When patients are admitted to hospital from residential care homes, effective communication between the two settings on nutrition needs is crucial
Citation: Bond P, Ewen J, Miller M (2013) Sharing nutrition needs from care home to ward. Nursing Times; 109: 39, 20.
Authors: Penny Bond is implementation and improvement support team leader, Healthcare Improvement Scotland; Jane Ewen is education facilitator/nutrition champion at NHS Grampian; Michelle Miller is improvement adviser at Healthcare Improvement Scotland
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When care home residents are admitted to or discharged from hospital, ensuring their nutritional needs are met requires effective communication between the two settings. This is a crucial part of the transition to ensure patients receive appropriate and safe nutritional care and assistance.
The national overview of food, fluid and nutritional care in hospitals (Healthcare Improvement Scotland, 2010) said discharge documentation needed improvement. This was reinforced by care home staff and nutrition champions from every NHS board, who recognised that it is often at the point of transition between care settings that critical nutrition information about patients’ care needs is lost.
Developing a communication tool
Nutrition champions worked with colleagues from across Scotland to develop and test a communication tool (Box 1) to record key nutritional information at the point of transfer from care home to hospital and vice versa.
Box 1. Communication tool components
- Nutritional screening (BMI and MUST scores)
- Physical assistance with eating and drinking, including chewing and swallowing difficulties
- Personal dietary needs
- Specialised/therapeutic diet requirement
- Food fortification/food snacks
- Prescribed nutritional support
The tool was first tested in one hospital ward and one care home. Responses to a staff questionnaire and anecdotal evidence suggested that staff found the tool easy to use, but some comments were made about the order of information. The tool was reformatted and tested again before being tested in other wards and care homes.
It became clear that there was poorer compliance with the questions relating to therapeutic diet and texture-modified diet in the tool. Staff highlighted problems with understanding terminology and what was meant by texture-modified diet. An agreed scale for ranking levels of texture modification was therefore included.
What worked well
Staff consistently reported that the layout of the tool was easy to follow. One staff member said it was beneficial when a new resident arrived at a care home at dinner-time. Staff were able to make an immediate and person-centred assessment of the resident’s nutritional requirements using the tool so individual food preferences were met.
Both hospital and care home staff commented that a comprehensive nutritional care assessment was particularly beneficial for vulnerable patients who need assistance with eating and drinking or had specific nutritional requirements and preferences. Other benefits include:
- Increased compliance in undertaking nutritional screening and care planning;
- Better identification of patients’ individual requirements, for example if they need to be encouraged or prompted to eat or have their food cut up;
- Improved documentation of likes and dislikes, which ensures patients’ individual requirements are met;
- Clearer communication and improved rapport between hospital and care home staff;
- Greater reassurance for family and carers that nutritional care is a priority.
As staff became more confident in using the communication tool and recognised its benefits, they identified opportunities to use it more broadly including:
- Adopting the tool for transfers within and between hospitals;
- Using the tool with community nursing teams;
- Providing a communication tool for care home catering teams;
- Demonstrating compliance with national clinical quality indicators.
The development and introduction of the nutrition communication tool supported the admission and discharge process for patients, ensuring a seamless nutritional care journey between hospital and care home.
Increased compliance and embedding the tool in everyday practice increases opportunities to support safe, effective and person-centred nutritional care.
The tool was initially tested in one clinical area and feedback sought from staff on its usability. It was refined and retested in to achieve reliable use of the tool before it was introduced in other clinical areas.
NHS Quality Improvement Scotland (2010) National Overview – April 2010. Food Fluid and Nutritional Care in Hospitals.