A Guide to assisting adults to feed and supporting the patient experience – Volunteer Feeding

Welcome to Worcestershire Acute Hospitals NHS Trust and thank you for your interest in helping to support our patients and improving their patient experience.

This guide outlines how volunteers can support adults with feeding and is intended to be used alongside the general ward volunteer profile information. This guide details the expectations, activities and the competencies required. The guide also explains which patients should be assisted and the correct methods for providing that support. Training will be provided alongside Health Care Support Workers (HCSW) to ensure consistent expectations.

On completion of competencies, please forward a copy of to the Ward Manager and the Volunteer Manager. A certificate will be issued to you on completion of the competency element.

Useful numbers

Ward
Switchboard	01905 7633333
Emergency	2222

Useful email
[email protected]

Points to remember

• Please remember to adhere to infection prevention policy and stay ‘bare below the elbows’. You will have been given and you will have signed a Uniform and PPE Guidance at the recruitment stage which outlines expectations. Copies are available from the Volunteer Office.
• Hand gel is available in all clinical areas and should be used on entering and leaving a clinical area.
• Hand gel should also be used before and after every patient contact.
• A green apron should be used when handing out meals, on the drinks round and when feeding patients.
• Please do not sit on the beds. A chair will be provided.
• If you have diarrhoea or vomiting, please do not visit the hospital or other care setting until 48hrs clear of symptoms. If in doubt, speak to a member of staff.

It is the responsibility of the Nursing staff on the ward to identify the patients who you are able to assist with feeding.

Expectations and the volunteer role on our wards
Please refer to the ward profile at the end of this document
Many volunteers stay on the same ward and become a fundamental part of the team on the ward.  The following is an example of the main activities you will be doing:

• Assisting in the handing out of meals.
• Completing a drinks round – if a patient requires thickener in their drink, please ask a trained member of staff to add the thickener.
• Talking to patients and putting them at ease.
• Reading to patients.
• Tidying patient tables and ensuring that refreshments are readily available.
• Helping staff to keep the clinical area clutter free.
• Making beds where appropriate once trained to do so.
• Assisting patients to complete menus where appropriate with their meal choices.
• Assisting relatives with queries and direct to other staff when required.
• Encouraging patients to remain independent (to take an active role in their own care where possible, which will support the healing process and their rehabilitation).
• Feeding patients or assisting to feed where necessary.
• Cleaning patient hands prior to mealtimes.
• Answering patient call bells – assisting with non-clinical support such as requests for more blankets or pillows and additional drinks
• Friends and Family feedback data collection – to support patients to share feedback.
• Help complete “This is me “documentation for the patient, with the family/carer.
• Supporting patients with the use of technology – assisting with the bedside TV or telephone or helping patients with their own technology (ipads for example)
• Speak to a member of staff if you have any concerns or are asked to perform any tasks you are unsure about.

Please note that volunteers are not expected to perform any intimate or clinical procedures on a patient

Communication
Many of our patients experience problems communicating and require extra time to process information.  This may include visual and hearing impairment.  Some patients will have an ‘All about me’ booklet which will be located in their bed space and contains information on likes, dislikes and their home environment.  Other patients may have a ‘forget me not’ flower on their back board denoting that they have a diagnosis of dementia.

All patients should be given the time to respond to questions in accordance with the Trust’s Dignity and Privacy policy.     

If at any time you feel unsure or uncomfortable about communicating with any patient, please speak with a member of staff.  

Volunteer Feeding  
Nutrition and Hydration is a priority for the Trust and the primary role of a volunteer meal time helper is to help feed those patients who require additional support.  Patients needing assistance will be identified by nursing staff and their meal will be brought to them on a red tray. 

Patients who SHOULD NOT BE FED by Volunteers are: Those who have a NIL BY MOUTH (NBM) sign above their bed. Patients who are under the care of a Speech and Language Therapist (SLT). There will be signage above their bed to denote this. Patients awaiting an assessment by Speech and Language Therapist.

Patients requiring assistance includes those with limb weakness, visual impairment, lethargy and general malaise.  Some patients require adapted cutlery to assist them with their feeding, please speak to a member of staff if your patient does not have any on their red tray.

Please inform the nurse in charge if a patient is only eating small amounts or not at all. Check whether the patient’s food intake is being documented on a food chart. This should be completed by a nursing staff, so please inform staff as to what has been taken.

If the patient does not like the meal offered, please inform nurse who will try to source an alternative meal.

Snacks for patients are available in each ward area.  Please ask a member of staff for the options available.

Steps that must be taken when supporting each patient

Pre-procedure

• Explain and discuss feeding with the patient.
• Wash hands, put on green apron.
• Ensure that the patient is comfortable, that is, they have recently been to the toilet. Check there are no unpleasant sights or smells around that may put them off eating.
• Ensure the patient’s hands are clean
• Check that you are positioned in front or to the side of the patient and sat at the patient’s level to assist with feeding.
• Ensure that the patient is sitting upright, preferably in a chair (if it is safe to do so) and at a table. If the patient is not upright, please ask for assistance to move the patient into the correct position.
• Protect the patient’s clothing with a napkin.

Procedure

• Assist the patient to take appropriate portions of food at the correct temperature but encourage self‐feeding. Tailor the size of each mouthful to the individual patient.
• Allow the patient to chew and swallow foods before the next mouthful. Avoid hovering with the next spoonful.
• Avoid asking questions when the patient is eating, but check between mouthfuls that the food is suitable and that the patient is able to continue with the meal.
• Use the napkin to remove particles of food or drink from the patient’s face.
• Ask the patient when they wish to have a drink. Beakers should be readily available to help the patient drink. Assist the patient to take a sip. Support if necessary the glass, cup or beaker gently so that the flow of liquid is controlled, or use a straw if this is helpful. Take care with hot drinks to avoid offering these when too hot to drink.
• If the food appears too dry, ask the patient if they would like some additional gravy or sauce added to the dish.
• Observe patient for coughing, choking, a wet or gurgly voice, nasal regurgitation or difficulty swallowing. If any of these actions are noted call immediately for help, consider sitting the patient upright if appropriate.
• Encourage the patient to take as much food as they feel able to eat, but do not press if they indicate that they have eaten enough.

Remember to adhere to infection prevention and control procedures at all times

Volunteers must at all times maintain high standards of hygiene, confidentiality, dignity and privacy.

If any volunteer feels unsure or uncomfortable at any time, please speak with a member of the nursing team who will listen and support you.

Our Volunteer Charter has been created by our volunteers and our staff. We display our Charter on our wards and we have included a copy below:

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Our Volunteers & Staff Charter

We recognize the important roles that volunteers play in supporting staff and patients in the Trust. We have developed this charter to ensure volunteers and staff show mutual respect and support to each other in the roles they perform to support our patients.

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Training for volunteer feeders includes:

• Infection Control
• Personal hygiene
• Manual handling
• Diet and Nutrition
• Privacy and Dignity
• Food Handling
• Communicating with patient

Policy and Guidelines
The following guidelines will be useful for reference purposes and can be found on the intranet:

• Privacy and Dignity
• Mealtime Guidance
• Infection Prevention and Control

Competencies
In order to help patients who have been identified as requiring assistance with feeding the following competencies must be achieved.

Competency	Date Achieved
Receives appropriate handover from Nursing staff
Greets patient appropriately
Obtains consent to assist with feeding
Positions bed table correctly for height
Assists patient to clean hands/ use hand wipes
Cleans own hands and puts on an apron
Assists with condiments and serviettes
Sits adjacent to patient
Uses appropriate cutlery
Applies appropriate portion sizes on cutlery
Waits for the patient to finish before offering another portion
Wipes/assists the patient to wipe their mouth as required
Offers a drink throughout the meal
Reports to staff those patients who have eaten little or declined food
Reports immediately any patient experiencing difficulties swallowing
Offers the patient the opportunity to clean their hands post meal
Reports to staff the quantity of food eaten
Removes apron and clean hands
Reports effectively any concerns noted whilst caring for the patient
Completed relevant feed training by ward staff
Offering of additional drinks and snacks to appropriate patients

Signed – Ward Manager
Signed – Volunteer

Once signed the Ward Manager and Volunteer Co-ordinator are to hold a copy of these competencies for their records.

Worcestershire Acute Hospitals NHS Trust follow the Royal Marsden Guidance on feeding patients.