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Do red trays improve food intake?

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20 February, 2012

Do red trays improve food intake? What do you think?

Many hospitals are introducing a red tray system at mealtimes to identify patients who need help or their dietary intake monitored. It was recently introduced at Norfolk Community Health and Care NHS Trust where patients with a specific dietary requirement have their meals served on an orange tray, while water jugs with red lids are provided to patients that require their fluids to be monitored.

However in this week’s practice comment Neil Wilson, senior lecturer at Manchester Metropolitan University asks whether red tray systems are putting a sticking plaster over the greater problems of poor nursing direction and leadership.

Wilson said: “The introduction of a vast amount of initiatives - such as “nutritionally screening” all patients on admission, even if the initial nursing assessment identifies they are at minimal risk of being nutritionally deficient - have increased the documentation workload for nurses. Alongside this, “red tray systems” and “red water jugs” for those at risk of dehydration/malnutrition have only proved to put a sticking plaster over the problem of poor nursing direction, leadership and the lack of management support for nursing quality care”.


Readers' comments (18)

  • I think its a bit of a joke to ask nurses to be responsible for peoples nutritional intake - when many nurses do not have control over portion size or any say in outside caterers choices.

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  • Oh dear anonymous - what a cop out. Nurses may not have any direct control over portion sizes but that is the least of the problem.
    "The nutritional value of food left on the plate is nil" as Rick Wilson ,dietitian once said.
    Okay you may not have any control over portion sizes but you do have a responsibility to make sure people can eat. You have a responsibility to ensure that they can reach their food. You have a responsibility to make sure that there is not a reason why they are not eating.
    If someone finds that their meal is too small and they are still hungry, you have a responsibility to find them something else to eat - a snack box for example.
    If they find the meal is too big and they are only picking, then you are responsible for trying to coax them, help them with menu choices and if necessary refer to a dietitian.
    I am absolutely appalled at your comment and hope that it is one said in isolation.
    Nurses are not the only ones responsible for nutritional care of patients - it is an MDT effort. BUT we are in the unique position of being with our patients 24 hours a day and as such will know them best. We are their advocates and the ones who should be observing and reporting EVERYTHING!

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  • portion size and presentation are very important for patients. if you have little appetite there is nothing worse that a plate full of too much heavy, stodgy unappetising looking food. nurses should ensure patients are served the meals they need according to their personal tastes, appetite, and ability to eat and chew and any special dietary and calorific needs.
    I presume in UK hospitals there is also a choice of menu and that meals are well balanced to provide all the required daily nutrients? It is quite extraordinary that hospitals and nurses do not consider diet a vital part of patient care as it is a basic human need in any circumstances and especially so for patients as they are unable to cater for themselves.

    How about looking at airline catering for some lessons and the European hospitals?

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  • tinkerbell

    Liz Evans | 24-Feb-2012 7:10 am

    Well said, otherwise we might as well all just go home. Food is such an important part of recovery and for some long term patients maybe the highlight of their day. We can only do the best we can with what we've got, where we are. Also the amount of medications some patients are on should not be given on empty stomachs, unless px to be given before meals. I am loathe to give patients meds before they have breakfast and a cup of tea.

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  • in i trust i used to work for red tray were used for infection, as to identify how the crockery should be cleaned and a ad memoir to new/agency staff to use PPE that would led to confusion

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  • red trays, red mug lids, red uniforms for sisters, red laundry bags and red tabards. It would look very funny if all these landed on one ward and very tiring for everybody and especially the patients.

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  • This is the sort of issue that ought to be debated at Congress, REAL issues that affects nurses and patients alike. Perhaps responsibility for patients nutritional status ought to be taken away from nurses and given to dieticians who could then employ their own team of staff to ensure that patients are adequately fed.

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  • Yes thats a good idea. And lets take away infection control and give it to a team of microbiologists who could then employ their own team to ensure that the wards are clean and wound dressings are done aseptically and that people all wash their hands properly!!!
    Nutrition is EVERYONE's responsibility - and the last time that nutrition was removed from the responsibility of nurses was in the 80s when it was proclaimed to a hotel service- look how well that turned out.

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  • there is a vast difference in catering for hotel guest and sick patients and in the diets required

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  • @ anonymous - completely agree but try telling some Trust managers that.

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  • Anonymous | 24-Feb-2012 2:42 am

    I am not appalled by your remarks, but I am saddened. I suspect that your comment arose less from the perceived cop-out you are being accused of, and more from the increasing frustration many nurses feel. That of the endless daft initiatives, which would not be required if nurses were actually listened to and able to look after our patients the way we should like to look after them.

    Yes, nutrition is everyone's responsibility. However, it would that appear that the blame for poor nutritional issues in hospitals and care settings does seem to land almost exclusively in the laps of nurses.

    Nurses, particularly those in the NHS, are the largest single workforce of the health care professions and we have only ourselves to blame for our lack action in advancing the care of our patients.

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  • I completely disagree with everyone here,
    although nutrition is every bodys responsibility, the red lid's and trays are a good idea, because it pin points who staff may need to give extra attention to, and highlights who may have an issue with their fluid or nutrition intake. Some staff may not have the time to concentrate and remember who needs assisting with their food and fluid intake, the red lids and trays are a good reminder to the staff, that if they do see someone struggling, that it is their responsiblity to stop what they are doing and to help.

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  • Anonymous | 27-Feb-2012 2:31 pm

    I can't agree with you. You should already know which patients are at risk and understand why they are at risk. This isn't rocket science. You should have the staff and resources available to ensure that nutritional requirements of patients are met. Red lids, red trays, red anything do not address the real issues challenging many care settings. As Neil states, ".....the problem of poor nursing direction, leadership and the lack of management support for nursing quality care”."

    I don't need any reminders of who requires assistance with their nutrition and hydration. I know who needs careful attention and help. What I need are the staff and resources to do my job, and I am sick of asking/demanding it......but I will never stop.

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  • Anonymous | 27-Feb-2012 7:58 pm

    I agree with you. They won't replace bad nursing and one should know one's patients. However, I haven't seen this system in practice but wonder whether it would not be a good idea for ancillary staff and those helping on the ward or who have just come on to the ward such those returning from leave, etc., so that they can see straight away who needs help which would temporarily discharge the busy staff nurses of the duty having to constantly ha remind or delegate the work to others. These members of staff or volunteers, etc. would immediately spot those needing help without having to go and ask or seek information in the notes thus saving time. I guess it also depends on the type or ward, organisation and staffing.

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  • To follow up my own post on 25 feb at 10.35 am, I was playing devil's advocate. Are nurses responsible for everything that happens on a hospital ward? Answer: No. My reasoning therefore is that because dieticians are trained extensively in their specialism that they ought to become more involved in meeting patients' nutritional needs whilst they are in hospital. This would free up nurses to concentrate on other aspects of care. Many nurses are exhuasted and stressed trying to meet the demands placed on them, so maybe it's time to look seriously at letting go of one area of responsibility. I'm not advocating that nurses leave patients to starve, far from it!

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  • Anonymous | 28-Feb-2012 10:16 am
    Anonymous | 27-Feb-2012 7:58 pm

    I take your point and to a large extent agree with what you are saying. In my ward, there are no volunteers or spare hands floating around to help out at mealtimes. Of course nutrition goes far beyond that. But if there are just not enough staff to ensure that patients are adequately hydrated and nourished, then everything else is meaningless. No point in assessing, flagging up potential issues and slapping red trays around the place!!

    However, having this crucial role and responsibility taken away from nurses is counter-intuitive. I'm happy to keep the responsibility. I just want the resources, staff and power to carry it out as it should be done.

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  • Anonymous 28th Feb 2012 10.16am

    I agree with you you have a good point. It would be a great help to us if dieticians came to see their patients and ensure they get the required nutrition, they also might realise the difficulty of trying to feed patients who no longer want to eat and who are too ill to eat as sometimes they look at you as if you don't care.

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  • Anonymous | 3-Mar-2012 9:03 am

    Good point. There is a larger problem in many hospital wards. Too many AHPs float into the ward, make a little assessment, issue instructions on diet, OT issues, physio exercises to be carried out, etc and then float back out again. An extremely clever move, as it will inevitably be the fault of the nursing staff if any of it doesn't get done. AHPs should be made available to carry out their own instructions, and that should include doing proper shifts and weekends. After all, it's 24 hour care and we're ALL supposed to be a part of the MDT.

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