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'If food is visible, patients make a better choice'

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Allison Baxter and her team brought in picture menus to help people with cognitive and physical problems choose the food they wanted.

You might think that complex problems, such as strokes and dementia, require complex solutions, but this is not always true. The latest initiative for food menus in Northumbria Healthcare Foundation Trust is simple, but is receiving great feedback from the nurses using it.

NHS Information Centre data has shown Northumbria Healthcare is one of the UK’s top-performing organisations when it comes to patient hydration and nutrition. This is due in no small part to the work of Allison Baxter and her colleagues, who have implemented a picture menu to help patients with cognitive and physical conditions choose their meals more easily.

The picture menu is based on a simple concept: if patients are able to see the options, they are better able to select what they would like.

Mrs Baxter qualified as a nurse in 1991 and spent most of her early career on a stroke ward, starting out as a staff nurse and progressing to ward manager. She worked with people who had had strokes, both in the acute phase and beyond into rehabilitation.

“I had an insight into the complex issues regarding maintaining adequate patient nutrition through working with these patients so, when the nutrition nurse specialist position came up, it was an opportunity to develop my skills further,” she said.

“One of my first priorities was to ensure that the trust’s patients who were elderly or had dementia were receiving adequate nutrition and fluids.”

Looking at how patients chose meals was also a priority.

The trust’s 10 hospitals in Northumberland and North Tyneside, which serve around 500,000 people, had been using a bedside communication system for their menus. However, older patients and those with dementia often could not remember all of the options they were offered.

She said: “Often people would only remember the last option and order that. If the food can be seen, it helps the patients make a better choice.”

Thanks to her history as a stroke nurse, Mrs Baxter knew patients who had had strokes often had trouble swallowing and communicating. This awareness helped focus the aim of the pictorial menu booklet.

Mrs Baxter stresses that the nurses are still spending the same amount of time with each patient, but communication has become easier.

The trust’s catering superintendent, Michael Taylor, originally came up with the idea of the picture menu. He and Mrs Baxter knew from speaking to ward managers that a tool that encourages patient choice at mealtimes was an area that could benefit patients with cognitive or physical conditions or both.

They went to the trust’s charity Bright Northumbria for funding, which awarded them £500 to start a project. They then piloted the menus on wards in North Tyneside General Hospital.

The menus are now used in all three of the trust’s main hospitals. Mrs Baxter has received enquiries from local trusts that were keen to find out more about the project.

She is pleased with the impact of the picture menus, but is keen to stress that they are just one tool among many.

“The trust is proactive. We also use dignity crockery and cups, which are brightly coloured to help patients with both physical and cognitive problems.”

No figures are yet available for the difference that the menus have made, but feedback has been positive.

Mrs Baxter says nurses are encouraged to seek out solutions to problems. There has been a rise in interdisciplinary work and sharing of good practice to improve nutrition in hospitals, which is encouraged by the Northern Nutrition Network. The network holds regular meetings to discuss ways to improve care and practice, and is making great strides.

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