Nutrition Network Newsletter I S S U E

NUTRITION: THE DRIVING FORCE FOR BETTER HEALTH

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A U T U M N

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Welcome to the 2nd Trust Wide Newsletter Catering Special - by Emma Wilson

Promoting skin health and wound healing

Promoting a safe environment

Reducing constipation and urinary problems

Getting patients home sooner

EQONS PROJECT: ENHANCING THE QUALITY OF ORAL NUTRITIONAL SUPPORT

This edition will focus on the Catering Department where we gain an insight into their fantastic work and give you some interesting snippets of information that you can use in your clinical areas to improve nutrition for your patients!! It’s all about building upon our relationship with the department and improving communication. The department is currently undergoing a major refurbishment and Emma Wilson (Head of Catering) gives us some exciting information and update on what’s currently happening.

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Emma Wilson (Head of Catering)

place at WPH and more recently at NGH, and is the model which will eventually be realised across all wards at RHH and JW by the beginning of the financial year 2013.”

ward over its service delivery The service is more responsive to supporting the moving clinical agenda

Emma Wilson added: “To ensure consistency and realise efficiencies within our department we will be centralising our main meals production at the Food Production Unit at NGH following refurbishment improvements. The receiving units at RHH and WPH will have reduced on site production and diet bay facilities. The Food Production Unit operates the cook chill method of service and therefore meals will be regenerated (or re-heated) from a chilled state in the bulk hostess trolleys in either the ward kitchen or a central regeneration zone.. All wards kitchens will be equipped with ward dishwashers.”

The key benefits of this style of “To achieve our long term goal of meal service to patients are: providing a consistent, high quality, flexible and personalised catering service, a period of consultation was • Choice of meal at the point of service from food available The Trust Catering Department undertaken between Catering, Hotel directly from the hostess trol- currently works out of three proServices, Nursing, Dietetic, Infection ley - no need for patients to duction kitchens-one at WPH, D Control, Staff Side, Patient Governors pre order floor at RHH and the Central and Patient Representatives, with Estates and Finance input to realise • Improvements to the quality of Production Unit (CPU) at the NGH. The Catering Department the meal time experience in the need to invest and improve on terms of the temperature and produce and provide to 90 wards the current services provided. texture of the food 3 times a day. The department As a result last year we embarked on • Portion sizes can be tailored to also caters for 2 day nurseries, The Longley Centre - NGH, 4 individual appetite a major capital scheme to change main dining rooms, 3 deli bar • It provides a more personalthe face of patient services across ised service at the bedside or outlets and 3 coffee shops for staff the Trust, which is being completed and visitors!! In simple terms, where appropriate, in a day on a phased basis over 3 years. It 5,000 meals are produced and room involves improvements to the fabric served daily by a 250 strong caof the buildings we occupy, upgrades • Timings of meals are more flexible to ward requirements tering workforce and all on a very to RHH ward kitchens and imple• Greater nursing participation in tight budget!! mentation of a bulk hostess style the meal service; improving meal service for all patients. patient interaction and improving monitoring stanThis method of service is already in dards, giving control to the

NIHR CLAHRC for South Yorkshire

www.clahrc-sy.nihr.ac.uk

Sheffield Teaching Hospitals NHS Foundation Trust

"Transferring to the bulk meal system" To achieve the consistent, high quality, flexible and personalised meals, the department offer a flexible menu structure to cater for patients who can eat normally as well as 13 different therapeutic and specialist menus to meet the needs of the patients. The department works closely with patients, Nursing, Speech and Language, and Dietetic colleagues to continuously improve the service. Ward kitchens are provided with provisions to be able to offer snacks throughout the day and a snack box or light bite service is available should a patient have missed a meal for any reason.

New Principles Set Out For Hospital Food

Transferring to the bulk meal system has had major benefits for the patients. The wards now have the ability to amend orders of popular menu choices and the convenience of adjusting portion sizes according to patient requirement. For example some patients are ‘over faced’ with the amount of food they were served on the plated system. By adjusting the portion sizes for the patient, the pa-

New standards set out by the Government about what patients should expect from hospital food: •

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Catering participates in the work of the trust Nutrition Steering Group and has active involvement in many Trust projects such as the EQONS project (Enhancing the Quality of Oral Nutrition Support) with CLAHRC, the Productive Ward, and other relevant practice development projects.

The Food Trail

patients get a choice from a varied menu – including meals suitable for religious needs






all patients should have access to fresh drinking water at all times, unless it contradicts clinical advice


The journey of the food trail…



hospitals should promote healthy diets to staff and visitors the Government Buying Standards for Food should be adopted as standard whenever possible

” Bulk is best; in the evening we give out the meals and then stop to feed everyone that requires assistance. Now we have the bulk trolley, we only start giving the deserts out when the patients have eaten their main course. On a Friday, the patients look forward to the fish and chips; this choice is very popular with elderly patients as they absolutely love them.”

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nutritious and appetising hospital food and drink is essential

food and drink should be available at all times, not just planned mealtimes

tient may be more likely encouraged to eat. Jenny Washington (Sister) from Brearley 5 says:-

It is amazing how many food processes contribute to the final product. Catering work hard to prepare and deliver the food to the patients and the staff. Here are the processes involved every day to bring the service to our wards…hats off to the Catering Department for all their hard work in providing a brilliant service.





hospitals should regularly evaluate their food service and act on feedback from patients the NHS as a whole should look for and reward excellence in hospital food

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Did you know? The Catering Department perform a Food Quality audit on the wards every month. The team are anxious to hear your views and this is a good opportunity for Medical staff, Nursing staff, Dietitians and the Speech and Language department to work with Catering, to discuss the meal service and have your say!!! The audits include looking at ways on how we can improve service aspects for the patients, including some food sampling sessions and also look at ways that we can reduce waste. If you are interested in attending these meetings, please see “Dates for your diary” below. Any future dates of these meetings can be found by looking at the Catering intranet site.

Special Diets

Food Waste Any patient transfers, discharges or cancellations of meals – please inform the Catering Department straight away on tel: 14290 (NGH) or tel: 61334 (RHH) so that food waste can be reduced. Other food ingredients for example milk, bread that are stored on the ward can also be monitored on a regular basis in order to prevent excess food waste.

The Catering Department work hard to produce a variety of menus for the patient. These include: • • • • • • •

The Catering Department are working in partnership with us to continuously improve the service for the patients. Please notify Catering straight away if there is a problem. They endeavour to sort out any problems at ward level so that the situation can be resolved as soon as possible.

℡ Useful contact numbers Tel: 14290 (NGH) - to order extra meals/cancel or transfer meals etc Tel: 61334 (RHH) - to order extra meals/cancel or transfer meals etc Bleep: 2472 (NGH) - for late ordering or missed meals/snack boxes Bleep: 2684 (RHH) - for late ordering or missed meals/snack boxes




Useful e-mail addresses

Emma Wilson, Head of Catering: [email protected] Liz Hawks haw, Catering Manager Central Campus: [email protected] Jeff Swallow, Catering Manager Northern Campus; [email protected] Eva Zehentner, Training Manager; [email protected] Kay Weston, Quality Manager; [email protected] Rita Schlemiel, Production Manager Central Production Unit: [email protected]

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Fork mashable (dysphasia) No gluten containing ingredients Halal High protein Low fat and weight reducing Renal Shaped puree Fork mashable (renal) Standard No added salt Afro-Caribbean Kosher Low residue Weight loss-surgery

Any patient that requires a specific diet - please complete the appropriate menu slip and fax to CPU on fax: 14465 (NGH) or fax: 11754 (RHH)

Thank you! Sue Shearstone

Sue Shearstone (KT Facilitator)

End of an era: Sue Shearstone one of the Knowledge Translation Facilitators on the EQONS Project secondment finished at the end of September 2012. The EQONS Team along with the Nutrition Champions involved with the project would like to thank Sue for all her hard work and enthusiasm over the past 2.5 years. We are sure that we haven’t heard the last of Sue and we know she will still be championing the project through her clinical role. Additionally a big thank you to; Sue Shearstone, Elaine Cotton and Emma Wilson for all their help in developing this edition of the newsletter.

Dates for your diary 

*Patient Meal Wastage Standards Group meeting - 21st November 2pm, A Floor Seminar * Nutrition and hydration awareness th week - week commencing; 5 November Room, Robert Hadfield Wing, NGH * Nutritional Forum for the elderly wards *Patientth Meal Wastage Standards Group meet6th November - 2pm - 3pm, C floor Seminar ing -19 December 2pm, waitress service area D floor, RHH room, Robert Hadfield wing N.B Please note that this nutritional forum is primarily for the care of elderly patients wards

Food hygiene Food hygiene is extremely important when serving meals. All nursing staff should ensure they wash their hands and use the green aprons prior to serving the patient meals. Oven gloves should also be worn when contact with hot food in the trolley.

Ordering snack boxes/missed meals Any missed meals or snack boxes can be ordered by bleeping: 2472 (NGH) or 2684 (RHH)

Brearley 1 Staff Nurse

BAPEN’s malnutrition screening survey: the proportion of patients admitted to hospital and care homes who are at risk of malnutrition Results: Winter, 2010 “1 in 3 at risk” Spring, 2011 “1 in 4 at risk” British Association for Parenteral & Enteral Nutrition, BAPEN (2010, 2011) Nutrition Screening Survey in the UK & the Republic of Ireland

Malnutrition Universal Screening Tool (MUST) predicts mortality & length of hospital stay in acutely ill elderly:

♦ Direct significant relationship between mortality in hospital and increasing MUST risk score (P=0.01) ♦ The risk of mortality 3 months post- discharge also significantly higher among high MUST score when compared with low MUST score patients (24% & 5%,respectively; P=0.01)

♦ Direct significant relationship between length of hospital stay & MUST risk category: low risk 15 days, medium risk 24 days, high risk 28 days (95% CI) Stratton, R.J., King, C.L., Stroud, M.A., Elia. J. and Elia, M. (2006) ‘Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill

What’s happening around the Trust What’s been happening around the trust? Nutritional Forum…a Nutritional Forum has been set up to incorporate care of the elderly patient wards at NGH which include RH3, RH4, RH5, RH6, B5 and B7. The Catering Department, Occupational Therapy, Speech and Language Therapy, Dietitians, Nursing Staff and Nutrition Champions are all involved and the group meet on a regular basis on Robert Hadfield wing to get together to discuss issues regarding nutrition and how we can address the problems and share good ideas. The group has been well attended and have discussed applying for funding for feeding equipment, food wastage, weighing patients, MUST scoring, oral hygiene, preparation of the patient prior to the mealtime, patients on nil by mouth. If you wish to know more about the Nutritional Forum for the elderly patients or are interested in setting up something similar for your own area, please contact Justine Dent (Ward Manager) on RH3 on tel: 14328. **The next Nutritional Forum is at; 2pm - 3pm, C floor Seminar room, Robert Hadfield wing on 6th November, where Ann Harrison (Oral Health advisor) from Charles Clifford Dental Hospital will be giving a talk on oral health. Other dates for the Nutritional Forum are 2pm - 3pm, C floor Seminar room, Robert Hadfield wing on 6th November And 2pm - 3pm, C floor Seminar room, Robert Hadfield wing on 15th January

This newsletter presents independent research by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for South Yorkshire (NIHR CLAHRC SY). The views and opinions expressed are those of the authors, and not necessarily those of the NHS, the NIHR or the Department of Health. CLAHRC SY would also like to acknowledge the participation and resources of our partner organisations. Further details can be found at www.clahrc-sy.nihr.ac.uk.

Food Quality Circle meeting As part of the EQONS project (Enhancing the Quality of Oral Nutrition Support) a Food Quality Circle (FQC) was initiated to help with Brearley 1 ward transferring from the plated system to the bulk meal system. Nursing staff from the ward attended the meetings along with staff from the Catering Department, Dietetic Department and the project Facilitators.

The meetings were very well attended and gave the staff the opportunity to meet with other disciplines to discuss issues and any problems as they arose and find ways to work together to find solutions. The Food Quality Circle worked very well and received very positive feedback from all involved.

Something juicy!!! Did you know that large cartons of fruit juice can now be ordered from the Regional Distribution Centre and stored in the fridge for use by the patients? The fruit juice comes in a variety of flavours and includes apple, orange and pineapple.

day; as it is a good source of vitamin C. The cook chill process loses some of the vitamin C; fruit juice can be offered as an alternative to soup. These can be offered to the patients as an alternative at least 3 times a day. Patients should also be encouraged to eat fresh fruit and vegetables as part of their everyday diet.”

Elaine Cotton (Head of Dietetics) says” fruit juice is a good way of offering one of the portions of 5 a

If you have any queries regarding the project, resources or would like some advice please contact us: Project Manager (for RHH & NGH): Sara Laker sara.laker:@sth.nhs.uk (22)65448 Team Administrator: Emma Bishop [email protected] (22)68464 Additional STH links: Head of Dietetics: Elaine Cotton [email protected] (27)15752 Practice Development Coordinator (Evidence Based Practice): Irene Mabbott [email protected] (27)14281