Keeping You Safe
How are nutrition and diet linked to patient safety?
Dietitians are one of the key professionals responsible for the nutrition and hydration of patients and users of NHS services. Inadequate nutrition and hydration has been identified as a ‘major source of death and severe harm’ (National Patient Safety Priorities).
In the modern NHS under nutrition (malnutrition) is avoidable provided good practices and processes are in place and followed. It causes physiological and psychological harm that results in depression, delayed wound healing and increased susceptibility to infections - to list but a few. Dietitians are the key professionals responsible for the nutritional care of patients and can act as system leaders in the multidisciplinary teams involved in ensuring that patients meet their nutritional needs and malnutrition is avoided. Groups that are particularly vulnerable to malnutrition include: people with mental health needs, learning disabilities, children, the acutely ill and older people.
Over nutrition or obesity can occur at any age and may mask an underlying poor nutritional status. Obesity is associated with many avoidable harms / acquired illnesses including cardiovascular disease, hypertension, diabetes, and some cancers. Dietitians work in integrated public health teams to prevent obesity by enabling people to eat a healthy balanced diet and increase activity levels. In this way they help to prevent harms associated with being overweight or obese.
Dehydration is avoidable yet often goes unnoticed resulting in significant harm to patients in their homes or in hospital. It results in confusion and decreased cognitive function, increased risk of infections especially urinary tract infections, kidney problems, hypotension and cardiovascular problems, increased susceptibility to venous thrombotic embolisms and ultimately death. Dietitians are the key professionals responsible for hydration and can act as system leaders in the multidisciplinary teams involved in ensuring adequate hydration is achieved for all patients. Susceptible groups include the elderly, acutely ill, babies and children and people with learning disabilities and mental health problems.
Vitamin deficiencies are avoidable in modern, developed countries like the UK. They result in a variety of clinical and sub clinical conditions that are harmful. Dietitians are key to the identification of groups at risk of vitamin deficiencies and act as professionals in treating the deficiencies as well as acting as system leaders in the creation of schemes to prevent deficiencies from occurring e.g. vitamin D in babies and young children.
Severe allergic reactions to foods are avoidable harms. Dietitians work directly with people with allergies as well as act as system leaders to ensure that, when on NHS premises and using NHS services, people are alerted to the presence of all the main allergens so that they can make safe food choices.
Dietitians are involved in the provision of artificial nutrition to patients which may include the placement of and care of nasogastric and other enteral tubes. Misplacement of tubes can cause avoidable harm ultimately resulting in death. Dietitians work in teams with Nutrition nurses to ensure that people are adequately trained to site and care for enteral tubes.
Sign Up to Safety
'Sign up to Safety' is a new national patient safety campaign that was announced in March 2014 by the Secretary of State for Health. Its mission is to strengthen patient safety in the NHS and make it the safest healthcare system in the world.
'Sign up to Safety' aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients.
Organisations, like the British Dietetic Association, (BDA), who Sign up to Safety commit to strengthen patient safety by:
- Setting out the actions they will undertake in response to the five Sign up to Safety pledges and agree to publish this on their website for staff, patients and the public to see.
- Committing to turn their actions into a safety improvement plan which will show how organisations intend to save lives and reduce harm for patients over the next 3 years.
The BDA is the first Allied Healthcare Professional membership organisation to 'Sign up to Safety'.
The BDA Pledges
1. Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally.
Dietitians are an integral part of the multidisciplinary and multiagency teams working to provide public health and NHS services to patients and users of the NHS. The BDA fully supports action to improve the quality of care and a reduction in the number and severity of patient safety incidents.
We will therefore:
a) Continue to engage with national public and stakeholder consultations (for example NICE guidance on safe staffing levels) putting safety at the forefront of our responses.
b) Encourage debate amongst our membership about safe dietetic practices and patient safety through the mediums of our print, web and social media as well as Branch and Group meetings
c) Make available and accessible, across the length and breadth of the country, information on safe practices and tools for assessing the risk of dietetic related activities such as calculating total parenteral nutrition regimens.
2. Continually learn. Make their organisations more resilient to risks, by acting on the feedback from patients and by constantly measuring and monitoring how safe their services are.
a) Encourage dietitians to follow local protocols to obtain feedback from patients about the dietetic services and use the information gathered to improve services and patient outcomes where needed
b) Encourage dietitians to follow local protocols to measure and monitor the safety of dietetic services and use the information gathered to improve services where needed
c) Encourage dietitians to raise safety issues via local clinical incidence reporting mechanisms
d) Provide professional guidance to support members to mitigate risk and make safe clinical decisions e.g. liquidised feeds policy
e) Support and encourage continuing professional development in all its forms: face to face training, online learning, shadowing etc. This is a requirement of the HCPC, the regulatory body for dietitians.
f) Continue to keep dietitians informed and up to date on topics and developments that could impact on patient safety via our Dietetics Today publication, CED and the website.
g) Encourage the training of dietitians on how to assess risk and work to minimise risk in patients accessing their services
h) Ensure regular updating of all training and education for pre-registration diettians, registered dietitians, dietetic assistants and Assistant practitioners through our CED.
3. Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong.
a) Publish our commitment to the ‘Sign up to Safety’ pledges on our website.
b) Encourage dietitians to publish the results of their regular service monitoring and patient feedback as per local protocols
c) Encourage local dietetic teams to share good practices and innovative services amongst the national dietetic community so that others may learn from them
d) Encourage dietitians to publish their safety related work in the Journal of Nutrition and Dietetics or other established peer reviewed journals and to enter such work to the Award schemes on offer by the BDA and other bodies.
4. Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use.
1) Work with colleagues to promote patient safety and safer working practices in all relevant organisations such as BAPEN, PINNT, PHE, NHS Education, NHS England, local professional networks and the local NHS England Patient Safety Collaboratives.
2) Encourage dietitians to work with manufacturers and service providers to develop safe products, packaging, services and resources
5. Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the progress.
a) Support dietitians who have concerns about patient safety. This support will be available via the Policy Officer for Professional Development and the Trade Union.
b) Foster and encourage a culture of continual learning throughout the profession by providing a conducive environment for learning so that members have the courage to share their experiences (both positive and negative) and also their ideas for improvement e.g. BDA conferences, Group meetings.
c) Continue to provide practice advice to individual dietitians facing issues with their practice in line with BDA strategy.
d) Showcase examples of innovative safe practices via Dietetics Today and the website and other ezines, social media and events