trust-wide clinical policy document · trust-wide clinical policy document 2015 – version 1 ....

TRUST-WIDE CLINICAL POLICY DOCUMENT

NUTRITION POLICY

Policy Number: SD44 Scope of this Document: All Staff Recommending Committee:

• Secure Division Physical Health Care Group

• Local Division Physical Health Forum

Appproving Committee: Executive Committee Date Ratified: May 2015 Next Review Date (by): May 2018 Version Number: Version 1 Lead Executive Director: Executive Director of

Nursing Lead Author(s): Advanced Dietitians for

Secure and Local Divisions

TRUST-WIDE CLINICAL POLICY DOCUMENT 2015 – Version 1

Quality, recovery and wellbeing at the heart

of everything we do

1 | P a g e S D 4 4 N u t r i t i o n P o l i c y – 2 0 1 5 V 1

TRUST-WIDE CLINICAL POLICY DOCUMENT

NUTRITION POLICY

Further information about this document:

Document name SD44 Nutrition Policy

Document summary

This policy outlines the mechanism for ensuring availability of nutritious and healthy food for service users and staff within Secure and Local Divisions of Mersey Care NHS Trust in line with current national

guidelines for healthy eating.

Author(s)

Contact(s) for further information about this

document

Michelle Barton Senior Mental Health Dietitian

Telephone: 0151 472 0303 ext 3734 Email: [email protected]

Anna Ashton

Senior Mental Health Dietitian Telephone: 0151 472 4033

Email: [email protected]

Published by

Copies of this document are available from the Author(s) and via the trust’s website

Mersey Care NHS Trust 8 Princes Parade

Princes Dock St Nicholas Place Liverpool L3 1DL

Your Space Extranet: http://nww.portal.merseycare.nhs.uk

Trust’s Website www.merseycare.nhs.uk

To be read in conjunction with

Physical Healthcare Policy HSS Food and Fluid Refusal Guidelines

Dysphasia Guidelines Enteral feeding Guidelines

Food Hygiene Policy This document can be made available in a range of alternative formats including

various languages, large print and braille etc

Copyright © Mersey Care NHS Trust, 2015. All Rights Reserved

Version Control:

Version History: Version 1 Executive Committee for Approval 14 05 15


mailto:[email protected]

mailto:[email protected]

http://nww.portal.merseycare.nhs.uk/Pages/MCNHSHome.aspx

http://www.merseycare.nhs.uk/

SUPPORTING STATEMENTS – this document should be read in conjunction with the following statements:

SAFEGUARDING IS EVERYBODY’S BUSINESS

All Mersey Care NHS Trust employees have a statutory duty to safeguard and promote the welfare of children and vulnerable adults, including: • being alert to the possibility of child/vulnerable adult abuse and neglect through their

observation of abuse, or by professional judgement made as a result of information gathered about the child/vulnerable adult;

• knowing how to deal with a disclosure or allegation of child/adult abuse; • undertaking training as appropriate for their role and keeping themselves updated; • being aware of and following the local policies and procedures they need to follow if they

have a child/vulnerable adult concern; • ensuring appropriate advice and support is accessed either from managers,

Safeguarding Ambassadors or the trust’s safeguarding team; • participating in multi-agency working to safeguard the child or vulnerable adult (if

appropriate to your role); • ensuring contemporaneous records are kept at all times and record keeping is in strict

adherence to Mersey Care NHS Trust policy and procedures and professional guidelines. Roles, responsibilities and accountabilities, will differ depending on the post you hold within the organisation;

• ensuring that all staff and their managers discuss and record any safeguarding issues that arise at each supervision session

EQUALITY AND HUMAN RIGHTS

Mersey Care NHS Trust recognises that some sections of society experience prejudice and discrimination. The Equality Act 2010 specifically recognises the protected characteristics of age, disability, gender, race, religion or belief, sexual orientation and transgender. The Equality Act also requires regard to socio-economic factors including pregnancy /maternity and marriage/civil partnership.

The trust is committed to equality of opportunity and anti-discriminatory practice both in the provision of services and in our role as a major employer. The trust believes that all people have the right to be treated with dignity and respect and is committed to the elimination of unfair and unlawful discriminatory practices.

Mersey Care NHS Trust also is aware of its legal duties under the Human Rights Act 1998. Section 6 of the Human Rights Act requires all public authorities to uphold and promote Human Rights in everything they do. It is unlawful for a public authority to perform any act which contravenes the Human Rights Act.

Mersey Care NHS Trust is committed to carrying out its functions and service delivery in line the with a Human Rights based approach and the FREDA principles of Fairness, Respect, Equality Dignity, and Autonomy


CONTENTS

Paragraph

1 Purpose and Rationale

4 Outcome Focused Aims and Objectives

5 Scope

7 Definitions

17 Duties

30 Process

30 Process for Nutritional Screening

31 Process for service users who are Identified as at ‘High Risk’ of under nutrition, obesity or with nutritional co-morbidity

32 Process for service users who are identified as at ‘Medium Risk’ of under nutrition

33 Process for service users who are identified as ‘Routine Care’

34 Process of Consent

35 Food Service

36 Protected Meal Times

37 Oral Nutritional Supplements (ONS)

38 Healthy Eating

39 Extra Portions at Mealtimes Guidance

40 Patient CHOICE

41 Hydration

42 Dealing with food refusal

43 Addressing the Nutritional Needs of Patients who Lack Mental Capacity

44 Audit


45 Consultation

46 Controls and Archiving

47 Implementation and Monitoring

49 Training and Support

References

Appendices

Appendix A Nutritional screening assessment

Appendix B International guidance on BMI/waist circumference thresholds

Appendix C General healthy eating guidelines

Appendix D Policy Implementation Plan

Appendix E Food chart and fluid chart

Appendix F Equality & Human Rights Analysis


PURPOSE AND RATIONALE

1. Purpose – As a Mental Health care provider the Trust understands that managing a long term mental health condition has the potential to compromise nutritional status.

2. This Policy explains the roles, responsibilities and process for delivering

the national standards of nutrition and improving the nutritional care of patients.

3. Rationale – to recognise the importance of nutrition and ensure a

consistent approach to the nutritional care of patients.

3.1 The importance of nutrition in the prevention of numerous illnesses and the maintenance of physical and mental health and well-being has long been recognized.

3.2 The role of nutrition is an obvious but under utilised factor in mental

health and therefore delays in treatment. There is a growing body of research which indicates that food plays an important role in the development, management and prevention of specific mental health problems. Achieving the nutritional and hydration needs of all service users is a priority and is an integral part of effective health care.

3.3 Care Quality Commission (CQC), whom register and license

providers of care services, have monitored Nutrition to ensure needs as part of the National Patient Safety Agency Agenda since 2006.

3.4 As a registered health care provider, the Trust is obliged to satisfy

standards of nutrition as laid down in the Health and Social Care Act under the Care Quality Commission Fundamental Standards of Quality and Safety. The NHS Commissioning Board has introduced patient-led assessments of the care environment (PLACE). The policy has been written to aim to comply with the DOH Hospital Food Standards report for Food and Drink in Hospital, NICE Guidelines, also meets CQC Regulations. The documents in Section 10.1 provide the framework within which the Trust is working to improve the nutritional care of its patients.

OUTCOME FOCUSED AIMS AND OBJECTIVES 4. For this Policy the aims and objectives are as follows:

(a) To provide a clear understanding of the Trust’s principle

responsibilities and minimum standards in respect of addressing the nutritional needs of Service Users whilst in contact with the trust.


(b) To reflect the requirements that a truly holistic approach is adopted to care, that improves nutrition and hydration status and therefore general health and wellbeing of inpatient settings. The policy also describes the standards and practice for Nutritional screening, assessments and treatments of inpatients and the duties and responsibilities of Trust staff.

(c) To improve the nutrition and hydration status and therefore general

health and wellbeing of Users in inpatients settings. (d) All service users will be nutritionally screened using MUST within 72

hours of admission as routine and reviewed according to MUST recommendations.

(e) The Trust provides patient specific care to meet individual nutritional

needs and specialized services as appropriate eg. Dietitians, Speech and language therapy.

(f) To maintain the dignity and respect of all service users and to ensure

they receive timely care and treatment with due consideration given to mental illness, learning disabilities, age, cultural background, disability, income, gender, sexuality, spiritual and religious beliefs or dietary needs – in accordance with the Trust.

SCOPE 5. This policy applies to: people who access Mersey Care NHS Trust

inpatient services: it recognises that the food provided needs to be appetising, nutritious and in line with current national guidelines for healthy eating.

6. This policy does not cover: outpatients, community, carers, relatives, staff and other visitors to the Trust but recognizes that these groups may need to eat on the premises and must be catered for in a manner sensitive to their preference, comfort and nutritional needs. The trust accepts no responsibility when food is brought in by visitors for food safety.

DEFINITIONS 7. The relevant terms and their definitions (within the context of this policy

document) are outlined below.

8. Malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.


9. The term Malnutrition also describes ‘over nutrition’ (over weight/obesity) which can cause health problems.

10. Obesity is defined in terms of Body Mass Index (BMI): BMI is a measure that is used to see if an adult is a healthy weight for their height. Please see Appendix B for International guidance on BMI/waist circumference thresholds. (a) The Trust recognises that there are particular physical health conditions with

intrinsic consequences for nutrition such as diabetes and high blood cholesterol. Long term mental health condition can compromise nutritional status. The Trust will ensure that specialist advice, support and interventions will be provided and that specific Department of Health guidance relating to these and other such conditions will be followed.

(b) Trust will work in partnership with service users and carers to promote good nutrition and hydration as part of a healthy life style, which is in keeping with a recovery focused approach and improving physical health.

11. Nutrition Support should be considered in people who are malnourished

(undernourished), as defined by any of the following:

(a) A body mass index (BMI) of less than 18.5 kg/m2 (b) Unintentional weight loss greater than 10% within the last 3-6 months (c) A BMI of less than 20 kg/m2 and unintentional weight loss greater than 5%

within the last 3-6 months. 12. Nutrition support should be considered in people at risk of malnutrition, defined

as those who have:

(a) Eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer.

(b) A poor absorptive capacity and/or high nutrient losses and/or increased

nutritional needs from causes such as catabolism.

NB – A person may be malnourished but not underweight due to poor diet, substance misuse or physical illness.

13. Dysphagia is a term used to describe swallowing disorders that may occur in

the oral and/or pharyngeal stages of eating and drinking. These can arise from a wide range of neurological, structural, psychological and organic conditions including the dementias. People with mental health conditions are more at risk of experiencing swallowing problems and choking.

14. Psychiatric Medication and Physical Health - several classes of medicines used in mental health can have an impact on a patient’s nutritional intake. A number of medicines used for different indications can cause weight gain, often through increased appetite. These include:


(a) Antipsychotics, such as olanzapine, clozapine, quetiapine and risperidone, (b) Antidepressants, such as mirtazapine, (c) Mood stabilising agents such as lithium and valproate. (d) In addition, antipsychotics such as olanzapine and clozapine can have an

effect on cholesterol, triglycerides and blood glucose. (e) The side effects of medication should be discussed with the patient before

prescription. Also side effects should be reviewed if a significant change in a patient’s dietary intake is noted, particularly if there have been recent changes to his/her medicines.

(f) Should effects on weight and appetite become a concern, medication should be reviewed by the multidisciplinary team.

15. Food and Mood - it is important to eat regularly and healthily to maintain good

mental and physical health. Regular balanced meals and / or snacks help to maintain blood sugar levels within normal limits. If eating is erratic and unbalanced mood swings, irritability, low mood, poor sleep, and poor concentration may result (See Appendix C for detail on a healthy balanced diet to support optimal physical and mental health)

16. Social/Therapy sessions - any food and drink used as part of therapy or as refreshments should be in accordance with the clinical needs of the service users and are not the prime incentive for attendance at therapy sessions.

DUTIES 17. Trust Board – is responsible for ensuring that effective nutritional care

systems are in place and that these are monitored. The provision of good quality food and fluid to meet the requirements of all patients is essential. This should be both cost effective and nutritious and encompass all therapeutic diets. The Trust supports and promotes the need for effective multi disciplinary working to provide the best possible care for patients, which includes meeting their nutritional needs.

18. Chief Executive – is responsible for ensuring the Trust meets its statutory and non-statutory obligations in respect of maintaining appropriate standards of privacy and confidentiality for patients and their carers in relation to the nutritional status, needs and requirements of patients.

19. Executive Director of Nursing – is accountable to the Trust Board for the implementation of the Policy and ensuring that appropriate physical health and nutrition care management is monitored and reported to the Trust Board accordingly.

20. Divisional Head of Services are responsible for delivering the nutritional and hydration agenda. They will:

(a) ensure that specialist advice, support and interventions will be

provided according to an individuals dietary needs or preferences, including their religious and/or cultural dietary requirements.


(b) oversee a multi disciplinary approach to nutritional care and values the contribution of all staff groups working in partnership with service users and users.

(c) seek assurance of work in partnership with service users and carers

to promote good nutrition as part of a healthy lifestyle, in keeping with a recovery focused approach, which emphasizes the prevention of poor nutrition as well as treatment.

21. Modern Matrons and Team Managers – will ensure:

(a) all staff are aware of this protocol and procedures. (b) all staff have received appropriate training. (c) all equipment is maintained, logged on the Trust medical device

inventory and replaced when necessary (d) if the service user is discharged before referred to dietetics and

nutritional status is a concern this will be included on the GP discharge notification/ Discharge Summary.

22. Medical Staff – will be aware of:

(a) the service user’s nutritional needs and care plan as identified by MUST and the need to refer to dietetics if needed.

(b) the protected meal time initiative. (c) prescribing nutritional and food supplements as recommended by the

dietitian assessment. (d) including in the GP discharge notification/Discharge Summary if the

service user is discharged before referred to dietetics and nutritional status is a concern.

23. Dietitians

(a) Dietitians are the only qualified health professionals that assess,

diagnose and treat diet and nutrition problems. (b) Advise and inform the trust on new initiatives, polices and guidelines

in nutrition. (c) Maintain evidence based practice within the trust regarding nutrition

and dietetics. (d) Dietitians will provide a nutritional assessment for appropriate patients

referred.


(e) Education for staff on nutrition related issues i.e. Screening/Therapeutic diets.

(f) Liaise with catering and have active involvement in assessing the

nutritional adequacy of meals (g) Liaise with the relevant Catering staff as required for the provision of

appropriate meals/special diets. (h) Be involved in menu planning and development of therapeutic menus. (i) Advise and educate service users and carers on therapeutic diets. (j) Advise and prescribe nutritional supplements. (k) Leading dietetic health promotion activities. (l) Refer and Liaise with other health care professionals including

Speech and Language Therapists on dysphagia issues and Occupational Therapists on activities of daily living as part of an integrated approach to care.

(m) Identify and implement training to catering, nursing and other clinical

staff. (n) Advise on an appropriate nutritional care plan; liaise with nursing staff,

catering staff and the wider MDT. (o) Undertake assessment for obesity especially within mental health

patients as the psychotropic medication they are prescribed can cause weight gain leading to physical health complications

(p) If continued dietetic care is needed on discharge from Mersey Care

Trust, the Dietitian will send a nutrition discharge letter to the GP and if appropriate the community service required.

24. Facilities Staff

(a) Facilities Staff will provide food and nutrition in accordance with the

agreed service level arrangements for the Trust and undertake regular patient satisfaction surveys.

(b) They will be responsible for food preparation/presentation to ensure

food is appealing. (c) Provide a comprehensive menu which provides a choice of dishes to

meet diverse needs including: religious and cultural, therapeutic diet in conjunction with the Dietitian.


(d) Ensuring meals will be sufficient to meet estimated average requirements (EAR) for energy and the reference nutrient intake (RNI) for protein and vitamins and minerals.

(e) Support service users and nursing staff to enable food delivery

services to meet the needs of service users at all times.

25. Ward Managers and Nursing staff are responsible for:

(a) Nutritional screening (MUST) of service users within 72 hours of admission, appropriate documentation and reviewing and rescreening regularly throughout admission as indicated by the MUST tool.

(b) Justification if unable to screen a patient in service user’s clinical

notes should also be documented. (c) Referral to the Dietitian where a comprehensive nutrition assessment

is necessary because the nutritional screening assessment identifies risk of poor nutrition and hydration.

(d) Providing personalized and evidence based nutritional care, which

includes being aware of an individual’s needs or preferences; inclusive of vegetarian, vegan and cultural, ethnic or religious requirements.

(e) Providing accessible menu’s and the arrangements for mealtimes. (f) Supporting the service user to understand the impact of their

medication on their nutrition and hydration and any action they need to take to avoid poor nutrition or dehydration.

(g) Attending training on MUST and care planning. (h) Arranging any special diets that service users require. (i) Ensuring the environment supports good nutritional care and

protected meal times adhered to. (j) Providing assistance/education with menu choice and positioning for

meals as required.

(k) Making sure appropriate fluids are available 24 hours a day and patients encouraged to meet their requirements.

(l) Food and fluid record charts completed according to MUST. (m) Monitoring food provision brought in by patients, carers and visitors

and advising as necessary.


(n) Challenging poor practice in relation to nutrition and hydration and keeping up to date on MUST training

(o) The facilities departement and Dietitians are to be informed if a patient

requires a therapeutic diet, religious or cultural purposes.

(p) Protected mealtimes guidance is followed to provide an environment conductive to patients enjoying and being able to eat their foods.

(q) Assistance is provided when needed, to choose options from the

menu, appropriate feeding aids and adaptions, protecting the patients dignity.

(r) To follow care plan as outlined by the specific health professional e.g.

Dietitian/Speech Therapy and report to the health professional if a patient non compliant.

(s) If the service user is discharged before referred to dietetics and

nutritional status is a concern this will be included on the GP discharge notification/ Discharge Summary.

26. Speech and Language Therapist (SLT)

(a) SLTs advise and inform the trust on new initiatives, polices and guidelines in dysphagia. Advise on an appropriate swallow/feeding assessment, management and care planning; support it’s implementation and review the treatment/care plan. This may include food/fluid texture modification and feeding strategies and palliative care.

(b) Liaise and advise with service user, carers, GP and other professionals

involved such as Dietitians and Nursing staff and refer on to other MDT services.

(c) If continued SLT care is needed on discharge from Mersey Care Trust, the

SLT will send a discharge letter to the GP and if appropriate refer to the local community service

27. Physiotherapist - a Physiotherapist’s advice and / or care may be required to

help position a patient appropriately at meal times.

28. Secure Division Physical Health Care Group and Local Division Physical Health Forum have been established. The role of these groups is to monitor the implementation of this Policy throughout the Trust.

29. Patients should be encouraged to take a positive approach to improving their nutrition and should be given information about what to expect and what to ask about when they come into hospital.


PROCESS 30. Process for Nutritional Screening

30.1 All inpatients, must receive a nutritional screening assessment (MUST amended for Mersey Care use, Appendix A to identify Nutritional risk, within 72 hours of admission and throughout the admission. If this is not possible then this should be recorded and the reason given in accordance with the Trust Physical Health Policy.

30.2 All patients identified to be at risk will be referred to appropriate

services (Dietitian/Speech Therapy). 30.3 MUST reviewed at least monthly or more frequently depending on

individual patient assessment. 30.4 MUST Nutritional Screening to be carried out by healthcare

professionals with the appropriate skills and training. 30.5 Any known food allergies and specialist dietary requirements will be

recorded in the patient’s clinical records. 30.6 All patients should have an individual Nutritional Care Plan on

admission and should be updated throughout the admission. The results of the nutritional screening will be recorded in the service user’s care plan.

30.7 Treatment and care should take account patients’ individual and

cultural needs and preferences. 31. Process for service users who are Identified as at ‘High Risk’ of

under nutrition, obesity or with nutritional co-morbidity

31.1 If the service user is identified ‘at high risk’ they must be referred to a Dietitian for a comprehensive assessment.

31.2 Healthcare professionals should ensure that people who are high

risk nutritionally, and their carers, are kept fully informed about their nutrition care plan. They should also have access to appropriate information and be given the opportunity to discuss diagnosis and treatment options.

31.3 A food chart and fluid chart (Appendix E) should be kept by nursing

staff as evidence of under or over nutritional intake and to ensure appropriate referral to the Dietitian.

31.4 Staff should explain (and give a copy if appropriate) and

incorporate into the service users care plan first line advice for nutrition support or weight management (Appendix E)


31.5 Planning implementation and evaluation of nutritional care will be

recorded in the service users care plan. 31.6 All staff will then be aware of the service user’s nutritional status

and how nutrition care will be provided, if required.

32. Process for service users who are identified as at ‘Medium Risk’ of under nutrition

32.1 A food chart and fluid should be commenced and closely

monitored 32.2 If inadequate intake noted - implement and explain first line

nutrition support advice (Appendix E) and refer to Dietitian

33. Process for service users who are identified as ‘Routine Care’

33.1 Repeat nutritional screening tool monthly and review nutritional intake and care plan routinely.

33.2 Nutrition care plans not only detail service user’s nutritional needs

but also their need for assistance in being able to access and eat appropriate food/drinks. If vulnerable service users do not consume their meals or nutritional supplements or are consuming in excess to their nutritional care plan, this must be documented and feedback given to the Nurse in Charge of the ward and Dietitian.

33.3 If a person does not have the capacity to make decisions, health

professionals should follow the Department of Health guidance – ‘Reference guide to consent for examination or treatment’ (2009).

34. Process of Consent

34.1 All patients will be supported in the making of informed decisions

about their care and treatment, in partnership with their health professionals. The Trust is committed to encouraging users to choose a diet that is appropriate for them.

34.2 Advice and support will be compatible with Department of Health

guidelines – Reference guide to consent for examination or treatment (2009).

34.3 Healthcare professionals will obtain consent from all those

deemed to have capacity to provide informed consent. 34.4 Act in the patient’s best interest if he/she is considered not to

have capacity to give consent and in the patient’s best interest when offering meals, see Mental Capacity Act.


34.5 Decisions on withholding or withdrawing of nutrition support will

be considered with reference to both ethical and legal principles (Both at common law and statute, including the Human Rights Act 1998).

35. Food Service

35.1 All of the meals offered by Mersey Care from the menus have

been specially created to ensure that they aim to conform to the DOH Hospital Food Standards Report on Food and Drink in Hospitals. The core menu follows a cycle 2-4 weeks depending on unit.

35.2 All food preparation and service will comply with food safety

legislation. 35.3 All food should be served in an attractive and appropriate manner

follow catering department guidance. 35.4 Nutritional standards for the menu follow national guidelines. 35.5 Food and beverages will be accessible twenty four hours a day. 35.6 To help patients make an informed choice about the nutritional

content of the menu, the menus are labeled with standard codes (e.g. Healthy eating, high energy and vegetarian).

35.7 A number of special dietary menus (e.g. Kosher, Halal, vegan and

dysphasic) are available to ensure that those patients who have specific nutritional/dietary and/or cultural requirements are provided with an appropriate choice of meals in order to meet their needs. Copies of these special diet menus will be kept in every ward kitchen.

35.8 Staff need to have an understanding of the handling and

production of Halal and Kosher foods, as well as meeting the religious requirements of the service user and preparing and plating food.

35.9 The Trust need to respond to the needs of service users who are

observing religious celebrations such as Ramadan. At these times food may need to be provided outside of protected meal times, food must be of the same standard and variety as normally provided.

36. Protected meal times

The Trust promotes protected meal times and aims to provide mealtimes free from avoidable and unnecessary interruptions by limiting ward based


activities at meal times so that the focus of the ward is on meal service and assisting patients to eat. It is also a requirement of CQC and PLACE.

37. Oral Nutritional Supplements (ONS)

37.1 Should be considered when a patient is unable to take sufficient

dietary intake to meet their nutritional needs and should be assessed by the Dietitian. The patients’ physical and mental medical condition, biochemistry, MUST score, current dietary intake, BMI and re feeding risk should be assessed prior to prescribing or providing oral nutritional supplements.

37.2 ONS should be part of a nutritional care plan with clear aims of

treatment and planned review. 37.3 Mersey Care protocol for prescribing Nutritional supplements

should be followed if prescribing without a dietetic assessment. (Appendix A)

38. Healthy Eating

General healthy eating guidelines – please refer to Appendix C

39. Extra Portions at Mealtimes Guidance

39.1 It is important that all services users’ nutritional needs are met

and this is achieved by standard portions provided by the trust. 39.2 Patients with a clinical need for extra portions/snacks (e.g.

nutrition support or pregnancy) will have an assessment from the dietitian and it will be included in the individual’s care plan.

39.3 Second helpings of higher energy items at meal times encourage

over nutrition and therefore increase the risk of weight gain and other complications associated with obesity. As a trust we should be committed to promoting health and to ‘do no harm to patients’.

40. Patient CHOICE

40.1 All menus to be displayed on the ward.

40.2 All patients will be provided with a nutritional choice of meal

during their in-patient stay. 41. Hydration

The Trust is committed to ensuring that where appropriate patients are encouraged to take regular fluids (to meet preferences) to meet their nutritional requirements and intake is documented where appropriate. If patients are unable to tolerate oral fluids the use of alternative routes e.g.


enteral, IV for the provision of fluids should be discussed with the patient’s clinical team.

42. Dealing with food refusal

43.1 An individual who continually refuses to eat or drink / refuse to open

their mouth is at high risk of dehydration and malnutrition. 43.2 The appropriateness of artificial support (e.g. nasogastric or PEG

feeding), including the ethical issues involved, should be discussed and documented by the multidisciplinary team. Mersey Care Trusts: Guidelines for Food and Fluid refusal are available to guide clinical staff in these circumstances.

43. Addressing the Nutritional Needs of Patients who Lack Mental

Capacity If a patient lacks capacity and is unable to make safe and appropriate food and fluid choices for themselves they may be putting themselves at nutritional risk and compromising their health outcomes. This should be documented and appropriate intervention should be taken, taking into consideration the requirements of the Mental Capacity Act (2005)

44. Audit

44.1 An audit will be undertaken annually in accordance with national standards and local initiatives PLACE and CQC.

44.2 Gaps and omissions within the Nutritional policy will be identified and monitored through the Physical Health meetings and Nutrition and Health Promotion groups group meetings. Action plans will be developed and subsequently reviewed by the appropriate management team.

CONSULTATION 45. Consultation on proposed changes to this policy document will be led by the

Senior Mental Health Dietitians and will include but not be limited to:

• Medical staff • Nursing staff • Divisional Directors • Service Leads • Modern Matrons • Allied Health Professionals • Service Users

CONTROLS AND ARCHIVING 18 | P a g e S D 4 4 N u t r i t i o n P o l i c y – 2 0 1 5 V 1

46. The Trust Secretary / Assistant Trust Secretary have responsibility for us the Trust’s policy set.

IMPLEMENTATION AND MONITORING 47. The Senior Mental Health Dieticians will develop an implementation plan.

They will identify any barriers to the processes described in this Policy and/or substantive changes in current practice requiring inclusion in the implementation plan.

48. The application of this Policy will be monitored by the Trust Physical Health Strategy Group, via reporting of KPI’s. CQUIN, audit of implementation of NICE guidelines, PLACE and CQC.

TRAINING AND SUPPORT 49. The Senior Mental Health Dieticians will consult on the collective training and

support required through the consultation process and through their own personal development review.

50. All healthcare professionals who are directly involved in inpatient care will have the appropriate skills and competencies needed to ensure that service users’ nutritional and hydration needs are met by monitoring using the appropriate charts and assisting with menu choice.

51. All registered and non registered nursing staff will have competencies

assessed as part of MUST training. See implementation plan Appendix D

52. All staff must be able to assess their own competency; clinical staff should identify their continuing professional development needs through appraisal and supervision

53. As a minimum training (a) MUST: Nutritional screening which will include; procedure, documentation

on food and fluid charts, referral process and care planning, provided for ward based staff. To be provided by Trust Dietitians

(b) Trust Dietitian to attend Training for physical health care link nurses/Assistant Practitioners and deliver basic healthy eating principles and to ward staff on request.

(c) Training to appropriate identified staff who are involved in food preparation on Allergen legislation. In addition it is recommended each ward should have an allocated staff trained in Allergen Legislation.


REFERENCES

(a) Department of Health The Hospital Food Standards report on Standards for food & Drink in Hospitals (2014)

(b) NICE Guidance on Nutrition Support in adults: oral nutrition support,

enteral tube feeding and parenteral nutrition (2006) (c) Care Quality Commission (CQC), 2015. Regulation 14: meeting nutritional

and hydration needs. Available at: http://www.cqc.org.uk/content/regulation-14-meeting-nutritional-and-hydration-needs >[Accessed 18 May 2015].

(d) PLACE (2013). Assessments relate to provision of safe and appropriate

food and drink for patients and assistance when required at mealtimes within an environment conducive to eating and drinking.

(e) British Dietetic Association. The Nutrition and Hydration Digest July

(2012) : Improving Outcomes through Food and Beverage Services (f) Improving Nutritional Care, a Joint Action Plan from the Department of

Health, which incorporates Nice guidelines (Feb 2006) and the recommendations from the Council of Europe Resolution, “Food and Nutritional Care in Hospitals 2003” (10 key characteristics of good nutritional care in hospitals).

(g) Manual of Dietetic Practice Third Edition revised and edited by Briony

Thomas in conjunction with The British Dietetic Association. (h) NICE Guidelines. (2006) Dementia. November. Department of Health (i) Food Standards Agency (2014). Allergens Legislation (j) NICE (December 2006) Obesity Guidance on the prevention,

identification, assessment and management of overweight and obesity in adults and children

(k) The British Dietetic Association www.bda.uk.com (l) BAPEN Malnutrition Matters – Meeting Standards of Care for Nutrition

and Hydration in hospitals (2010) (m) Evidence from the National Patient Safety Agency's, (NPSA) National

Reporting & Learning System has identified dehydration as a patient safety issue.

(n) Department of Health, Healthier and more sustainable catering: Nutrition

principles. 2011


http://www.cqc.org.uk/content/regulation-14-meeting-nutritional-and-hydration-needs

http://www.cqc.org.uk/content/regulation-14-meeting-nutritional-and-hydration-needs

(o) Department of Health, Healthier and more sustainable catering: A toolkit for serving food to adults. 2011

(p) NHS Kidney Care Hydration Matters (2012)


Name: DOB: Ward:

Date of Assessment: Height: Weight: BMI: MUST SCORE: Risk Factor (please tick) Action (if any risk identified) Physical/ Psychological Effects on Intake □ Physical illness e.g. Cancer □ Pain □ Eating disorder □ Anxiety □ Constipation □ Depression □ Diarrhoea □ Psychosis □ Nausea/ vomiting □ Impaired senses – taste, smell, vision

Consider referral to medical team/GP If any unexplained D&V in last 48hrs, contact Infection Control team

Swallowing Difficulty □ Low level of alertness at meal times □ Diminished or absent reflexes e.g. cough □ Reduced appetite/ food refusal □ Complaining of pain/obstruction on swallowing □ Dribbling □ Difficulty in chewing/ slow eating □ Choking, coughing □ Change in breathing on eating/ drinking

Consider referral to Speech and Language Therapist

Condition of Mouth and Teeth □ Sores or ulcers □ Bleeding gums □ Loose or broken teeth □ Bad breath/dirty teeth □ Dentures loose, broken or missing

Consider referral to dentist

Special Dietary Needs □ Food allergy or intolerance □ Religious or cultural requirements e.g kosher, halal □ Other special diets e.g diabetic, vegan, coeliac, renal □ Nutritional supplements □ Modified food/ fluid texture e.g soft, puree, thickened fluids

Please specify______________ __________________________ Order special meals via Catering. Refer to dietitian for special diets and textures if required.

Attitude to Eating /Drinking □ Unable to choose from menu/ express choice □ Poor intake e.g. refuses food/ fluid, many food dislikes limited range of foods eaten □ Poor appetite □ Excessive intake □ Speed of eating too fast/ slow □ Changes in clothing size over past six months

Assist with ordering food/ fluids. If MUST nutritional screening outcome is high risk malnutrition/ obesity, refer to Dietitian.

Positioning of Patient and Feeding Aids □ Poor position for eating (not upright)

Consider referral to Occupational Therapist

Appendix A

NUTRITIONAL NEEDS


□ Cannot sit at table to eat □ Cannot feed self □ Requires feeding aids, adapted cutlery

Assist with feeding

REFER TO TRUST POLICY ON THE MANAGEMENT OF DYSPHAGIA (SD 30)


Nutritional Screening Tool Care Plan High Risk – MUST score 2 High risk Obesity

Management – MUST score 0

Medium Risk MUST score 1

Low Risk – MUST score 0

Treat Treat

Observe

Routine Care

Document screening outcome and High risk 2+ Careplan Observe intake using a food chart and fluid chart Improve and increase nutritional intake. Give first line nutrition support advice. Resources may be accessed on Sharepoint. Follow local guidelines Refer to the dietitian Repeat nutritional screening tool and review dietary care plan weekly *Unless detrimental or no benefit is expected from nutritional support e.g. in terminal phase of illness

Document screening outcome and High risk obesity 0 care plan Encourage healthy eating and lifestyle Give first line healthy eating advice. Resources may be accessed on Sharepoint. Referral to Dietitian as per weight management pathway Repeat nutritional screening tool monthly and review nutritional care plan accordingly

Document screening outcome and Medium risk 1 careplan Observe intake using a food chart and fluid chart If inadequate intake – improve and increase nutritional intake using first line advice. Resources may be accessed on Sharepoint and follow local policy. If adequate intake then there is little concern Repeat nutritional screening tool weekly

Document screening outcome and Routine 0 care plan Resources may be accessed on Sharepoint Repeat nutritional screening tool monthly and review nutritional care plan

For all categories –

• Treat underlying condition and provide help and advice on food choices, eating and drinking when necessary.

• Refer to the dietitian for any nutritional problems e.g. diabetes, celiac disease, renal diets etc. • Record the need for special diets and local policy • Re-assess clients identified at risk as they move through care settings.

Please contact Mersey care Dieticians should you have any queries using this tool


Tool based on the Malnutrition Universal Screening Tool (MUST) by the BAPEN Malnutrition Advisory Group. Adaptions by Mersey care Dietetics 2012


These guidelines have been added to the nutrition policy as guidance for staff as the thresholds for BMI.

In 2004, the World Health Organization (WHO) concluded the international body-mass index (BMI) cut-off points for determining if someone is overweight (BMI 25 kg/m2) or obese (BMI 30 kg/m2) probably not appropriate for Asian populations, as there is a high risk of type 2 diabetes and cardiovascular disease among some black and minority ethnic groups at a BMI lower than 25 kg/m2.

Due to lack of data in 2004, it was not possible to redefine thresholds for all Asian groups and WHO recommended that the current thresholds (BMI 25 kg/m2 and 30 kg/m2) should be retained as international classifications – see data below

Box 1: International guidance on BMI/waist circumference thresholds WHO advice on BMI public health action points for Asian populations (World Health Organization 2004) White European Populations Asian Populations Description Less than 18.5kg/m² Less than 18.5kg/m² Underweight 18.5- 24.9 kg/m² 18.5 – 23 kg/m² Increasing but acceptable risk 25- 29.9 kg/m² 23-27.5 kg/m² Increased risk 30kg/m² or higher 27.5 kg/m² High risk International Diabetes Federation guidance on waist circumference thresholds as a measure of central obesity (Alberti et al. 2007) European Men ≥ 94cm (37inches) Women ≥ 80cm (31.5 inches) South Asians Men ≥ 90cm (35 inches) Women ≥ 80 cm (31.5 inches) Chinese Men ≥ 90cm (35 inches) Women ≥ 80 cm (31.5 inches) Japanese Men ≥ 90 cm (35 inches) Women ≥ 80 cm (31.5 inches) Ethnic south and central Americans

Use south Asian recommendations until more specific data available

Sun-Sahara Africans Use European data until more specific data available Eastern Mediterranean and middle east (Arab) populations

Use European data until more specific data available

South Asian Health Foundation position statement on BMI and waist circumference (Kumar et al. 2010)

Recommends lower thresholds for advising South Asians to adopt a healthier lifestyle and avoid further weight gain. States that South Asians should be targeted as a special group for raising awareness of the risks of obesity. The Foundation supports a lower threshold of 23 kg/m2 for classification as overweight in British South Asians, as suggested by other

Appendix B International guidance on BMI/waist circumference thresholds


http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(03)15268-3/fulltext%23article_upsell

http://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2007.02157.x/abstract;jsessionid=FA83DE6CBD28AAC8BB5F26FE1C241B76.d02t04?systemMessage=Wiley+Online+Library+will+be+disrupted+on+17+December+from+at+23%3A00+GMT+%2818%3A00+EST%29+for+essential+maintenance+for+approximately+one+hour

expert groups. It acknowledges that more research is needed to establish appropriate thresholds for waist circumference in different sub-groups. In the meantime, it suggests that men with a waist circumference greater than 90 cm (35 inches) and women with a waist greater than 80 cm (31.5 inches) should be considered overweight.

Other guidance is available from:

• Scottish Intercollegiate Guidelines Network (2010)

• Ministry of Health India (Misra et al. 2009)

• Ministry of Health Singapore (Health Promotion Board Singapore 2005)

• Obesity in Asia Collaboration (2007)

• Cooperative meta-analysis group of the working group on obesity in China (Zhou 2002)


• Eat a source of starchy carbohydrate (bread, potatoes, rice, pasta, crackers or breakfast cereals) at each meal or snack as these can help to maintain blood sugar levels, give energy and prevent hunger. They give nutrients such as the B vitamins and iron so it is important to have a variety of these during a week. Include a small portion of a protein source such as meat, fish, eggs small portion of cheese, baked beans or other beans, pulses or nuts twice a day. These can help prevent hunger and stop inappropriate snacking between meals.

• Include 5 portions of fruit and/or vegetables/salad per day to help prevent

constipation which can affect mood and be uncomfortable. This can also cause confusion in the older person. The anti oxidant vitamins contained in the fruit and vegetables can help to lower the risk of heart disease and some cancers, these vitamins can help the immune system which helps to prevent infections.

• Caffeine has positive effects on cognitive and performance when taken in

moderation, however when taken in excess caffeine can cause high levels of anxiety and add to feelings of panic. If the caffeine levels are repeatedly changing over a day, this can lead to mood swings too. Caffeine is addictive so if the daily intake is high, it is important to reduce the amounts of caffeine in the diet over a period of time to prevent withdrawal effects such as headaches. Caffeine is also found in coffee, tea, chocolate drinks and cola type drinks ‘high-energy’ stimulant drinks and foods containing chocolate.

• Sugar intake should be limited in drinks, such as tea, coffee or cold/fizzy

drinks, or on cereals as well as from foods such as sweets, chocolates, cakes and biscuits. These foods taken regularly as part of an unbalanced diet can also add to mood swings due to the blood sugar levels going up and down in the same way as caffeine levels as discussed above.

• Regular fluids should be taken over a 24 hour period. These can include

water, fruit juices, squashes, decaffeinated tea or coffee. Adequate fluids are important to prevent constipation and reduce the risk of urinary tract infections and cystitis. Mild dehydration can lead to poor concentration, headaches and confusion.

• Overconsumption of high calorie fluids should be discouraged where weight

gain is undesirable or diabetes or hypertriglyceridaemia is present. A range of low calorie/calorie free drinks, caffeine free sugar free drinks and sugar free sweeteners should always be available and staff should encourage their use, where appropriate.

Appendix C A healthy balanced diet to promote optimal mental health.


• It is important for good health to have a regular source of the Omega fats to help brain function, memory and prevent low moods as these fats are needed by the brain. Good sources include the oily fish such as mackerel, pilchards, sardines, salmon and tuna and should be eaten twice a week as part of a balanced diet. For vegetarians and vegans, a source of flaxseed should be taken as these are good sources of the Omega fats. Animal fats e.g. butter, lard and hydrogenated fats which are the sort found in foods such as shop-bought cakes, biscuits, pastries and some crisps can lead to raised cholesterol levels and weight gain if taken in moderate or large quantities. Better sources include sunflower and olive oils but these still need to be taken in small or moderate amounts as they can also lead to weight gain if taken in large amounts.

• Low intakes of micro nutrients can also affect mood. Low folate intake can

increase the chances of feeling depressed, especially in older people. Folates are found in liver, green leafy vegetables, oranges and citrus fruits, beans and foods such as marmite and breakfast cereals. A deficiency of B vitamins can cause mood problems including fatigue, irritability and depression. These are mostly found in meats and fish, cereals and bread.

• Iron is needed to prevent anaemia which can cause lethargy and tiredness

and lead to depression. Iron containing foods include red meats beef, pork or lamb), liver and kidney, eggs, green vegetables, peas, beans ( including baked beans) and pulses, breakfast cereals and bread, particularly white bread.

• Low selenium levels can also increase the chances of depression and other

negative mood states. Food sources are meat, fish, eggs and brazil nuts


Communicating What are they key messages to communicate to the

different stakeholders? How will these messages be communicated? Effective communication will ensure that all those affected by the Policy are kept informed thus smoothing the way for

Each ward is provided with an up to date menu folder incorporating dietary coding of menu options, Allergen information and general healthy eating advice. Information on how to contact key personnel with any problems or queries.

Issues identified/Action to be taken Timescale Co-ordination of Implementation How will the implementation plan be co-ordinated

and by whom? Clear co-ordination is essential to monitor and sustain progress against the implementation plan and resolve any further issues that may arise.

Audits and action plan to be reviewed regularly by Physical Health care group/Nutrition and health Promotion Group, Dietitian and Catering Manager to ensure that timescale deadlines are met.

Ongoing

Engaging Staff Who will affect directly or indirectly by the Policy? Are the most influential staff involved in the

implementation? Engaging staff and developing strong working relationships will provide a solid foundation for changes to be made.

This policy will affect both service users and staff. Its implementation will be achieved largely by incorporating changes into the menus. This involves close liaison between the Dietitian, Catering and Facilities.

Ongoing

Involving Service users and carers Is there a need to provide information to service

users and carers regarding this policy? Are the service users, carers, representatives or

local organizations who could contribute to the implementation.

Involving service users and carers will ensure that any actions taken are in the best interest of service users and carers and that they are better informed about their care.

Service users views are taken into account in several ways:

1. Regular interaction with dietitian who will feed back to catering staff

2. Attendance at community meetings when invited 3. Catering surveys, at least once / year 4. Service users to be involved in Nutrition/catering

groups

Ongoing

Appendix D Policy Implementation Plan


any changes. Promoting achievements can also provide encouragement to those involved. Training What are the training needs related to this Policy? Are people available with the skills to deliver the

training? All stakeholders need time to reflect on what the Policy means to their current practice and key groups may need specific training to be able to deliver the Policy.

Training training on MUST nutritional screening and care planning, provided for ward based staff. Training of physical health care link nurses/Assistant Practitioners in basic healthy eating principles will be undertaken by the dietitian. Training to appropriate identified staff on Allergen legislation.

Ongoing

Resources Have the financial impacts of any changes been

established? Is it possible to set up processes to re-invest any

savings? Are other resources required to enable the

implementation of the Policy, eg increased staffing, new documentation?

Identification of resource impacts is essential at the start of the process to ensure action can be taken to address issues which may arise at a later stage.

Small financial implication of providing extra fresh and dried fruit to patients on psychotropic medication. This should be offset by reducing the number of constipation-related hospital admissions.


Securing and sustaining change Have the likely barriers to change and realistic ways

to overcome them been identified? Who needs to change and how do you plan to

approach them? Have arrangements been made with service

managers to enable staff to attending briefing and training sessions?

Are the arrangements in place to ensure the induction of new staff reflects this policy?

Initial barriers to implementation need to be addressed as well as those that may affect the on-going success of the Policy.

The provision of healthy foods is futile if service users refuse to eat them. Continuous health promotion initiatives are essential A Nutrition &Health Promotion Group/Physical Health Group/Catering meeting to share ideas and monitor progress. Members of the group include staff from several disciplines including medical, nursing, physical education and dietetic.

Evaluating What are the main changes in practice that should

be seen from the Policy? How might these changes be evaluated? How will lessons learnt from the implementation of

this Policy be fed back to the organization? Evaluating and demonstrating the benefits of new Policy is essential to promote the achievements of those involved and justifying changes that have been made.

Clinical audit team will be developed in conjunction with clinical staff audit tools and outcome measures to evaluate the changes in practice. Auditing patient data and biochemistry. Audit results to be feed back to Primary health care meeting and Clinical Governance. Improve nutritional intake and reduce risks associated with Malnutrition. Improved clinical outcomes for Diabetes management should help reduce/prevent Complications of diabetes. Reducing fat, particularly saturated fat, should result in a reduction in cholesterol levels and a reduction in weight or in rate of weight gain. Increase of fiber should result in a decrease in constipation and related conditions. A reduction in sugar intake should have a beneficial effect on teeth and weight.

Ongoing


Reduction of salt intake should reduce blood pressure.

Other considerations


FOOD CHART

Name: Date: Date of birth: X or Patient number: Ward: Food/fluid allergies:

Specialist food requirements (e.g cultural/ modified consistency):

Requires assistance YES/NO Comments (eg. adapted utensils):

*Description of meal or snack offered Please tick for amount eaten none 1/4 1/2 3/4 full Breakfast

Mid Morning

Lunch

Mid afternoon

Evening meal

Mid afternoon snack

Supper

Any additional intake

* Accurately describe the content of the meal and portion size and tick the amount eaten.

Appendix E Food and Fluid Monitoring Charts and First Line Nutritional Advice


GUIDE: FLUID INTAKE Document all fluid intake (including nutritional supplements) and refusal of offered fluids on charts provided

Ensure staff encourage fluid intake and are aware of patients personal preferences and offer alternatives if fluid refused

Please note: Check service users Nutritional Care Plan for individual fluid requirements and if not stated or no special requirements (eg fluid restrictions) please use information below as a guide

Average Recommended Daily Intake: Adults including (older people) – Men 2000 mls and Woman 1600 mls

Note there are groups of patients that will differ from the average eg weight management patients – please seek advice from the Dietitian if unsure

Early Signs of Dehydration:

• Feeling Thirsty

• dark urine and not passing much urine when you go to the toilet

• headaches

• lack of energy

• feeling lightheaded

The colour of your urine is the best indicator; if you are drinking enough your urine should be a straw or pale yellow colour.

Please measure accurately the volume of fluid the following cups hold appropriate for your ward (add if necessary):

1 medium size glass ≈ mls

1 mug ≈ ml

1 tea cup ≈ ml

1 plastic cup ≈ ml

1 polystyrene cup ≈ ml

1 Feeder cup ≈ ml

1 bottle Ensure Plus ≈ 220 mls

1 bottle Ensure Compact ≈ 125 mls


http://www.google.co.uk/url?q=http://www.soutron.com/YourChallenges/SuccessStories.aspx&sa=U&ei=6u_9UrvlDcWv7Ab17oCIBw&ved=0CDIQ9QEwAg&usg=AFQjCNE_1zEvpxFjwBs2yMMhfv9LidyxVw

Fluid Balance Chart:

Name: Date: Date of Birth: X or patient number: Ward: Food / fluid allergies: Specialist fluid requirements (eg Fluid restriction):

Requires assistance: Yes/No Comments (eg Feeder cups):

Time Fluid Type

Route-oral

Amount-mls

Total input- mls

Output- mls

Total output-

mls Signature

08.00

09.00

10.00

11.00

12.00

13.00

14.00

15.00

16.00

17.00

18.00

19.00

20.00

21.00

22.00

23.00

00.00-02.00

02.00-04.00

04.00-06.00

06.00-08.00

Total


Equality and Human Rights Analysis

Title: NUTRITION POLICY

Area covered: Trust wide

What are the intended outcomes of this work?

This policy outlines the mechanism for ensuring availability of nutritious and healthy food for service users and staff within Secure Service and Local Divisions of Mersey Care NHS Trust in line with current national guidelines for healthy eating.

Who will be affected?

Service users/ patients

Staff in relation to their practices/actions in relation to the policy.

Evidence

What evidence have you considered?

The policy and the high services Nutrition policy.

Disability inc. learning disability

Easy Read menus/ Visual menus

Eating disorders

Drugs and alcohol

Issues identified in relation to food and mood/mental health.

Appendix F Equality & Human Rights Analysis


Sex

No issues identified.

Race

BMI issues and differences in the South Asian community identified.

International guidance on BMI/Waist circumference thresholds referenced.

Age

Dementia: considered in terms of nutritional support a well as swallowing difficulties (see Dysphagia page 9).

Gender reassignment (including transgender)


Sexual orientation


Religion or belief

The policy identifies the need to consider religion in the dietary needs of service users in relation to religious belief (including Halal and Kosher diets). Nutrition needs and provision for Ramadan included.

Vegan and vegetarian needs considered.

Pregnancy and maternity


Carers


Other identified groups



Cross cutting


Human Rights Is there an impact?

How this right could be protected?

This section must not be left blank. If the Article is not engaged then this must be stated.

Right to life (Article 2)

All Patients/service users will have a nutritional assessment completed. However those identified as being high risk of malnutrition will be referred to a dietician for a comprehensive assessment.

Right of freedom from inhuman

and degrading treatment (Article 3)

Human rights approach supported.

Right to liberty (Article 5)


Right to a fair trial (Article 6)


Right to private and family life

(Article 8)

Consent: issues are explored in section 8.5 page 15.

All patients will be supported in the making of informed decisions about their care and treatment in partnership with their health care professionals.

Capacity: issues are considered within section 8.14 page 18.

Right of freedom of religion or belief



(Article 9)

Right to freedom of expression

Note: this does not include insulting language such as racism (Article 10)


Right freedom from discrimination

(Article 14)


Engagement and involvement

Service users/patients views are taken into account via several ways:

1. Regular interactions with dietician who will feed back to catering staff.

2. Attendance at different service users meetings across the Trust.

3. Regular surveys and audits across the Trust.

Summary of Analysis

Eliminate discrimination, harassment and victimisation

The policy takes account of a wide range of nutrition needs across the protected groups. This will ensure that BME/religious needs and disability requirements are considered and actions reflect this.

Advance equality of opportunity

N/A

Promote good relations between groups

N/A


What is the overall impact?

This policy should have a positive impact n the patients/service users from the protected characteristics.

Addressing the impact on equalities

See above.

Action planning for improvement

Add Equality and Human Rights statement.

For the record

Name of persons who carried out this assessment (Min of 3 ):

Anna Ashton

Michelle Barton

George Sullivan

Date assessment completed:

30/04/2015

Name of responsible Director: Executive Nursing Director

Date assessment was signed: 21/05/2015


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