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This Policy will define the Organisation’s philosophy regarding the assistance given to the service user in a Domiciliary Care environment that ensures that he / she receives nutritious, appetising meals, and adequate hydration through the supply of adequate fluids, according to choice, preferences and appropriate clinical factors. This Policy refers to the “MUST” (Malnutrition Universal Screening Tool) to identify risks of malnutrition or obesity which forms an essential part of the service user’s Care Plan:


1. BASELINE ASSESSMENT OF NEEDS (Ref Form No: 3-002, page 2):


1.1 The original Baseline Assessment of Needs, which forms the basis of the service user’s Care Plan, will include a “MUST” score to assess risk of malnutrition or obesity. Details of the “MUST” scoring system may be found at www.bapen.org.uk/musttoolkit/html .


1.2 The following essential factors affecting the service user will need to be considered as part of the “MUST” scoring system:


  • Establish a BMI score using the charts provided, or alternate procedures shown;

  • Note percentage unplanned weight loss in past 2 - 3 months using tables provided;

  • Establish acute disease effect and cause (where the service user is acutely ill and there has been, or

  • likely to be, no nutritional intake for more than 5 days);

  • Record the malnutrition risk category, and the need for any special diets.


1.3 Form No: 3-400 - Nutrition Risk Assessment - provides an alternative document for recording findings.


2. EATING & NUTRITIONAL CARE:


The following factors will need to be considered when planning nutritional care for a service user within the Domiciliary

environment:


2.1 Establish and record the service user’s food preferences in terms of likes, dislikes, favourite foods, and those forbidden for religious or cultural purposes. Care staff should not make assumptions about their food preferences on the basis of their cultural background - the service user should always be asked what their preferences are.


2.2 Ensure food and drinks are provided in sufficient quantities, and at the mealtimes of the service user’s choice. Ensure that, where appropriate, food and drinks are available and accessible by the service user between mealtimes.


2.3 Ensure that the Care Worker has sufficient allocated time and the skills to prepare a meal of choice for the service user, including freshly cooked meals.


2.4 Refer the service user for professional assessment if “MUST” screening identifies particular concerns. These can include the following, with due regard to the dignity of the service user:


  • The need to puree certain foods for the service user with swallowing difficulties;

  • The need for specially adapted cutlery and crockery to enable the service user to feed themselves where appropriate;

  • The need for special diets relating to a service user’s illness or other medical condition.


2.5 Maximise the eating experience by giving the service user time to eat and ensuring that their meals are not rushed. Where necessary this should be built into the Care Worker’s allocated time with the service user.


2.6 Provide assistance discreetly to the service user who has difficulty eating. Maintain an awareness of the need to offer privacy to the service user to avoid embarrassment or loss of dignity should the service user express a preference to eat alone.

2.7 Where indicated in the service user’s Care Plan, record food and fluid intake on a daily basis, and act upon the findings as appropriate.


2.8 Ensure that Care staff are properly trained in food technology and the importance of good nutrition and hydration.


2.9 Ensure that Care staff have the skills to communicate with service users who have dementia and / or communication difficulties. Visual aids such as pictorial menus and non-verbal communication skills may help the service user to make choices.


2.10 To ensure adequate hydration, encourage the service user to drink regularly throughout the day.


2.11 If the service user is reluctant to drink water, offer other ways of increasing their fluid intake such as with alternative drinks and foods that have a higher fluid content; e.g. soup and breakfast cereals with milk.


2.12 If the service user is reluctant to drink because they are concerned about incontinence, reassure them that help will be provided with using the toilet, with due regard to the service user’s dignity. In this respect, Care staff should be aware of urine colour as an indication of hydration level - odourless, pale urine indicates good hydration, but dark, stronger-smelling urine could be an indication of poor hydration or other causes that may require investigation.



FORMS REFERENCES:

Form No: 3-002 Baseline Assessment of Needs for Daily Living - Service User

Form No: 3-013 Care Plan - Service User

Form No: 3-400 Nutrition Risk Assessment

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