Nutrition and hydration are extremely important, particularly for older people. Insufficient food and fluid intake can cause fragile skin, increased risk of infections and falls, kidney problems, along with other avoidable consequences.

Care home residents are particularly susceptible to malnutrition and dehydration based on their age, health conditions and their increased dependency.

Since 2015, we have been supporting care homes in the East Midlands to perform yearly prevalence audits for common care problems and supporting them to make improvements to the care they deliver.

The Landielijke Prevalentiemeting Zorgkwaliteit (LPZ) - Care Homes Harms Prevalence Audit Tool was developed by Maastricht University and was adopted by the East Midlands Patient Safety Collaborative (EM PSC) as a way of working for care homes. The EM PSC has worked with local care homes to introduce the tool which measures the prevalence of common care issues such as nutrition, pressure ulcers, continence, falls, restraint and pain. 

An aspect of the LPZ audit looks at nutrition and hydration and which interventions have been performed for the resident, for example; introducing malnutrition screening, referral to dietician, energy/protein enriched diet, support at mealtimes, adjustment of meal consistency, food specifically desired by the resident, oral nutritional supplements and monitoring of fluid intake for those at risk. These elements allow care homes to review data and identify areas that can be a focus to drive improvements.

Routinely reviewing LPZ data, allows care homes to make improvements to the care they deliver and there have been tangible improvements made in many areas, including the nutrition and hydration of care home residents.

Over the course of the project, we’ve seen some excellent initiatives and improvements made by our care homes which we are extremely proud of and inspired by. For Nutrition and Hydration Awareness Week, I wanted to highlight some great examples of practical initiatives from three of our LPZ care homes.

Wren Hall Nursing Home – Making mealtimes a positive social space

Wren Hall Nursing Home in Selston Nottinghamshire have participated in the LPZ audit since 2015. They have fully embraced the process and used it as an opportunity for all teams and staff across the home to understand the needs of residents.  As part of the LPZ audit, they established that they could make some real improvements to the nutrition and hydration of their residents.

The Catering Team are trained to understand the impact of dysphagia, malnutrition, dementia, meaningful occupation and communication.

To make a real difference, the Catering Team stepped out of their comfort zone and entered the hub of the care home.

They used the lounge areas to tempt residents with aromas of the food, they involved family members in preparing meals and made food more accessible to residents. They did this to highlight mealtimes as a critically important multi-disciplinary social event. Overall their focus is offering each person a positive meal-time social interaction based on their individual needs.

They used inventive techniques such as:

• signalling mealtimes approaching by frying spices and herbs prior to lunch
• modifying food texture to provide those with dysphagia with safe foods that are tasty and moulded to resemble to the natural form of the food
• offering Wren’s Nest, a monthly fine dining experience which offers families the opportunity to have a special meal without taking residents out of their comfort zone and experiencing the associated distress
• facilitating CookSkool, enabling residents to cook and bake and have a sense of purpose and achievement.

This has made a huge difference to the nutritional status of family members and has reduced the incidence of malnutrition from 32.7% to 18.9% (data from LPZ audit 2018 and 2019).

As well as the impact this has had on residents, staff also have greater job satisfaction and more motivation to make further improvements.

For their hard work and impacts in this area, Wren Hall’s Catering Team won the Supporting Team of the Year Award at the annual LPZ awards in February 2020.

Rathgar Care Home – Making hydration fun

2019 was Rathgar Care Home in Northamptonshire’s first year participating in LPZ.

They noticed that pressure ulcers and hydration were two areas that they could make improvements to.

They recognised that residents often don’t drink and snack outside of mealtimes, which contributed to dehydration and malnutrition. To tackle this the team at Rathgar wanted to make taking on fluids more appealing, so they introduced the Rathgar Cocktail Bar. The drinks are non-alcoholic, of course, but they are served in champagne flutes and are taken around to residents on a trolley with the look and feel of real cocktails.

Residents and families love this touch and staff have seen a real uptake.

Agnes House – Proactive malnutrition screening

Agnes House, based in Wyggestons’s Hospital in Leicester, are new to LPZ for the 2019 audit.

Following the audit, they put a focus on the prevention of malnutrition and have introduced screening of all residents which includes:

• recording of residents’ height, weight and unintentional weight loss
• malnutrition screening assessments to identify those at risk – this then allows for proactive interventions to be put in place when required. For example, monitoring of food and fluid intake, earlier involvement of the multi-disciplinary team and clarity of roles and responsibility for staff in supporting those who need additional support at mealtimes

Agnes House have also involved their catering team who have focused on the presentation of food for those residents who require a softer diet. The aim being that it looks the same type of meal as other residents who are on a normal diet, to encourage them to participate in meal times in the same way.

Staff at Agnes House have really embraced these new measures.

There are a number of resources available to care homes, created by various organisations across the region as part of the REACT to… series. You can see the REACT to… Malnutrition and Dehydration resources here.

To find out more about LPZ, read this case study. 

Author 

Eddie Alder, EMAHSN Head of Patient Safety