Chapter 8: Nutrition and fluid balance
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Pre‐procedural considerations
Sufficient staff need to be available to support those who need help with eating and drinking. Patients who require assistance should be identified through screening and a discreet signal should be evident to identify that further assistance is required, for example a red tray, a coloured serviette or a red sticker (BDA [21]).
Specific patient preparation
Before commencing assistance, discuss this with the patient in order that they understand and consent to assistance being provided. When verbal communication is not possible, non‐verbal agreement needs to be obtained wherever possible. Try to engage the patient in the feeding process and interpret and record any preferences or dislikes they may express regarding the meal process.
Prior to eating, make sure the patient has the opportunity to visit the bathroom, to wash or clean their hands with an antiseptic wipe, and to undertake any appropriate mouth care. Establish whether any medication is to be administered prior to or after feeding that will facilitate the feeding and digestive process.
Individual symptoms should be assessed; for example, if patients are nauseous they may benefit from the prescribing and administering of antiemetics or prokinetic agents. Patients who have pancreatic insufficiency may require pancreatic enzyme replacements. The timing in relation to feeding is important and antiemetics should be given approximately 30 minutes prior to meal service. Any special equipment, such as cutlery or non‐slip mats, that is required to assist the patient with the meal should be provided. This may require referral to an occupational therapist for an assessment.
If the patient has dysphagia, ensure that the diet textures are as recommended for the patient by the speech and language therapy team as per the International Dysphagia Diet Standardisation Initiative (IDDSI [69]) (see Figure 8.18). This is in line with National Patient Safety Alert NHS/PSA/RE/2018/004 (NHSI [118]).
Procedure guideline 8.9
