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Find out more ways of improving the nutri-tion and hydration of the people you’re car-ing for. Take a look at new resources and training. Talk more about food fluid and nutri-tional care standards; mealtime and NBM SOPs. Find out about the work of the oral health education team in care homes. See what happened when we delivered a bespoke training event on Skye.
Hear why we were
at the recent Highland
research, development
and innovation event.
NUTRITION NEWS J A N U A R Y 2 0 1 6
Produced by Evelyn Newman, nutrition and dietetic advisor for care homes, and NHS Highland’s communications team
Food for thought
at training event
The quarterly newsletter for care homes and care-at-home services across the Highlands
AT the end of November, I had the pleas-
ure of leading a nutrition and hydration
training event on Skye.
Twenty-two members of staff from five care
homes and the MacKinnon Hospital came to-
gether for the day at The Aros Centre for a full
day of practical, interactive learning, supported
by local dietetic, SLT and OT colleagues.
This was a first for many of the care home staff,
many of whom hadn’t been able to access train-
ing elsewhere due to the challenges of their
remote locations and the associated difficulties
with travel, distance and staff cover.
Topics covered included: measuring and scoring
MUST; supporting safe swallowing; adaptive
equipment for eating and drinking and safe posi-
tioning; food fortification and; the benefits of
good hydration.
The day was very positively evaluated and many
aspects of the learning have now been put into practice. All staff enjoyed mixing with colleagues
from other homes and much fun was had during
SLT, Lisa Fox’s interactive workshop on feeding
dysphagic residents positively and safely (see
main picture).
At the Howard Doris Centre in Strathcarron,
care home resident Tommy MacKay has now
had his swallowing assessed by local SLT col-
leagues allowing staff to prepare him safer, var-
ied meals and drinks which give him greater
confidence to eat.
Care home manager Sally Ross reports: “This
gentleman has now had more emphasis placed
on his diet and hydration.
“The staff are more aware and take more care
over his meal preparation and presentation, this
has resulted in his weight increasing and he is
also well hydrated.”
At An Acharsaid care home in Broadford, the
general care assistant says: “I am much more
aware to encourage residents to drink more
and I keep encouraging them to have drinks of
water and juice. As a result of the training I am
definitely drinking much more myself than I did
before.” The plan will be to repeat this event at the end
of 2016 and to continue to assess and evaluate
how learning from the event has been translated
into improvements in the health of both resi-
dents and staff.
Welcome to the first edition of Nutrition News in 2016. I hope that you’ve managed to keep up those New Year’s resolutions but maybe you could start afresh to consider how to improve your daily fluid intake (see Au-tumn Nutrition News).
ABOVE: Participants learn firsthand about the challenges of feeding and being fed: lots of fun and very messy! RIGHT: Howard Doris Centre resident Tommy MacKay
The role of oral health educators
MY name is Ailsa Gordon and I am
employed by NHS Highland as an
oral health educator and dental
nurse.
I deliver oral health education to all age
groups and training in Caring for Smiles.
NHS Highland has teams in the different
Community Health Partnerships. I work
with the Inner Moray Firth team and al-
though based in Inverness travel to the
areas of Dingwall, the Black Isle and part
of West Ross.
Caring for Smiles is a National Training
Programme and has been running for
several years but the training was re-
amped in 2014.
It has now been split into two levels,
foundation and intermediate, and is SCQF
credit rated.
Foundation level training has been rolled out in the NHS Highland area so far, with
a view to starting intermediate training
this year. This way, everyone who is
trained has a recognisable qualification
and can use it in any care home across
the country and we would hope eventu-
ally, that everyone working in a care set-
ting is trained to at least foundation level.
So far I have trained employees in five out
of the nine care homes in the area I visit
at foundation level.
They have all enjoyed and found the train-
ing invaluable in both their professional
and personal lives.
The training at foundation level focuses
on being aware of the importance of good
oral health of older people in care, recog-
nising factors that contribute to poor oral
health, demonstrating good practice in
providing oral care and knowing how and
when to report any concerns. This in-
cludes being able to carry out an oral
health risk assessment, plan and docu-
ment oral care. An oral health risk as-
sessment should be completed within 48
hours of a new resident being admitted to
the care home and enable staff to identify
potential problems that may arise from
past neglect. If any risks are highlighted
from the assessment then the resident
must be referred for dental treatment.
This could be with the dentist they are
already registered with or via the Public
Dental Service. Being able to do this
quickly means any problems can be recti-
fied quickly enabling the resident to settle
into the home relatively pain and discom-
fort free.
But of course it’s not just the new admis-
sions to the home that benefit, all resi-
dents should be risk assessed every six
months to ensure they have the best care
possible. The recording of care given
means staff have documented evidence if
any concerns are raised. Making sure
residents have pain-free mouths helps
keep them well nourished, hydrated and
confident to socialise both within and out
with the care home.
Care home employees have developed
more confidence in delivering oral care to
their residents after attending the practi-
cal session of the training.
I’ve heard from numerous carers in the
past that they were not keen to give oral
care to residents, either cleaning dentures or natural teeth.
However, as the practical assessment and
self reflective case studies are part of the
pass mark of the training it must be com-
pleted. And as the old saying goes
“Practice makes perfect”; staff gain ex-
perience and confidence.
Confident, educated employees are able
to provide evidence based care which
reflects in the residents who gain from
the benefits. Isn't that something we
would all like to happen, especially as we
all get older and are living longer?
For further information on training in
your area, please contact our oral health
improvement co-ordinators Miranda
Moodie, [email protected],
01349817122 or Jane Ingleby,
[email protected], 01955609940
Delivering Caring for
Smiles accredited
foundation training
www.healthscotland.com 'Caring for Smiles - Guide for Care Homes'
ABOVE: Ailsa Gordon with her oral health puppet
NHS HIGHLAND has become the
first area in Scotland to develop and
implement food, fluid and nutri-
tional care standards in care homes.
Thanks very much to all of you who
helped me with the consultation and
shaping of the final documents.
They were emailed out to all care homes
in Highland in December, along with a
mealtime co-ordinator and nil by mouth
SOPs (standard operating procedures).
They have been condensed and adapted
from existing NHS documents, which are
designed to ensure that service users’
nutritional needs are co-produced and
delivered using a person-centred ap-
proach, in a pleasant and safe environ-
ment.
At Ach an Eas care home in Inverness,
manager Alma Scott commented on the
benefits of having a mealtime co-
ordinator .
She said: “In Ach an Eas our mealtime co-
ordinator is the shift leader, so that is
three different people every day, as a few
of our residents eat during the night/early
morning.
“Day/evening shift leaders liaise with
kitchen staff and care staff re making sure
that everyone has eaten, and kitchen staff
have a tick sheet for this. This also flags
up any problems such as someone with a
poor appetite etc. There is also a tick
sheet for N/S, to let shift leader/kitchen
staff know who has had early breakfast,
and this can be different every day. We
find this works well.”
Chris Allan, representing Scottish Care,
says: “All care homes are encouraged to
takes steps to implement these, as an easy
way of evidencing how they are delivering
against the national care standards (2007),
which they have been cross-referenced
with”
Joanna MacDonald, director of adult
social care agreed, saying: “We continue
to actively encourage residents’ family
members and friends to join them for mealtimes, which are such an important
social activity in any care setting. These
standards will help to support better care
for our residents and service users across
Highland care home settings.”
If anyone would like to discuss any aspect
of implementing or evidencing nutritional
care standards please contact Evelyn using
the details at the end of this newsletter.
Correction
Nutricia Clinical Care have asked me to
point out a minor change to their lami-
nated texture descriptors and which state
that texture C (thick puree) requires the
use of a thickener.
This is not the case for all foods, how-
ever, and should read “may require the
use of a thickener”.
Nutricia will therefore be developing
corrected resources for distribution as
soon as I receive them.
N UTRITION champion training will start in March
for 15 care homes in North Highland. This is
made up of 12 modules and assessed project work
within local care home settings, which is delivered
over a six-month period.
In the next edition of Nutrition News, we will describe
what this has involved and how we plan to take it for-
ward across Highland.
The next texture modification master class is due to
take place on 7th April at Smithton Church, Inverness.
You can access a range of information, including a free
app, posters, calculator and self assessment tool to
help you understand and easily work out MUST scores
by looking on the BAPEN website: http://
www.bapen.org.uk/screening-for-malnutrition/must/
introducing-must
For up-to-date recipe ideas and links to YouTube dem-
onstrations by chef, Neil Palliser-Bosomworth, for tex-
ture modified meals and drinks go to
www.mynutilis.co.uk
Training and resources
Raising nutritional standards in
care homes throughout Highland
Highland research,
development and
innovation day
ON 13th November, those of us who
have been piloting placements for
student dietitians in social care set-
tings, were selected to present a
poster and workshop of our work so
far ( see poster on next page).
We were delighted that the work
was shortlisted for sharing and it
was really encouraging that 2 of our
students were able to see first- hand how interested delegates were in
the work they had been so involved
in.
Pictured right are Denise Scott
from Parklands care group and
Stephen Pennington from Highland
Home Carers, who have both been
crucial to supporting students from
Robert Gordon University to ex-
perience social care in practice.
You can read what the students said
about their recent experience of
working with carers in NHS High-
land’s December edition of High-
lights (see NHS Highland’s website).
We plan to continue to develop and
refine these placements for future
dietetic students at different stages
of their training, as this will help us
build a better informed workforce
as well as raising awareness of the
key role that nutrition and hydra-
tion have in maintaining and im-
proving health of service users.
Need my contact details? Email evelyn.newman&nhs.net; twitter @evelynnewman17; phone 07870 868475