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Why are patients being put at risk of dehydration and starvation?

In 2011, The Patients Association commissioned the largest survey of its kind in the UK on the issue of malnutrition in the community and hospital setting (5,018 respondents). The survey results informed the report, Malnutrition in the community and hospital setting, the results of which were truly shocking.

The study revealed that malnutrition contributed to the deaths of 284 elderly hospital patients with a further 800 deaths being attributed to dehydration. Furthermore it was also discovered that two out of three hospital patients were not being checked for signs of undernourishment, and community carers were also failing to weigh their elderly clients, thus keeping a track of their nutritional status.

Later on in November of 2011, the Care Quality Commission also produced a report, Dignity and Nutrition in Older People, which despite highlighting examples of excellence in clinical nursing practice, also raised some grave concerns with regards to nutrition and hydration, including:

·      Lack of assistance required to eat, resulting in patients struggling to, or being unable to eat.

·      Lack of assessment of nutritional needs, and monitoring of nutritional status during hospital stay. 

·      Malnourished patients not being identified and action plans not being implemented.

·      Lack of drinks, caused by situations such as water placed out of reach, or no fluids for long periods.

·      Patients requiring water to be prescribed to ensure adequate fluid intake.

This is unacceptable and it begs the question as to why there are such vast differences in standards of clinical nutritional care across the UK.

Nutrition is a fundamental aspect of patient care and it should not be necessary to “prescribe water.” Katherine Murphy, the Chief Executive of the Patient's Association, also points out that “Food and water should not be seen as a treatment but as a human right”!   

As nurses, we need to take urgent action in order to begin to reverse the standards of poor nutritional care and more importantly to prevent the deaths associated with both malnutrition and dehydration.

There are many toolkits available to assist nurses in optimising their patients' nutrition and hydrations status. The British Association of Parenteral and Enteral Nutrition provide an excellent malnutrition universal screening tool (MUST) and online training. The Royal College of Nursing also has 'Nutrition Now' which includes a 'Hydration Best Practice Toolkit' as a further resource.

How can you promote excellence in nutritional care in your clinical areas? How can we prevent patients from starving and being at risk of dehydration? Do you think nurses need to be made more aware of the importance of nutrition? Please leave your suggestions and comments below.