The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [265]
Preprocedural considerations
Sufficient staff need to be available to support those who need help. Patients who require assistance should be identified through screening and a discreet signal should be evident to identify that further assistance is required, for example a red tray, a coloured serviette or a red sticker (Bradley and Rees 2003).
Assessment and recording tools
Food record charts can provide the essential information that forms the basis of a nutritional assessment and help to determine subsequent nutritional care. They are therefore a valuable resource for dietitians, nurses and ultimately the patient (Freeman 2002). They can be used to assess whether the patient is eating and drinking enough, thereby enabling action to be taken to encourage intake in those who have a reduced dietary intake.
The objective is to quantify the amount of food and drink consumed by a patient over an agreed time period and, although open to error, it has been demonstrated that this type of record keeping provides more accurate information than methods involving recall (Kroke et al. 1999). In hospital, a patient’s intake frequently changes as a result of disease, symptoms, medication and unfamiliar surroundings and food availability. It is frequently not evident how much a patient is eating, particularly on busy wards with regular staff changes.
All screening, including food charts, should be linked to a care plan and documented in the patient’s notes (Freeman 2002, NPSA 2009). If there is noted weight loss, concerns expressed by staff or from relatives regarding the patient’s nutritional intake, particularly where there are difficulties observed with eating and drinking, close monitoring of oral intake is essential. The only exception to this is when a patient is receiving palliative care and it has been clarified with the clinical team that active nutritional support is not appropriate.
Food charts should be available on all wards and should be simple to complete. It is often preferable to include on the chart household measures such as tablespoons, slice of bread or hospital portions, to assist with the speed of completion.
Training should be given on how the chart should be completed and preferably should be undertaken by the dietitian or the specialist nutrition nurse, as this will facilitate understanding of the rationale and continuity of recording and improve accuracy. Charts need to be carefully completed over a minimum and consecutive 2 or 3 day period or longer if requested by the dietitian. Some research suggests that information should be collected over at least 7 days in order to estimate protein and energy intake to within ±10% (Bingham 1987).
Specific patient preparations
Before commencing assistance, please discuss this with the patient in order that they understand and consent to assistance being provided. When verbal communication is not possible, non-verbal agreement needs to be obtained wherever possible. Try to engage the patient in the feeding process and interpret and record any preferences or dislikes they may express regarding the meal process.
Make sure the patient has the opportunity to visit the bathroom and wash hands or clean their hands with an antiseptic wipe and to undertake any appropriate mouthcare prior to eating. Establish whether any medication is to be administered prior to or after feeding which will facilitate the feeding and digestive process. Individual symptoms should be assessed; for example, if patients are nauseous they may benefit from the prescribing of antiemetics or prokinetic agents. Patients who have pancreatic insufficiency may require pancreatic enzyme replacements. All drugs should be correctly prescribed on the drug chart. The timing in relation to feeding is