The ‘Model Ward’ for Nutrition and Hydration

Joanne Jefford, Dietetic Services Manager

Judyth Jenkins, Dietetic Service Lead

Lee Wyatt, Head of Facilities

Rebecca Aylward, Nurse Director Medicine Clinical Board

Claire Constantinou, Clinical Lead


Cardiff and Vale University Health Board


This Bevan Exemplar Project introduced a collaborative, multidisciplinary team approach to maximising nutrition and hydration practises within the inpatient setting.


Background


Food, fluid and nutritional care are crucial for the physical and mental health well-being of patients and are fundamentals of care elements that enhance the patient experience. Poor nutrition has significant financial implications for healthcare and good nutritional care supports improved outcomes, reduction in complications and length of stay, improved quality of life and Health Board resource utilisation. However all too often, a patient’s nutritional status can deteriorate during their hospital stay either as a cause or consequence of disease.


The Model Ward seeks to ensure all patients can access and receive the best possible nutrition and hydration outside the rigid confines of set meal times, exceeding Governmental standards and making this the baseline core care model in the ward environment; appropriate skill mix and a cohesive shared approach to managing nutrition at ward level. A model that is sustainable and easily applicable to other organisations based on the premise that good nutrition and hydration provision are markers of patient safety, quality care and reputational management as identified by staff, patients and relatives in the 3 key external reports Francis, Berwick and Andrews.


The model ward has been made possible by the support of Cardiff and Vale Health Charity.


Aims


To bring Nursing, Therapy, Facilities and Patient-experience teams together within the health board to examine how best to deliver standardised nutritional care to maximise patient outcomes.


Utilising inter-professional integrated working and challenging the traditional boundaries of care, the project aimed to deliver comprehensive and coordinated nutritional care, whilst simultaneously improving patient outcomes and experience.


Outcomes


Four medical wards became ‘Model Wards’ focusing on greater opportunities for patients to eat and drink.


An additional band 2 catering host and a band 3 dietetic support worker (DSW) were recruited. The DSW supported feeding, performed nutrition risk screening and undertook milkshake and fresh fruit rounds to increase patients’ energy, protein, fluid and fibre intake.


Menu changes included cooked breakfast daily and snacks with the afternoon tea round to increase nutrition available.


Blue coloured crockery was introduced aiding patients with visual/cognitive impairment maximise oral intake.


Protected mealtimes were revitalised including greater focus on pre-meal patient hand hygiene.


The additional catering host enabled increased drinks rounds through the day. Discussion of nutrition risk, therapeutic, cultural and religious dietary needs, and nutritional concerns were added to ward based patient safety briefings.


  • Potential to reduce length of stay.

  • Improved management of nutritional risk and prevention of deconditioning linked to improving patient safety and focusing on what matters to people, i.e. going home to their own home.

  • Positive patient experience and service user feedback.

  • Ward team experience – lead consultant and senior nurse feedback extremely positive as evidenced in the video.

  • Sustainability – the model has been successful for the duration of the year. Changes to the daily routine and culture have become embedded with the additional staffing resource.

  • Avoids harm, waste and variation – food waste reduced.

  • Improved hydration, served drinks increased 19%.

  • An MDT scorecard with clinical measures is currently being evaluated.


Next steps


Outcomes indicate re-modelling nutritional care at ward level, and supporting the patient with dietary intake can result in improved quality care and benefits including reduction of risk and harm for patients.


The Bevan experience brought health care professionals from very different backgrounds and services together demonstrating
that we all have a similar journey achieving   service change and
can share our learning.



Part of cohort Bevan Exemplar Projects 2018-19