Good nutrition and hydration are a priority in supporting people’s health and wellbeing and ultimately our patients and service user’s rehabilitation and recovery. We embrace a culture where everyone works together to improve the nutritional outcomes for our patients and service users in environments where our food is high quality, is part of our patients and service users care and is an important part of everyone’s day. Meals that look good, taste good and are nutritious are key to good health and together in an organisation where food and drink are everyone’s business, we can achieve our ambition of delivering the highest level of nutritional and safe care possible.
We have developed a Trust Nutrition & Hydration Strategy and policy, which are overseen and monitored by our Nutrition and Hydration Steering Group. You can view the policy on the policies and procedures section of YourSpace.
For our patients, malnutrition and dehydration are a significant risk, and both contribute to significant harm. Making sure our patients get the nutrients they need from their diet supports health and can speed up recovery.
For our patients, malnutrition and dehydration are a significant risk, and both contribute to significant harm. Making sure our patients get the nutrients they need from their diet supports health and can speed up recovery.
National obesity rates continue to rise and we are passionate about promoting healthy lifestyles amongst our staff and visitors.
Our inpatient catering services and catering outlets aim to offer healthy food in a context of informed choice, while maintaining awareness of sustainability and environmental issues.
What Is Dysphagia?
Dysphagia is the term used to describe difficulties that may occur with an individuals eating, drinking or swallowing. Dysphagia affects both adults and children and usually occurs as a result of another health condition. Conditions that are associated with Dysphagia include:
- Neurological disorders, including stroke, Brain Injury, Parkinson’s disease, dementia, Muscular Dystrophy, Moto Neuron Disease etc
- Respiratory conditions, including COPD, asthma
- Learning Disability or developmental and acquired disorders e.g. Cerebral Palsy, Autism, Down Syndrome, Cleft Lip and palate
- Cancers, including Oesophageal, Head and Neck etc.
- Disorders of the immune system
- Gastroesophageal disorders, including reflux
Watch our animation around dysphagia
Implications of Dysphagia
Eating, drinking and swallowing difficulties have potentially life-threatening consequences and can greatly affect the quality of life of the individual with Dysphagia and those around them. Some identified implications and consequences of Dysphagia include:
- Choking
- Malnutrition
- Dehydration
- Fatality
- Inability to take medications
- Aspiration or developing a respiratory condition
- Reduced Quality of Life and social implications
- Anxiety and/or embarrassment around eating, drinking and swallowing
What are the signs of Dysphagia?
Early identification and management of Dysphagia can reduce hospital admissions, fatality but also improve quality of life and mental health wellbeing.
Common Signs and Symptoms of Dysphagia include:
- Coughing or choking while eating or drinking or up to 30 minutes post meal or drink
- Bringing food back up (regurgitation)
- Changes to voice quality around eating and/or drinking
- A sensation that food is stuck in your throat
- Drooling of saliva
- Change in breathing rate while eating or drinking
The individual may also show changes to their general health including:
- Recurrent chest infections
- Pneumonia
- Weight loss and/or reduced appetite
- Dehydration and/or UTI’s
What you can do to help
- If you are supporting a service user who is having difficulties with eating, drinking and swallowing, or you have concerns, please contact your Division’s speech and language therapy services (see list) Referrals are accepted based on the individual service's eligibility criteria however will also be able to offer advice.
How can we help you?
Our Team of speech and language therapists support individuals with Dysphagia by providing assessment, diagnosis and management of swallowing difficulties. We aim to improve the quality of life for patients and where possible improve function and independence within the community.
Speech and language therapists main roles whilst working within Dysphagia may include:
- Promoting safety through Diet or Fluid Modifications in line with the IDDSI framework (see below)
- Providing exercises or techniques to minimise risks with eating and drinking and aim to improve swallow function
- Highlighting the need for further assessment
- Working alongside the MDT as identified which may include GP’s, Nurses, Physiotherapists, Dietitians, Occupational therapists etc.
- Supporting the individuals or their carers with expressing preferences or beliefs around their eating, drinking and swallowing needs
The Clinical Skills Team also provides training and/or guidance to our workforce who are supporting individuals who are at increased risk of Dysphagia. For more information please visit the Clinical Skills Team webpage.
‘MUST’: The ‘Malnutrition Universal Screening Tool’
‘MUST’ is a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all care workers.
‘MUST’ - five-step screening tool
Step 1 Measure height and weight to get a BMI score. This chart can be used to calculate BMI . If unable to obtain height and weight, use the alternative procedures shown below.
Step 2 Note percentage unplanned weight loss. Please find weight loss charts to help with this calculation.
Step 3 Establish acute disease effect and score. If a patient is acutely ill and there has been or is likely to be no nutritional intake for more than 5 days this would give a score of 2.
Step 4 Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.
Step 5 Use management guidelines and/or local policy to develop care plan.
Alternative measurement for weight: Mid upper arm circumference (MUAC).
- If MUAC is < 23.5 cm, BMI is likely to be <20kg/m2
- If MUAC is > 32.0 cm, BMI is likely to be >30 kg/m2
Alternative measurement for height: Ulna Length.
Guides on how to take the measurements can be seen here
Guidelines for Managing Malnutrition and Oral Nutritional Supplements in Inpatients can be found here which includes First Line Nutritional Advice
ALL resources for MUST can be found on the BAPEN website: www.bapen.org.uk.
Community Dietitians:
Regular use of the Malnutrition Universal screening tool is encouraged in the community setting. The community dietitians offer training for using the MUST tool, for example to staff in care homes, ICRAS hubs, and to the district nursing team as part of their pressure ulcer training and other Mersey Care Colleagues as required.
The community dietitians request the malnutrition universal screening tool score is used as part of their referral criteria.
Mental Health Care Division Dietitians:
All new admissions are to be screened within 72 hours of admission the MUST score will be repeated weekly through the admission. All patients will require a Nutritional care plan in line with MUST score.
Please follow the guidelines for referral to Dietitian.
MUST training, food fortification and first line weight management is delivered monthly, please contact your dietitian for dates
Choking
Choking is the term used to describe when someone experiences difficulty or an inability to breath due to an obstruction of the airway. It also referred to as Foreign Body Airway Obstruction (FBAO).
Anyone can experience choking and some of the main causes of Choking include:
- Mechanical Causes
Including when we are not eating carefully or swallowing non food objects.
- Neurological
Includes neurological conditions including, Stroke, Parkinson’s disease, Brain Injury or Trauma, Cancer etc.
- Musculoskeletal
Weakness or changes to the structure of our muscles, bones and joints which can affect our posture and movements, for example- sitting up right or eating.
Symptoms of Choking
Choking symptoms may vary from person and may even be silent, however below are a list of common accompanying symptoms of choking:
- Breathlessness or inability to breathe
- Coughing
- Appearing to be in discomfort or pain
- Gagging
- Dizziness
- Unable to speak
- Eyes watering or nose running
- Unconsciousness
- Changes to the person colour
- Feeling something stuck at the back of your throat
Foreign body airway obstruction (Resuscitation Council UK Guidelines 2021)
- Suspect choking if someone is suddenly unable to speak or talk, particularly if eating.
- Encourage the person to cough.
- If the cough becomes ineffective, give up to 5 back blows:
- Lean the person forward.
- Apply blows between the shoulder blades using the heel of one hand.
- If back blows are ineffective, give up to 5 abdominal thrusts:
- Stand behind the person and put both your arms around the upper part of their abdomen.
- Lean the person forwards.
- Clench your fist and place it between the umbilicus (navel) and the ribcage.
- Grasp your fist with the other hand and pull sharply inwards and upwards.
- If choking has not been relieved after 5 abdominal thrusts, continue alternating 5 back blows with 5 abdominal thrusts until it is relieved, or the person becomes unresponsive.
- If you observe any of the following signs: The person becomes unresponsive, their legs are buckling or they are unable to hold their weight, start CPR.
Malnutrition/Nutritional Support:
Liverpool and Knowsley & St Helens Community Dietetic Teams
Within the Community dietetic teams, we provide nutritional support in a range of settings, including outpatient clinics, patient’s homes, and care homes. We accept referrals for anybody with a MUST (see MUST section on the Nutrition and Hydration page for further information) score of > or equal to 2 or those with a pressure ulcer of > or equal to a grade 2.
We accept referrals from GPs, consultants, other healthcare professionals, and care homes. For Liverpool Dietetic services, our referral form can be found on EMIS or on the Mersey Care Dietetic service internet page.
For Knowsley & St Helens we accept referrals from GPs, consultants, other healthcare professionals, and care homes. To receive a referral form please ring 0151 351 8550 and one can be emailed/posted out, or you can down load one here
We follow NICE guidance encouraging a food first approach initially and using oral nutritional supplements when clinically indicated. We also support those who are enterally fed within the community.
We provide in person training for nutrition support to staff in care homes, and intermediete care hubs. Implementation of virtual nutrition education training packages has commenced in a targeted approach in care homes within the Community Division.
For initial nutrition support advice prior to dietetic assessment, please refer to the BDA: Food Facts | British Dietetic Association (BDA) Spotting and treating malnutrition | British Dietetic Association (BDA)
Mental Health Care Division
Dietitians provide support for inpatient wards of Liverpool and Sefton. We accept referrals for a range of nutritional problems MUST 2+, food and fluid refusal, Unintentional weight loss – please be aware that some of our patients have unintentional weight loss due to deterioration in mental health but may have a BMI above healthy range these patients still require referral to dietitian.
In line with NICE Guidelines, we encourage food first approach and use oral nutritional supplements or artificial feeding where indicated.
We also accept referrals for other nutritional problems that are not identified by the MUST tool for example weight management, diabetes, bowels, Pressure areas this list is not exhaustive. Please contact your Dietitian for advice
Secure Services
Development of weight management pathway within the secure services.
Dietetics and the Health and Fitness team have developed an 8 week Nutrition and Fitness education programme in collaboration ‘FITTER’ with patients and service users in secure services.
Implementation of the NHS accredited FITTER programme which is monitored by NHS QISMET and feeds into a national agenda relating to nutrition and hydration. This is coproduced and delivered with patients and service users.
Dietetics also achieved NHS accreditation for the new 6-week Structured Diabetes Education Programme developed by Dietetics and Chronic Disease Nurses. Training and evaluation is being disseminated to multi-disciplinary teams to support delivery of these rolling programmes.
Special dietary information
All special diets including vegan, Halal, texture modified and allergies require a special diet request form to be completed and sent to your local catering/facilities team.
Further support:
- SOP special dietary requests
- Special dietary request rules
- Special dietary requests flowchart
- Special dietary requests poster
Catering information
Catering Team
Food is provided by your local catering team. They are here to help with all your catering and food needs
For Whalley Catering manager Dragana Jovanoska Dragana
Ashworth/Rowan view temp Catering manager Dragana Jovanoska Dragana
Hollins Park/Brooker centre/Peasley court/Knowsley Resource centre Catering manager Paddy Costello Paddy
Liverpool Catering manager Martin Currell martin
Clockview Facilities manager Kelly Manning Kelly
Broadoak/Windsor House/Hope centre Ulrike Sharpe Ulrike
Rathbone Facilities site manager Helen Coyne helen
Hartley Facilities site manager Helen McCarron helen
Leigh Moss/Wavertree bungalow/Heys court Jan Nunn jan
Emma Hyland Catering dietitian emma
Menus
Our menus have been developed with patients, caterers, dietitians, speech therapists and ward staff. The menus have been designed to meet the different needs of patients across the trust, providing healthy eating, higher protein/energy, vegetarian, and softer choices. Specialist menus including finger food, vegan and dysphagia menus are available. These can be ordered via the special diets request form.
To support patients in making healthy eating choices the amount of energy, protein, carbohydrate, fat, sugar, salt, and portions of fruit/vegetables of the meals is available for patients.
Full allergen information of the menus is also available on the ward. If a patient has any allergens, please let catering know via the special diets request form.
Copies of menus are in development and will be published here once completed for the following areas: Whalley, Rowan view, Ashworth, Liverpool, Hollins Park
Further information on making the most of your menu can be found here
Meal observations
Regular meal observations are carried out jointly by catering, dietitians or speech therapists and nursing staff called the power of three. These have increased collaboration between catering, dietitians, speech therapy and staff on the wards. It has also informed good practise and menu changes If you are interested in conducting a meal observation, please contact Emma Hyland catering dietitian emma
Please find copy of the audit here.
The catering dietitian along with catering also conducts regular meal audits which look at all aspects of food service and food safety.
Volunteers also regularly visit the wards and taste the food provided to give regular patient feedback regarding catering.
Patient feedback
There are regular catering meetings which catering, and ward staff attend. Catering staff and the catering dietitian will come to any community meetings to discuss food and catering with the patients. Please contact the catering dietitian Emma Hyland emma
Patient’s receiving food that they enjoy and is suitable for there needs is vital to help the catering services develop and make improvements. Patients can complete a patient satisfaction survey which can be returned to you local catering manager. Please click here for copy of the patient satisfaction survey.
Sustainability
Catering has an important role to play in the trust’s sustainability agenda. One of the ways this can be done is by reducing food waste. You can help by ensuring your orders are correct and not over-ordering food. Regular waste audits are conducted by catering staff.
Guidelines for food service
Staff on the wards or facilities management assistants may serve the food to patients depending to the site. Please click to find some guidelines for a safe and efficient food service.
All staff serving food should have completed their on-line food hygiene training. If not, please discuss with your ward manager.