a review of the cup of tea cycle... raising the multiple issues linked to preventable dehydration in...
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A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
A Review of the Cup of Tea
cycle...
Raising the multiple issues linked to preventable dehydration in
elderly care
By Naomi Campbell RGN
Hydration Lead (secondment)Innovator & lead of
Cornwall Hydration Project
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Why focus on the Cup of Tea?To keep it simple!
then we can ALL
understand the challenges we face in tackling the problem of dehydration in
elderly care
Cornwall Hydration ProjectSupporting Oral Hydration Care Systems (SOHCS ™)
How much does a person need to drink to avoid the
onset of dehydration ?
• Evidence from across the globe supports a minimum daily volume of 1,600mls
• This is the equivalent of 8 standard drinks
© 2012 Naomi Campbell 'Cornwall Hydration Innovation
Project'
So why is that dehydration is such a huge problem?
Drinks are regularly handed out!
The Tea Trolley ... A familiar sight in most care settings
6 x a day 7 days a week 365 days a year
A review of ‘ The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell
© 2012
The Tea Trolley
A review of ‘ The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell
© 2012
Six cups of tea a day = approx 75% recommended daily intake of 1600mls needed to prevent the onset of dehydration
The fact is... we simply don’t know how much our patients are actually
drinking!
“Failure to accurately monitor how much elderly people are drinking
– is a root cause of avoidable dehydration”
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Cornwall Hydration Project - Naomi Campbell © 2012
Weakness in system processes that support effective fluid management
Inadequate staff knowledge and competence in effective management of volume assessment leading to over or under hydration within the overall context of holistic clinical assessment and care of the patient
Insufficient governance of the accountability for effective fluid management
Adult Intelligent Fluid Management Bundle
– NHS East of England 2011
Cornwall Hydration Project - Naomi Campbell © 2012
•AKI can occur in all medical settings
•AKI affects 1:5 people admitted to hospital as an emergency & many elderly patients
•1/3rd are considered avoidable but to achieve this MONITORING of fluids must become part of regular care
Approx cost to NHS £500 million
Inadequate Hydration is one of the main causes of Acute Kidney Injury (AKI)
NHS Kidney Care
June 2012
© 2012 Naomi Campbell 'Cornwall Hydration Innovation Project'
200ml
100150
50
200ml
200ml
200ml
200ml
200ml
= 1200ml
10050
100
200 200 200 200 200 200
in most care settings patients are offered on average 6 cups of tea per day e.g.
If all the cups are drunk = 75% Daily fluid intake goal
The Reality is often much less...
How much are our patients actually drinking?
Failure to daily monitor and respond to poor fluid intake = the gradual onset of dehydration
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell ©
2012
Existing methods of recording oral fluids
is ‘notoriously inaccurate’
Finding new practical and
effective monitoring systems is essential
We need to think
differently!
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Chronic dehydration develops over time... Every day matters
Mon
Wed
FriSu
n
0
200
400
600
800
1000
1200
1400
1600
Daily Fluid GoalRealityWhat is the root cause for such a deficit?
© 2012 Naomi Campbell 'Cornwall Hydration Innovation Project'
50 yrs on... the same
amount of time is
needed at the bed
side
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Poor staffing levels are a known risk factor for dehydration
ButLittle is known about how much help a vulnerable elderly person
needs to drink
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
How much help
is needed to drink & eat?
How much time is
needed to drink & eat
Providing evidence to
support essential basic care
Improving accountability
at all levels
Recognising work load
staffing demandsSkill mix
Cornwall Hydration Project - is developing a ‘Tool’ to help evidence how much help a patient needs to drink & eat
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Patient admitted
No Dehydration risk assessment tool
Risks not clearly identified
Patient offered a cup of tea
No valid ‘needs’ assessment tool to
identify level of help to drink
Patient May OR may not have
had enough help to drink
cup cleared away
Who / How / When / Where?monitors how much has been
drunk?
Inconsistent outcome of care – risk of dehydration
The cup of Tea cycle
Highlights the gaps in the systems & processess
gap 1
gap
2Gap 3
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Community care
Hospital care
Primary care
Home
Where do you fit into the Cup of Tea Cycle?
What is your role?
How can you help to improve the systems & processes that provide our elderly with essential drinks
Encouraging & helping vulnerable people to drink & eat ... Is
CRITICAL CARE
Preventable Dehydration in Elderly Care( = immeasurable suffering + £billions )
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Chief Exec Finance
Matron
Patientsrelatives
Admin
GSA
House KeeperHCA
OT PhysioSALT
DischargeTeam
Doctor
And many others!
Catering
RGN
We are all involved in the Cup of Tea Cycle ...
We all need to work together to prevent avoidable dehydration in elderly care
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Education & Training Cornwall Hydration Project is
developing new innovative measures to raise the profile of this basic but complex nursing
task
cleaners, housekeepers... relatives & volunteers, admin staff,
managers, CEOs etc ?
We are ALLsupposed to be part
of ‘hydration’
care ... How can this be
achieved?
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
HEALTH PROMOTION
Encouraging elderly people to drink is vital
More needs to be done
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
‘What goes in.... Must come out!!!’
Supporting timely toileting needs is a vital part of hydration care
Fear of incontinence deters many elderly people drinking adequate fluids
A review of the The 'Cup of Tea' cycle: Cornwall Hydration Project- N Campbell © 2012
Hydration
Sociable
Pleasure
Kindness
Familiar
NurturingRoutine
Crosses all boundaries
Personal Likes & dislikes... I’d
prefer a coffee or water instead!
Comforting
Caring
The Cup of Tea... represents so many different things ... At so many different times... To so many different people