`Reliance on a Carer` (ROC) to drink Naomi Campbell Hydration

Introducing new screening tools
Reliance on a Carer
Reliance on a Carer
ROC
To Drink
ROC
To Eat
Screening for risk of
dehydration
across
health & social care
Pre-screening for
risk of malnutrition
across
health & social care
Naomi Campbell
Hydration Lead Nurse
Peninsula Community Health –CIC Cornwall
Cornwall Hydration Project
[email protected]
Background: Despite great effortsDehydration & Malnutrition : still remains a problem in 2015?
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2006- Age UK ‘ Hungry to be heard’
2007- Nutrition Now Campaign
2009- Nursing High Impact Actions included nutrition
2009- SCIE GUIDE 15 – DIGNITY IN CARE Nutritional care and hydration
2010- Dept Health ‘Essence of Care’
2010- Age UK ‘Still hungry to be heard’
2010-CQC ‘Meeting Nutritional Needs’
Campbell N (2011) Dehydration: Why is it still a problem? Nursing Times article
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2012-6 ‘Cs’ launched by Chief Nursing Officer
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2013- The Francis Inquiry (post Mid-Staffs)
2013- NICE guidelines for Acute Kidney Injury
2014- CQC ‘Meeting Nutritional & Hydration Needs’
2014- NHS England rolls out 6C’s to all healthcare workers
2014- Dept Health ‘Food & Drink Strategy in Hospitals’ for NHS Standard Contract
2015- Nursing & Midwifery Council (NMC) added to their professional Code -that
it is a registered nurses responsibility to ensure patients have enough support to
eat and drink
There are also many examples of local best practice across the UK in care homes &
hospitals, but spread and adoption remains patchy and poorly evaluated
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Currently we have no means to tell us who is at risk of dehydration?
And their level of risk? Or what level of care they need to drink
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Questions we all need to ask!
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Why do we need more screening tools?
What will it achieve?
How will it improve patient care?
Who will it actually benefit?
Who will do the screening?
How much training is needed?
What will we all do with the information?
What actions will it prompt?
Does such basic care need this level of screening?
Is a screening tool just another tick box exercise?
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MUST – Malnutrition Universal Screening Tool
and
the Red Tray & Jug have been widely adopted for > seven years
MUST is not designed to screen for:
• Risk of dehydration
or
• Level of support needed to eat or drink
Red tray & red jug
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No standard assessment to support who should be given a
red tray or jug
Focus is on patients who require a high level of ‘assistance’
Initially designed for use in acute hospital setting on wards
with mixed ages
Does not recognise the thousands of patients /residents
who need ‘some’ support
Simple concept but not evidence based
Naomi Campbell Hydration Lead Nurse Peninsula Community Health 2014
There is currently no evidence based screening tool to
support associated risk of Acute Kidney Injury linked to
NICE
(2013)
No
validated
tool
Naomi Campbell Hydration Lead Nurse
Peninsula Community Health 2014
The gaps in
Evidence Based Practice
represent
Patient Safety issues
– No validated screening tool for risk of dehydration
– No standard assessment to identify the level of support
needed to drink and to eat
– Therefore...
• No quantitative or qualitative means to measure the scale of
the problem across health and social care
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What do we need as a starting point?
• A dehydration screening tool that can be used in all care settings
that is:
– Fit for purpose across health and social care
– Meets requirements for:
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Francis Inquiry (2013)
CQC Outcome 14 (2014)
NICE AKI Guideline (2013)
NMC Professional Code of Conduct (2015)
Evidence based
Simple but effective
Quick to teach; Quick to learn; Quick to use
Understood by all concerned – including patients and public
Cost effective
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We know there are multiple reasons why a person may not
be drinking enough to remain adequately hydrated
Unaware of
the
importance of
hydration &
nutrition
Frailty
Delirium
COPD
Disabilities
Depression
Lethargy
Dexterity
Posture
‘giving up’
Dementia
Exhaustion
Personal
tastes
Palliative
&
EoLC
Poor
appetite
Forgets to
drink
Unmotivated
Not
wanting
to be a
nuisance
Tremor
‘Not
thirsty’
Reduced
thirst
response
Old
habits &
routine
Dental
sore
mouth
Stroke
Swallow
Fear of
incontinence
Nausea
Pain
Acute
illness
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Pride &
dignity
The ROC to Drink
Screening tool
ROC (Reliance on a carer to drink)
High
Med
Low
Identifies the level of basic care needed to drink; focussed on
two critical points
1. Assistance needed to drink:
• With swallow
and or
• Help to hold a drink
2. Encouragement needed to drink
None
Assistance
needed for:
Swallow
and or
Help to hold a
drink
Some
Full
Many people are reluctant to drink or simply
forget to drink
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For many people ‘Assistance’ is not always the main issue
“ Understanding the complexities and challenges of providing
basic hydration care is essential & should never be
underestimated”
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Research shows that ‘psychological’ factors can
also increase risk of dehydration
Unaware of
importance of
hydration &
nutrition
sore
mouth
Frailty
‘fear of
falling’
Personal
likes
dislikes
Pain
nausea
unwell
Poor
appetite
‘giving
up’
Set
habits &
routine
Not
thirsty
Depression
Just
Forgets
to drink
Unmotivated
Worried
about going
to the toilet
or
incontinence
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Advancing
dementia
Lethargy
malaise
The ROC to Drink
Screening tool
ROC (Reliance on a carer to drink)
Assistance needed
to drink or to eat
Encouragement
needed to drink or
to eat
Whichever has
the
highest RAG
score
Identifies
the risk
of
dehydration
&
Under nutrition
The ROC screening tools use the
RAG rating
(RED AMBER GREEN)
traffic light system
to quickly & simply identify
and level of risk
Level of care
needed
Level of Risk
None
Low
Some
Medium
Full
High
Developed so that ‘everyone’ can recognise the level of support a
person needs to drink and their associated risk of dehydration…
Family &
informal carers
Reliance on a Carer
ROC
To Drink
Voluntary
services
Screening for risk of
dehydration
across
health & social care
Domicile
agencies
[email protected]
Community health
Dementia services
Mental Health
Social Services
Day Centres
Acute care
Community Hospitals
ROC to Drink – offers a simple screening tool to improve the way
we manage hydration
Reliance on a Carer
ROC
To Drink
Screening for risk of
dehydration
across
health & social care
• Identifies the level of basic care needed
• Identifies a risk of dehydration
• Designed so it can be used by all levels of care
staff; as well as informal care givers
• Standardises assessment and review
• Highlights dependency & work force planning
• Supports health promotion & education
• Supports clinical and ethical decision making
• Suitable for all ages; including children
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Appropriate ‘Encouragement’ by a carer
is often the key to improved oral intake
A trial of the ROC screening tools in
Falmouth Community Hospital
highlighted that the level of
‘encouragement’ needed
was often greater than level of
‘assistance’ needed
Across Health & Social Care
many
GREEN / AMBER patients
‘ are falling through the net’
Assistance
needed
Encouragement
needed
Leading to symptoms of
dehydration that can increase risk
of
UTI / Falls / constipation /
confusion
weight loss
Poor outcomes & increased
nursing & medical needs
Naomi Campbell Hydration Lead Nurse Peninsula Community Health 2014
Remember
whichever has the
highest RAG rating
= level of care &
risk
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The new ROC screening tools, help everyone to agree and
understand the correct level of support that a person may
need to eat or drink. For example some people may need:
· physical assistance to cut up food or help hold their cup
· gentle encouragement to try and prompt them to eat and drink more
· support with swallow problems
· reminding to eat or drink
· more support with drinking compared with eating
· lots of support ‘little and often’ because they only want a few sips at a time
Full details will be documented in individual care plans and reviewed on a
regular basis.
As a patient’s needs change the care plan will be updated and the colour of
the coaster or placemat changed accordingly
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Health
Promotion
Family &
informal carers
Operational
Commissioning
services
Reliance on a Carer
ROC
To Drink
Voluntary
services
Supporting
strategies
Screening for risk of
dehydration
across
health & social care
Domicile
agencies
[email protected]
Community
nursing
Day Centres
Acute care
Community Hospitals
The ROC screening tool offers a simple means to identify who is at
risk of dehydration & what level of care they need
High
Med
Low
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[email protected]
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Vision for ROC to Drink & Eat
To be formally evaluated and validated and adopted across all care
settings as best practice
“Everyone is always given the correct level of
support to drink & eat according to their
individual needs; with kindness, dignity and
compassion in order to prevent avoidable
dehydration due to lack of care ”
[email protected]
To summarise: ROC screening tools aim to fill a gap
in evidence base practice
Reliance on a Carer
Reliance on a Carer
ROC
To Drink
ROC
To Eat
Screening for risk of
dehydration
across
health & social care
Pre-screening for
risk of malnutrition
across
health & social care
Creating a new foundation for health & social care
Designed to highlight the link between ‘dependency’ on a carer
and risk of poor oral intake; resulting in associated risk of dehydration and malnutrition
[email protected]
ROC to:
Drink
&
Eat
Should not be
seen in
‘isolation’
Only by
considering all
the other
factors can we
start to better
understand
the ‘role of the
carer’ and the
complexities
and challenges
and REWARDS
of ‘caring’
[email protected]
ROC to:
Drink
&
Eat
Should not be
seen in
‘isolation’
Only by
considering all
the other
factors can we
start to better
understand
the ‘role of the
carer’ and the
complexities
and challenges
and REWARDS
of ‘caring’
[email protected]
Thank you
For further details please contact :
Naomi Campbell
Hydration Lead Nurse for Peninsula Community Health
Falmouth Hospital
Cornwall TR11 2JA
[email protected]
[email protected]