The Care Certificate Framework For Adult Social Care Workers & Healthcare Support Workers

Transcription

1 The Care Certificate Framework For Adult Social Care Workers & Healthcare Support Workers Standard 8 Name of Learner: Role: Organisation: Mentor: Assessor: Date started: Page 1 of 26

2 The Care Certificate Framework Fluids and Nutrition Standard 8 Main areas: I will understand the principles of hydration, nutrition and food safety I will be able to support individuals to have access to fluids in accordance with their plan of care I will be able to support individuals to have access to food and nutrition in accordance with their plan of care Links Code of Conduct: Standard 2 & 3 Compassion in Practice (6 C s) Care, Compassion, Competence, Communication, Courage and Commitment Page 2 of 26

3 Standard 8 This standard enables you to understand the importance of food safety, including hygiene, in the preparation and handling of food and identifies principles of hydration and nutrition to ensure that you are able to support the clients to have access to food, nutrition and hydration in line with their plan of care. Food Safety Food safety is essential to ensure that the clients that we support are not harmed in any way from the food and drink that we give them to eat and drink. As a food handler, you have a legal responsibility to ensure that you do not cause harm to anyone through bad practice, ignorance or neglect. Food poisoning affects millions of people each year in the UK, and the seriousness of it can t be underestimated. The cost of bad practice and poor food safety can be immense and can include: Illness and possibly death from food poisoning Unhappy clients and therefore increased complaints Poor reputation Higher costs, due to food waste Staff disciplinary action and possible enforcement notices / closures Many of the clients that we support will be more susceptible to food related illnesses due to weaker immune systems and this can be due to age, illness or medication that they are taking. The people that are particularly susceptible include: Babies, toddlers and children Pregnant and breastfeeding women Elderly people Those who are living on a low income: they find it difficult to afford a healthy and balanced diet People in hospital, are often unwell in addition to the fact of the medication that they are on, their age or overriding illness Page 3 of 26

4 Food safety within health or social care ensures that the food that is served is safe for the clients and the team are therefore responsible for that, so all stages of the process are important. Food can arrive on your premises and it is already contaminated, i.e. it contains something harmful or objectionable, and we need to acknowledge that this can happen anywhere during the field to fork process. The 3 main types of contamination include: - Types of Examples Ways to prevent contamination Physical Hair Ensure hair secured up and if you Jewellery are in the kitchen wear a hat Flies and insects Don t wear jewellery when dealing Plasters with food False nails / nail varnish Ensure that you wear blue Buttons plasters, as then you should see them before you eat them No false nails / nail varnish Chemical Cleaning chemicals Ensure when using chemicals Metal from open tins of there is no food around food Do not store food in tins when Pesticides once they have been opened Ensure fruit and vegetables are washed Microbial Viruses As viruses enter the body through (most common Moulds / yeasts contaminated food or water and form of Harmful bacteria also through raw vegetables, poor contamination) Naturally poisonous food personal hygiene practices ensure hygiene practice is good Moulds / yeasts can grow on a wide range of food Poisonous food can include green potatoes, rhubarb leaves, under cooked kidney beans so these should be avoided Page 4 of 26

5 To grow, bacteria need the right conditions and these include: Fig 1 conditions required for growth of bacteria Throughout all stages of the food journey, temperature control is important, as if food is held or coked at the wrong temperature for example, then it could enhance the possibility of food poisoning. 100º = boiling point 75º = ensure cooked food reaches this temperature / reheated food 70º = cook food to this temperature and maintain for 2 mins 63º = hot holding temperature and top of the danger zone 37º = body temperature 8º = chilled storage (legal) 5º = cold holding temperature and lower end of the danger zone 0-5º = best practice fridge temperature 0º = bacteria become dormant 18º = freezer temperature Fig 2 food temperatures Page 5 of 26

6 When preparing food, you need to ensure that you: Keep raw and cooked foods separate Raw meat is stored at the bottom of the fridge so it doesn t drip over other foods Food should be covered or stored in the fridge in suitable containers Check the sell by and use by dates on foods Check food in the fridge is used as soon as possible The area for preparation is kept clean You are wearing appropriate clothing Good personal hygiene is particularly important for preventing the spread of food poisoning bacteria. If you are involved in handling food, you should wash your hands with soap and water and hot running water before you handle food, and also wash your hands when undertaking other activities, such as: Handling any uncooked or waste food Using the lavatory Assisting individuals to use the lavatory After contact with those your support or care for Handling rubbish, cleaning tasks or handling chemicals Using or handling any tissues or handkerchiefs Coughing or sneezing Touching your own or another individuals hair or face Returning from breaks, or starting your shifts in the workplace Awareness of clean clothing (uniforms or tabards) Page 6 of 26

7 Nutrition and Hydration Good hydration and nutrition are important for maintaining well being. All essential body processes depend on a constant and consistent supply of water to function and the body is unable to build and repair or even maintain itself without essential nutrients. What we eat is vital to how we look, feel and function and therefore it is important that people have a diet that is safe to eat and has all the nutrients they need. A diet that does not include the right balance of everything we need, can lead to illness and ill-health. The guidelines for a healthy diet are a collection of sensible suggestions describing food and lifestyle choices that promote good health, provide the energy for an active lifestyle and reduce the risk or severity of chronic illnesses such as diabetes and heart disease. The eight basic health messages are: 1) Enjoy your food. 2) Eat a variety of different foods. 3) Eat the right amount to be a healthy weight. 4) Eat plenty of foods rich in starch and fibre. 5) Eat plenty of fruit and vegetables. 6) Limit foods that contain a lot of fat. 7) Limit sugary foods and drinks. 8) If you drink alcohol, drink in sensible amounts. The eat well plate is a pictorial example of the eight guidelines of a healthy diet. The plate is divided into sections of differing sizes representing the five common food groups: 33% Fruit and vegetables A selection of fruit and vegetables of different colours are best, including fresh, frozen, tinned and dried varieties. Provides vitamins, minerals and fibre 33% Bread, cereals, potatoes and other starchy food Includes breakfast cereals, pasta, rice, oats, corn, chapattis, yams and plantains Page 7 of 26

8 Provides energy, vitamins, minerals and protein can be found in wholemeal varieties 16% Milk and dairy foods Includes milk, calcium-fortified soya milk, yoghurt, cheese, fromage frais. Provides calcium, protein, vitamins A and B 13% Meat, fish and alternatives Includes red meat, poultry, offal, fish, eggs and vegetable sources of protein such as nuts, beans, pulses, tofu and quorn. Provides protein, iron, zinc, essential fatty acids, various vitamins and minerals 5% Fats and sugars Includes spreading fats, oils, cream, butter, salad dressings and sauces, cakes, pies, biscuits, confectionery and savoury snacks like crisps and soft drinks. Provides energy and few other useful nutrients Fig 3 Eat well plate The balanced eat well plate delivers two practical and important messages; proportion matters and variety counts. Page 8 of 26

9 Different nutrients are required for different reasons, but it is essential that we have a diet where they are all included. Below is a summary of what each are needed for: - Nutrient Function Sources Provides energy for the body. There are 2 main types of carbohydrates simple and complex. Carbohydrate Protein Fat Simple carbohydrates are made up of 1 or 2 sugar molecules and are digested quickly by the body. Complex carbohydrates are made up of more than 2 sugar molecules and digested slowly by the body (e.g. starch found in potatoes) Provides amino acids (building blocks) that we can t make ourselves. Needed for growth, development and repair of the body. Also provides energy. Provides essential fatty acids (that we can t make ourselves but need in small amounts), as well as energy. It also carries important fat-soluble vitamins and is important for their absorption. All starchy foods, such as bread, rice, potatoes, pasta, cereals and cereal products; fruit and starchy vegetables, milk and milk products, sugar, preserves and confectionery. Meat, fish, eggs, dairy foods, cereal products such as bread, soya products, nuts and pulses. Fats and oils, meat and meat products, dairy foods, oily fish, nuts, cakes, biscuits, pastry products, crisps and other snacks, chocolate. Page 9 of 26

10 Water-soluble vitamins Water-soluble vitamins cannot be stored in our bodies and are readily excreted. Nutrient Function Sources Vitamin B 1 (Thiamin) Vitamin B 2 (Riboflavin) Vitamin B 3 (Niacin) Needed to release energy from carbohydrate. It is also involved in the nervous system and the heart. Releases energy from carbohydrate, protein and fat. It is also involved in the transport and metabolism of iron in the body and is needed for the normal structure and functioning of the skin and body linings. Releases energy from food, and is important for the normal structure of the skin and body linings. It also keeps the digestive and nervous systems healthy. Whole grains, nuts, meat (especially pork), fruit and vegetables and fortified breakfast cereals. Milk, eggs, rice, fortified breakfast cereals, liver, legumes, mushrooms and green vegetables Meat, wheat and maize flour, eggs, dairy products and yeast. Vitamin B 6 Involved in the use of protein, and helps to form haemoglobin in blood (the substance which carries oxygen around our bodies). Poultry, white fish, milk, eggs, whole grains, soya beans, peanuts and some vegetables. Vitamin B 12 Important for making red blood cells and to keep the nervous system healthy. Also helps to release energy from food. Meat, fish, milk, cheese, eggs, yeast extract and fortified breakfast cereals. Page 10 of 26

11 Folate/ Folic acid Vitamin C Needed for the formation of healthy red blood cells. It is also needed for the nervous system and specifically for the development of the nervous system in unborn babies. Acts as an antioxidant and is important for the normal structure and functioning of body tissues. It also helps the body to absorb iron from non-meat sources such as vegetables, as well as assisting the healing process. Green leafy vegetables, brown rice, peas, oranges, bananas and fortified breakfast cereals. Fresh fruits especially citrus fruits and berries; green vegetables, peppers and tomatoes. Also found in potatoes (especially new potatoes). Fat-soluble vitamins are absorbed through the gut with the help of fat. These include vitamin A, vitamin D, vitamin E and vitamin K. Nutrient Function Sources Vitamin A Vitamin D Important for the normal structure and functioning of the skin and body linings, e.g. in lungs. It also helps with vision in dim light as well as keeping the immune system healthy. Needed for the absorption of calcium and phosphorus from foods, to keep bones healthy. Recent research suggests that vitamin D enhances immune function and improves muscle strength. Liver, whole milk, cheese, butter, margarine, carrots, dark green leafy vegtables and orange-coloured fruits, e.g. mangoes and apricots. Oily fish, eggs, fortified cereals and margarine. Most is obtained through the action of sunlight on our skin during the summer months. Page 11 of 26

12 Vitamin E Acts as an antioxidant and protects the cells in our bodies against damage. Vegetable oils, nuts and seeds. Vitamin K Needed for the normal clotting of blood and is required for normal bone structure. Green leafy vegetables, meat and dairy products. Minerals - There are certain minerals we need to keep our bodies healthy. These include calcium, fluoride, iodine, iron, magnesium, phosphorous, potassium, selenium, sodium and zinc. Nutrition Poor nutrition can lead to a number of conditions, including the client becoming malnourished. According to NICE (National Institute for Health and Clinical Excellence) guidance in Nutrition support in adults (CG32), malnutrition is defined as: A body mass index (BMI) of less than 18.5 kg/m2 Unintentional weight loss greater than 10% within the last 3 6 months A BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3 6 months Malnutrition is both a cause and consequence of disease and illness and there can be many contributing factors. Whilst some causes of malnutrition might be the result of underlying ill health, disease or the body's inability to absorb nutrients, malnutrition can also be linked to other experiences or factors in a person's life. Factors that contribute to malnutrition include: Depression or anxiety Bereavement Page 12 of 26

13 Social exclusion Dental problems Influence of medication Medical conditions e.g. stroke, respiratory problems Presence of pain Loss of taste or smell Cognitive impairment e.g. due to dementia Altered image perception, e.g. anorexia Embarrassment of not being able eat independently Influence / distraction of others within the communal setting At any given time, more than three million people in the UK are either malnourished or at risk of malnutrition (BAPEN, 2009). The vast majority of these are living in the community (93%) with a further 5% in care homes and 2% in hospitals (BAPEN, 2009). The population of people over 75 is at highest risk of malnutrition and is projected to double in the next 30 years. Signs of poor nutrition include: Weight loss / weight gain (if eating inappropriate foods) Feeling tired Constipation Poor wound healing Frequent infections Difficulty in keeping warm Change in BMI Brittle nails Promotion of adequate nutrition When people receive any type of care or support, an assessment should be made about their nutrition, which includes likes and dislikes, food allergies, and the support they need to eat and drink and if they are on any special diet, for example a soft diet. This is important as, we should, at all times be working in a person centred manner, but to do this, you will need to gain information about the individual so as you can Page 13 of 26

14 then ensure that you are delivering the care / support in a manner that they find acceptable. To promote adequate nutrition, you also need to consider: The client has choice of what / when they eat Ensure clients are supported to eat in a manner that they find acceptable to them and it is in a dignified way Consider those clients with visual / hearing impairment and adaptations that need to be made to enable them to be able to manage Ensure client has access to appropriate accessories e.g. adapted cutlery Food is of the right consistency and presented in an attractive manner and is able to be eaten in a way that the client chooses There is variety of foods both flavour and textures Ensure food is within their reach Ensure meal times are a sociable event, within a calm and relaxed environment and so unwanted stimuli are removed It may be necessary to eat with the client to model eating, for those that are forgetting how to eat or remind them how to use cutlery Offer flexible meal times Where clients are underweight or at risk of losing weight, ensure foods are fortified, e.g. add cream to mashed potatoes, honey to breakfast cereals and offer supplementary drinks / snacks Ensure clients where appropriate have the option to graze on food and that it is available over the 24 hour period Offer snacks / supplements in between meals Staff to be observant to changes in swallowing abilities in clients or sudden change in eating patterns and causes for these Record weight as required and where necessary complete food charts so that their actual input can be monitored. Page 14 of 26

15 Hydration - The average adult body holds about 45 litres of water. Around 30 litres of this is in the liquid held in body cells. The remaining 15 litres is in all other body fluids such as: The fluid surrounding cells Blood plasma Lymph (found in blood vessels) Water makes up about two thirds of our body weight and without it the adult human body will survive only a few days. The body regulates the balance of fluid through electrolytes - essential minerals which dissolve in water. Sodium or salt is one of the most familiar sources of electrolytes. When the fluid level in the body is too low, the thirst mechanism in the brain reacts to the increased concentration of electrolytes in the blood, prompting you to need a drink. Recent studies have shown that 1 in 4 people don t drink enough fluid due to our thirst mechanism not being very sensitive. People are often dehydrated before they even begin to feel thirsty. Causes of dehydration include: Being cognitively impaired Dementia and forgetting to drink Acute confusion Depression Anxiety Needs help with activities of daily living Swallowing problems Loss of thirst Fluids not being available Poor appetite Multiple chronic illnesses Poor vision Incontinence Hot weather Page 15 of 26

16 Fluids being mistakenly with-held to prevent incontinence Clients feeling rushed or being in the wrong position to drink or assistance to reach / pour drinks Signs of dehydration: Drop in blood pressure Rise in pulse Dizziness Fatigue Clumsiness Falling Dry skin, mouth, chapped lips, dry and / or sunken eyes Loss of elasticity in the skin Dark urine / urine with strong odour Painful urination / decreased urine output Constipation Loss of appetite Difficulty in swallowing Lack of fluid intake being observed Dehydration can lead to: Kidney stones Urine infections Pressure ulcers Changes in diabetes control Death To promote adequate hydration, you need to consider: Having fluids readily available Encouraging fluids Offering choices, to include types / temperature of fluids that the client likes Use appropriate cups / mugs / accessories e.g. straws, so that fluids can be given in a dignified manner Page 16 of 26

17 Offer fluids after providing care Offer small amounts frequently and at times, when you are in an appropriate environment to do this, consider having a drink with them Offer substitutes for liquids, especially in the hot weather e.g. ice lollies, but also consider fluid rich foods Offer full cup with medicines Be aware of swallowing issues and assess accordingly, including using the Speech and Language Therapist Be prepared to adjust consistency of fluids as needed Explain that decreasing fluid intake does not decrease incontinence Provide good oral hygiene Position appropriately to drink For both nutrition and hydration, there may be times when you need to complete either a fluid chart and / or a food chart, so that you can clearly monitor their intake. Again, this needs to be done in a sensitive manner and it is imperative that it is completed accurately, as if all staff don t complete that client s intake (for either fluid or food) correctly, it would indicate that person has not had anything. Likewise if you are assisting someone with either their food or their fluids, it is imperative to do this in a dignified manner. Unless, it is contra-indicated for any reason, it is important that drinks are within that clients reach at all times and if this is contra-indicated, then it is imperative that someone takes responsibility to ensure that they are either offered or assisted with regular drinks, this information should always be recorded in their plan of care. These drinks need to be appealing to that individual, so it is important to take account of what their preferences are as well as temperature etc. A cold drink that has sat in the sun all day, and gradually warmed up, will not be appetising for that client, so if it supposed to be cold, make sure it is. If you had concerns about someone s fluid / food intake, then it is important that not only do you record it, in their notes, but you also report it to your senior. Page 17 of 26

18 Standard 8 Workbook Fluids and Nutrition Standard 8 Main areas: I will understand the principles of hydration, nutrition and food safety I will be able to support individuals to have access to fluids in accordance with their plan of care I will be able to support individuals to have access to food and nutrition in accordance with their plan of care Links Code of Conduct: Standard 2 & 3 Compassion in Practice (6 C s) Care, Compassion, Competence, Communication, Courage and Commitment Page 18 of 26

19 Standard 8.1 Understand the principles of hydration, nutrition and food safety 8.1a Describe the importance of food safety, including hygiene in the preparation and handling of food 8.1b Explain the importance of good nutrition and hydration in maintaining health and well-being Importance of good nutrition Importance of maintaining hydration 8.1c List the signs and symptoms of poor nutrition and hydration Page 19 of 26

20 Signs and symptoms of poor nutrition Signs and symptoms of poor hydration 8.1d Explain how to promote adequate nutrition and hydration Promote adequate nutrition by: Promote adequate hydration by: Page 20 of 26

21 Standard 8 Observation Fluids and Nutrition Standard 8 Main areas: I will understand the principles of hydration, nutrition and food safety I will be able to support individuals to have access to fluids in accordance with their plan of care I will be able to support individuals to have access to food and nutrition in accordance with their plan of care Links Code of Conduct: Standard 2 & 3 Compassion in Practice (6 C s) Care, Compassion, Competence, Communication, Courage and Commitment Page 21 of 26

22 Standard Observation Signature & Date of observation 8.2a Check that drinks are within reach of those that have restrictions on their movement / mobility 8.2b Check that drinks are refresher on a regular basis 8.2c Check that individuals are offered drinks in accordance with their plan of care 8.2d Support and encourage individuals to drink in accordance with their plan of care 8.2e Know how to report any concerns to the relevant person. This could include: - Senior member of staff - Carer Observation / simulation (please indicate) Page 22 of 26

23 - Family member (use of simulation / role play is permitted here) 8.3a Check that any nutritional products are within reach of those that have restrictions on their movement / mobility 8.3b Check food is provided at the appropriate temperature and in accordance with the plan of care (i.e. the individual is able to eat it) 8.3c Check that appropriate utensils are available to enable the individual to meet their nutritional needs as independently as possible 8.3d Support and encourage individuals to eat in accordance with their plan of care 8.3e Know how to report any concerns to the Observation / simulation (please indicate) Page 23 of 26

24 relevant person. This could include: - Senior member of staff - Carer - Family member (use of simulation / role play is permitted here) Page 24 of 26

25 Standard 8 Outcome To meet this standard Assessment Evidence Date signed off 8.1 Understand the principles of hydration, nutrition and food safety 8.1a Describe the importance of food safety, including hygiene, in the preparation and handling of food Assessed by any of the following methods: - 1:1 discussion - Group work - Written 8.2 I Support individuals to have access to fluids in accordance with their plan of care 8.1b Explain the importance of good nutrition and hydration in maintaining health and wellbeing 8.1c List signs and symptoms of poor nutrition and hydration 8.1d Explain how to promote adequate nutrition and hydration 8.2a Check that drinks are within reach of those that have restrictions on their movement/ mobility 8.2b Check that drinks are refreshed on a regular basis 8.2c Check that individuals are offered drinks in accordance with their plan of care 8.2d Support and encourage individuals to drink in accordance with their plan of care 8.2e Know how to report any concerns to the relevant person. This could include: Senior member of staff Carer Family member Assessed by any of the following methods: - 1:1 discussion - Group work - Written Assessed by any of the following methods: - 1:1 discussion - Group work - Written Assessed by any of the following methods: - 1:1 discussion - Group work - Written The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties. The opportunity to demonstrate this during the induction period may not arise. Therefore the use of simulation / role play using scenarios is permitted Page 25 of 26

26 8.3 Support individuals to have access to food and nutrition in accordance with their plan of care 8.3a Check that any nutritional products are within reach of those that have restrictions on their movement/ mobility 8.3b Check food is provided at the appropriate temperature and in accordance with the plan of care i.e. the individual is able to eat it 8.3c Ensure that appropriate utensils are available to enable the individual to meet their nutritional needs as independently as possible 8.3d Support and encourage individuals to eat in accordance with their plan of care 8.3e Know how to report any concerns to the relevant person. This could include: Senior member of staff Carer Family member The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties The assessment must be observed in the workplace as part of the normal work duties. The opportunity to demonstrate this during the induction period may not arise. Therefore the use of simulation / role play using scenarios is permitted I am satisfied with the evidence of learning that it meets all the required standards. Assessor s Name: Signature: Learner s Signature: Assessor s Position: Date: Date: Page 26 of 26