Standard 40: Nutrition and Dietetics

Why it matters. Nutrition care needs the right skill. A qualified dietitian, or a clinician trained for the task, assesses and plans the diet, so that the plan is safe and effective.

Sample. Review nutrition assessment and plan records for 20 patients, and staff competence records for those who wrote them.

1. Nutrition assessment is carried out by a qualified dietitian or a trained clinician.

Method. Check each assessment for the author and their qualification.

Evidence to show. Nutrition care by qualified staff (NUT-POL-001).

Pass when. Every assessment is by a qualified or trained clinician.

2. The author’s qualification is on the competence register.

Method. Check each author against the register.

Evidence to show. Nutrition staff competence register (NUT-REG-001).

Pass when. Every author is on the register with a current qualification.

3. Dietitian input is recorded where the plan is complex.

Method. Check each complex case for the dietitian review entry.

Evidence to show. Individual nutrition plan record (NUT-FRM-001).

Pass when. Every complex case has dietitian input recorded.

Immediate fail (any one means the criterion is not met)

• A feeding plan written by an untrained aide with no dietitian input.

Why it matters. Each patient has different nutritional needs. An individual plan, based on an assessment of their needs, is what keeps them well.

Sample. Review nutrition plans for 20 patients, including those with diagnoses, allergies or cultural or religious dietary needs.

1. Each patient has a documented nutrition assessment before the plan.

Method. Check each plan for an assessment dated before it.

Evidence to show. Nutritional risk screening and therapeutic diets (CLN-SOP-003, existing, reused).

Pass when. Every plan is preceded by an assessment.

2. The plan records diagnosis, allergies, intolerances and cultural or religious needs.

Method. Check each plan for the four items.

Evidence to show. Individual nutrition plan record (NUT-FRM-001).

Pass when. Every plan records all four items.

3. The plan is reviewed at the set interval.

Method. Check each plan for the review dates against the interval.

Evidence to show. Nutrition risk screen record (CLN-FRM-005, existing, reused).

Pass when. Every plan is reviewed at the set interval.

Immediate fail (any one means the criterion is not met)

• A diabetic patient given a standard tray with no nutrition plan and no allergy check.

Why it matters. Malnutrition slows recovery, weakens the immune system and can kill. Identifying it with a validated tool, and treating it, prevents harm.

Sample. Review malnutrition screening and monitoring records for 20 patients admitted in the last 3 months.

1. Each patient is screened for malnutrition with a validated tool.

Method. Check each record for the named tool and its score.

Evidence to show. Malnutrition identification and monitoring (NUT-SOP-001).

Pass when. Every patient has a validated screen recorded.

2. Weight and intake are monitored against documented targets.

Method. Check each record for weight and intake entries against the target.

Evidence to show. Falls, pressure injury and weight register (LTC-REG-001, existing, reused).

Pass when. Every at-risk patient has weight and intake monitored against target.

3. Treatment is started and reviewed when malnutrition is found.

Method. Check each positive screen for the treatment and review.

Evidence to show. Falls, pressure injury and nutrition risk screening (LTC-SOP-001, existing, reused).

Pass when. Every positive screen has treatment and review recorded.

Immediate fail (any one means the criterion is not met)

• A patient losing weight for six weeks with no screen and no monitoring.

Why it matters. A patient with swallowing difficulty who is given the wrong texture can choke or breathe food into the lungs. The diet must be matched to a documented swallowing assessment.

Sample. Review swallowing assessments and texture orders for 15 patients with a swallowing concern.

1. A documented swallowing assessment is on file before the texture is set.

Method. Check each texture order for an assessment dated before it.

Evidence to show. Swallowing assessment and texture record (NUT-FRM-002).

Pass when. Every texture order follows an assessment.

2. Diet texture and fluid consistency match the assessment.

Method. Check each order against the assessment result.

Evidence to show. Diet texture from swallowing assessment (NUT-SOP-002).

Pass when. Every order matches its assessment.

3. The texture is reviewed as swallowing changes.

Method. Check each record for the review and any change made.

Evidence to show. Swallowing assessment and texture record (NUT-FRM-002).

Pass when. Every change in swallowing is followed by a texture review.

Immediate fail (any one means the criterion is not met)

• A patient with a swallowing problem given thin fluids with no assessment.

Why it matters. Food that is not stored, prepared and served safely causes outbreaks of illness, and vulnerable patients are the most at risk. Documented food safety rules are the basis of safe food.

Sample. Review food safety records, temperature logs and staff training for the last 3 months.

1. Food is prepared, stored and served under documented food safety rules.

Method. Check the rules against the practice records sampled.

Evidence to show. Food safety and hygiene (NUT-POL-002).

Pass when. Every sampled practice follows the documented rules.

2. Food handlers are trained and the training is recorded.

Method. Check the training record for each handler.

Evidence to show. Hand hygiene at the point of care (HH-SOP-001, existing, reused).

Pass when. Every handler has training recorded.

3. Temperatures and hygiene are checked and recorded on each shift.

Method. Check each shift for the temperature and hygiene entries.

Evidence to show. Food temperature and hygiene check register (NUT-REG-002).

Pass when. Every shift has temperature and hygiene checks recorded.

Immediate fail (any one means the criterion is not met)

• Food kept at room temperature for hours and served without hygiene checks.