NHS Grampian Community Forum: Saturday 21 February 2009
UPDATE SESSION ON NUTRITIONAL CARE, PATIENT SAFETY AND HEALTHCARE ASSOCIATED INFECTION (HAI)
Invited guests:
Dr Alaistair McKinlay, Chair of NHS Grampian Nutritional Care Group
Jane Ewen, Nutrition Champion
George Reid, NHS Grampian Catering Manager
Jenny Ingram, Scottish Patient Safety Programme Project Manager
John McKinnon, Infection Control Manager
Pamela Harrison, MRSA Screening Pilot Project Manager
Karen Wares – Local Health Board Co-ordinator (national hand hygiene campaign)
Welcome
Maggie Emslie, Senior Communications Officer chaired the meeting and gave apologies on behalf of Laura Gray, Director Corporate Communications.
Members were thanked for re-registering with the Forum. New members are always welcome and the meeting had been publicised on Northsound radio. Maggie welcomed people for whom this was their first meeting.
Members of the Nutritional Care Group and the Infection Control Team had both presented at previous Forum meetings. The purpose of the meeting was to provide an update to members on progress with Nutritional Care and Infection Control issues.
Food, Fluid and Nutritional Care
Dr Alistair McKinlay introduced the session and explained how various reports had highlighted the importance of nutritional care and had identified a national problem of malnourishment amongst hospital patients. There was a link between poor nutrition and illness. The NHS Quality Improvement standards are very patient focused and cover catering and nutritional care and support. He welcomed the contribution of Forum members who have been working with the Nutritional Care Group on new menus and patient information.
The publication of the standards has helped to bring about a culture change in the way patients’ nutritional needs are now assessed and managed in the hospital setting. Much of the publicity is about over-nutrition, but about 20- 40% of hospital admissions are malnourished.
National funding has now enabled the appointment of Nutrition Champions for each Health Board, this role is helping to embed good practice in nutritional care amongst staff.
Mr George Reid spoke about the new kitchens at Aberdeen Royal Infirmary. Since the last visit to the Community Forum in November 2006, a priority had been to upgrade and modernise the kitchens at ARI. The public group has been involved in this, and toured the new facilities. The national “Food in hospitals” document issued in Summer 2008 specifies what all patients should receive in Scottish hospitals.
A new Grampian-wide menu system is being introduced in March 2009. This complies with the new standards and the public group has assisted locally in interpreting and developing a menu system which will meet the national standards. Stage 2 diets are now required by some 10-11% of inpatients and the catering department now has dedicated staff and production line for these diets.
The Scottish Government is sponsoring a national catering database which will assist in the analysis of new menus for their nutritional content. There is to be a core NHS Grampian menu. Various additional menus eg: finger food, snacks have been developed. The emphasis is on giving people choice and patients will be encouraged to ask if they need anything.
Other special cases are now being provided for, for example, packed lunches for patients coming to ARI for tests, from a community hospital. Patient transport may cause them to miss meals. A simple manual for staff with clear guidance on how to order routine diets, special diets, snacks and ward provisions and special items e.g packed lunch.
George expressed thanks to the public group who have made a really valuable contribution to this work.
Jane Ewen, Nutrition Champion for NHS Grampian explained some of the themes she is working on; food fluid and nutrition education for staff, patient stories and protected mealtimes.
An integrated staff training and education programme has been developed for improving nutritional care. It comprises education and communication in workshops which combine theory with practical work looking at issues like nutritional assessments and screening.
Staff are now encouraged to experience hospital food and experience how patients with different needs will cope with the meals they are given. For example, staff try eating a meal wearing restrictive clothing, or special glasses which aim to mimic physical impairments that patients may have which could cause them difficulty in eating their food. They are also encouraged to taste stage 2 diets and fortified drinks so that they will have a greater insight when caring for patients and encouraging them to eat.
Staff are also developing their practice by addressing issues raised by patients either through the feedback service or from patient stories. Patients are encouraged to talk about their experiences and this helps to identify where improvements are required.
Protected mealtimes is another initiative aimed at maximizing the number of staff on duty during mealtimes and to provide a safe environment when patients are allowed to eat without unnecessary interruptions. This is making sure staff have time to prepare patients for mealtimes, including handwashing, de-cluttering patient bedspaces, allowing patients time to transfer to a dining room for meals etc.
Question time
There was limited time for questions, but members were invited to speak to Jane and George at the end of the meeting when they had agreed to stay behind and speak to people. Several members took up this opportunity.
A number of issues were raised:
· Problems with patients admitted to Ward 49 – Acute Medical Assessment Unit. Dr McKinlay undertook to look into this ward which has a very high turnover of patients due to its role as an assessment unit.
· Questions about artificial nutrition for patients at end of life and the use of PEG feeding tubes. There was insufficient time to address this question in detail.
Healthcare Associated Infection and Patient Safety
John McKinnon introduced members of the Infection Control Team who are working very closely with the Scottish Patient Safety Programme particularly around hand hygiene issues.
Hand Hygiene
The national hand hygiene campaign with targets for compliance with good hand hygiene practice was first launched in 2007. A Local Healthboard Co-ordinator post was created in each NHS board area to co –ordinate this work, educate and promote good practice. Karen Wares explained there is a zero tolerance approach to hand hygiene with results of audits now published at ward entrances.
When auditing first started, NHS Grampian was one of the worst performers with compliance at 57%, recent audits are showing figures in excess of 90% which is the target. Audits are conducted every two months. Locally the Stop Gel Go campaign was launched aimed at visitors, but has found to be equally relevant to staff. Members of the Community Forum are on the audit team and take part in hand hygiene audits.
Jenny Ingram spoke about the national patient safety work, around 5 work areas: leadership, medicines management, peri-operative care, critical care and general wards. The programme is already producing tangible results, pilot areas have improved their hand hygiene compliance to 100% and several areas have had no bacteraemias infections for between 4-8 months. Areas are now posting this information up outside the ward for patients and visitors to read.
MRSA Screening
Pamela Harrison spoke about the MRSA screening pilot which is taking place in NHS Grampian, (one of three health boards in Scotland) as part of a feasibility study being run by Health Protection Scotland.
Locally posters and patient information has been developed to publicise the pilot screening programme and inform patients about screening and what to expect. All patients admitted to ARI and the orthopaedic wards at Woodend Hospital are being screened on admission. Screening at pre-assessment clinics is now starting also.
It is not compulsory to be screened but all patients are being encouraged to be screened. A comprehensive patient information campaign led by Madhuri Thakur Communications Officer for the MRSA pilot has helped to inform patients and the general public. She is currently collecting information about the patient experience of MRSA screening and results have been very positive. The majority of patients experienced no discomfort from the screening test and are being reassured by the MRSA screening programme. A public event is being held in Trinity Mall on 7th March with the Infection Control Team. Opinionmeters will be used to ask questions about general public awareness of MRSA and there will be demonstrations on Handwashing.
The results of the pilot will be made public at the end of the study later this year, but early results are encouraging with fewer incidences of patients who are MRSA positive on admission than had been expected. Patients found to be MRSA positive are given decolonisation treatment.
Question time
· Issue of bacteraemia associated with the use of cannulas – infection was traced to the valves.
· Forum member had recent experience of staff member taking blood sample who had long hair and kept touching her hair whilst taking the blood sample. This was potentially introducing infection after staff had washed their hands. People are encouraged to complain at the time if they can, if not to complete a feedback card.
· Suggestion about cleaning equipment in showers to decontaminate in between patients using a shower cubicle. This will be raised with Domestic Services Dept. There are health and safety issues with leaving cleaning fluids in patient areas.
· Patient who had been in Ward 45: there were insufficient drip stands, so staff were hanging drips from curtain rails, also a cannula removed by nursing staff while patient was in a corridor. These cases should not have occurred; again people were encouraged to make a complaint or feedback these issues to ward staff.
· Forum member whose father had died several months after a hospital stay who had contracted MRSA infection.
The Infection Control team welcomed this feedback, they were unable to respond to individual complaints or concerns in an open session of the forum. Members were encouraged to raise any concerns with ward staff as they arise, or to complete a feedback card.
NHS Grampian Corporate Communications Team
March 2009
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