The Health Information and Quality Authority (HIQA) has today published three reports on nutrition and hydration care in public acute hospitals. HIQA monitors against the National Standards for Safer Better Healthcare to review nutrition and hydration care of patients in Irish hospitals.  

HIQA inspections monitor hospitals to ensure that they have effective systems in place to identify and manage patients who are at risk of malnutrition and dehydration.The reports published today relate to inspections in Mallow General Hospital, University Hospital Kerryand Midland Regional Hospital, Mullingar.

An unannounced inspection in Mallow General Hospitalon 12 July 2016 found that patients who spoke with inspectors were satisfied and complementary about the food and drinks they received. Patients also reported that they were satisfied with the choice of food offered; however, the choice and variety of texture-modified diets was limited.

The hospital had implemented quality improvement initiatives to communicate patients’ nutrition and hydration needs, to identify patients who needed assistance, and to ensure that patients received the correct meal. Overall, snacks offered to patients were limited to tea and biscuits, which were not in line with best practice guidelines. Patients who required assistance were observed being assisted by staff.

Mallow General Hospital had a Nutrition Steering Team, but did not routinely screen patients for their risk of malnutrition on admission to hospital at the time of the inspection. The hospital was conducting some audits in relation to nutrition and hydration care, but they had not audited the nutrient content and portion sizes of hospital meals. The inspection found that the hospital needed to develop policies and provide structured training for staff in relation to nutrition and hydration.

During an unannounced inspection in University Hospital Kerry on 13 July 2016, inspectors observed that not all patients who required assistance with their meals had been offered assistance in a prompt manner and there was no system to make sure that staff who served meals to patients knew which patients needed assistance. While the majority of patients who spoke with inspectors were satisfied and complementary about the food and drinks they received and confirmed that they were offered a choice of meals, the hospital menu cards given to patients did not describe the full range of options available. For example, there was only one option detailed on the menu card for the midday meal and the evening menu had the same five choices outlined every day without variation.

The hospital had a Nutrition Steering Committee, and screened patients for their risk of malnutrition on admission. However, not all patients were rescreened for their risk of malnutrition. The hospital has developed a number of policies relevant to nutrition and hydration, and while there was evidence of a number of audits conducted in relation to nutrition and hydration, it had not yet audited the nutrient content and portion sizes of hospital meals.

During an unannounced inspection on 28 July 2016, patients in Midland Regional Hospital, Mullingar who spoke with inspectors were satisfied and complementary about the food and drinks they received and the choice of food available. However, inspectors found that the choice and variety of texture-modified diets was limited. Inspectors saw a number of examples of patients’ meals being interrupted by ward routines, for example, medication rounds and the taking of blood samples during mealtimes. Patients who required assistance were assisted by nursing and healthcare staff in a timely way.

The Hospital had recently re-established a Nutrition Steering Committee which needed to further develop and implement policies and procedures and introduce a structured approach to audit of nutrition and hydration practices. Only half of the patients whose records were reviewed by inspectors had been screened for their risk of malnutrition and not all scores were recorded accurately. Not all patients had been re-screened for their risk of malnutrition in line with national guidelines.