References
Changing the culture around hospital-based nutrition
Abstract
Following a serious incident and inquest after the death of a patient due to choking at Sheffield Teaching Hospitals NHS Foundation Trust, the Trust put in place an action plan and implemented strategies to reduce the risk of recurrence. Four key actions were identified as essential to try to reduce the risk of a similar event: introduction of a standard operating procedure for mealtimes that included a pre-meal safety ‘pause’; use of an electronic communication icon to indicate modified diet/fluid requirements, from emergency department and onward as a patient is transferred; job-specific mealtime safety training; and use of bedside posters with specific dietary requirements (in line with the International Dysphagia Diet Standards Initiative Framework). A new role of Lead Educator for Nutrition was introduced to support the changes and provide training. Changes were also made to the incident reporting system to ensure easy identification of events relating to dysphagia, so that these could be monitored, themes identified and lessons shared. A series of audits following the changes have shown that more staff across disciplines and teams have accessed training on nutrition and hydration practices, wards have increased the use of the icon and posters, and successfully implemented pre-meal safety pauses. The Lead Educator for Nutrition has helped embed learning, and increased awareness and knowledge about nutrition and hydration.
Sheffield Teaching Hospitals NHS Foundation Trust (STH) is a large trust that provides more than two million inpatient and outpatient care contacts annually across five hospital sites and various community settings. It employs more than 5000 nursing, midwifery and health visiting staff with over 2000 inpatient beds across the sites and around 37 000 meals served each week (Sheffield Teaching Hospitals NHS Foundation Trust, 2022). The Trust is one of only a handful that produce their own food for patients, staff and visitors, and it is recognised as an exemplar by the Hospital Caterers Association (Hospital Caterers Association, 2023).
The Report of the Independent Review of NHS Hospital Food (Department of Health and Social Care (DHSC), 2020) stated that, when a patient is in hospital, food is as essential as medicine and therapies. Malnutrition in hospital settings has negative effects on recovery, morbidity and mortality; Schuetz et al (2021) discussed the development of nutritional interventions that reverse the effect of disease-related malnutrition. There is a direct correlation between good nutritional care and physical and mental wellbeing – and, for food to be therapeutic, it has to be nutritious, tasty and appropriate for the patient (DHSC, 2020). Consequently, it is crucial that healthcare settings ensure the availability of a range of therapeutic diets, including texture-modified diets. Patients in acute healthcare settings have complex requirements and hospital food should reflect this (DHSC, 2020).
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