In this

edition

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, miranda.moodie@nhs.net,

01349817122 or Jane Ingleby,

jane.ingleby@nhs.net, 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