark Lodge said...

I understand Spook and I'm sure Clarinda does too. The variables are silly but the NHS are perhaps covering themselves.

I'll let Clarinda dispute that.

Clarinda said...

Heathpark Lodge
I once knew a pathologist who said that if the role of malnutrition was to be included as a contributory factor in establishing the cause of death - there would be an outcry - making statistics of MRSA and C.Diff.(however unacceptable) much less significant as a health care priority. "Cover up", you bet! I wonder how much more expensive it would be to deal with appropriate nutrition and it's direct nursing implications for every patient rather than make daft rules about flowers in wards and removing magazines from waiting rooms - where is the evidence? I rather think that this falls into the 'must be seen to do something' category. Do the waiting-room chairs get wiped down between every outpatient bahoochie that has touched them - I think not! I suggest faster recovery and wound-healing would be achieved through decent nutrition than the banning of begonias from the ward window sill. While I'm at it - openning a few windows would improve the stagnant fetid air in most wards and possibly reduce the potential of cross-infection.

subrosa said...

Oh Clarinda, you're mentioning everything I've thought about, particularly the lack of fresh air in wards. In PRI a couple of years ago the windows were never opened. I used to have to trauchle up and down two flights to stairs just to get a few deep breaths. I was told the patients complained there was a draft with the windows open. If the ones who weren't bed-bound bothered to put clothes on instead of sitting around in nighties all day, they maybe wouldn't feel the draught so much.

As for the flower business it's a nonsense. People bring in all sorts of things, fruit, juice etc and cross-infection goes on all the time.

I'm not at all surprised at what the pathologist said. My father was starved in Ninewells years ago and I can't say much has inproved. Oh that's perhaps unfair - I'm sure a lot of boxes on sheets of paper have been ticked and filed appropriately.

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