A Review of the Cup of Tea cycle... Raising the multiple issues linked to preventable dehydration in...

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


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

But how much is poured down the drain every day?

& why is it poured away?

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”


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!


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


Poor staffing levels are a known risk factor for dehydration

ButLittle is known about how much help a vulnerable elderly person

needs to drink


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


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


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 )


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


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?


HEALTH PROMOTION

Encouraging elderly people to drink is vital

More needs to be done


‘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


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

A Review of the Cup of Tea cycle... Raising the multiple issues linked to preventable dehydration in...

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