1 Nutritional aspects of Hospital Accreditation – Zorgnet-Icuro

Hospital Accreditation in Flanders

Vera De TroyerDominique VandijckKatleen ValtinJohan Hellings

Q & S Department Zorgnet-Icuro

Schaarbeek, February 27th 2016

2 Nutritional aspects of Hospital Accreditation – Zorgnet-Icuro

Some points before I start:

• Hospital accreditation cannot be seen split from the other quality initiatives

• A framework to embed quality through the whole organisation

• Direct link between the inspection model of the Flemish Government and Accreditation (see next slides)

• Indicators must be useful for professionals and instruments to objectify the quality of care (‘as is’-situation)

Situation in Flemish department Belgium

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An integrated and pro-active approach to work on Quality and Safety

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Situation in Flemish department BelgiumThe situation today…

• 59 general hospitals (n = 63) have chosen for

accreditation

• 7 general hospitals accredited• 2 NIAZ-hospitals: Jessa (Hasselt) and St.-Lucas (Brugge)• 5 JCI: UZ Leuven (Leuven), AZ Groeninge (Kortrijk), Jan Yperman

(Ieper), AZ Sint-Blasius (Dendermonde) en UZA (Antwerpen)

• 52 hospitals in preparation• 25 hospitals have chosen for Joint Commission International (JCI)• 33 hospitals have chosen for NIAZ

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S

Y

S

T

E

M

Situation in Flemish department BelgiumSplit between two different kinds of inspection:

• System inspection = inspection of the implemented quality system:eg. Process for identification checks patient identity

• Announced (every 4 years)

• Preceeded by a self assessment

→ Accredited hospitals with an ISQua-accreditedorganisation by the end of 2017 are exempted

• Inspection of compliancy → For all hospitalseg. Number of patients with a correct wrist band (2 identifiers)

• Unannounced

• Differentiated → Care paths (2013: surgical care, 2015: medicineservices, 2016-2017: cardiology)

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Hospital Accreditation - definition

A self-assessment and external peer

assessment process used by health care

organizations to accurately assess their level

of performance in relation to established

standards and to implement ways to

continuously improve.”

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Julia, 83 years old

• Admission because of hip fracture• Antecedents:

• type II diabetes with insulin injections• Lives in a home care facility• Widow

8 Nutritional aspects of Hospital Accreditation – Zorgnet-Icuro

Paul, 68 years old

• A very active grandfather• Admission because of a

stroke incident• No medical antecedents• Allergic to citrus fruits• Actual problem:

difficulties withswallowing

• Lives together with his wife

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Nutritional aspects of hospital accreditationAssessment of patients

• Q-mentum (NIAZ): The team accurately andappropriately assesses its clients

• The team assesses the clients physicalhealth → which elements? Medicalhistory, allergies, medication profile, health status, and nutritional status andspecial dietary needs

• JCI: AOP.1.4 Patients are screened fornutritional status, functional needs, andother special needs and are referred forfurther assessment and treatment whennecessary

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Nutritional aspects of hospital accreditationAssessment of patients → How do we do that?

… Some guidelines or recommendations are provided

For example, the initial nursing assessment form may contain basic criteria for a nutritional screen, such as five or six simple questions with a numerical score relating to recent decline in food intake, weight loss during the past three months, mobility, and the like. The patient’s total score would then identify a patient at nutritional risk requiring a more in-depth nutritional assessment.

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Nutritional aspects of hospital accreditationAssessment of patients → How do we do that?

… Expectations about qualifications of professionals

In each case, the screening criteria are developed by qualified individuals able to further assess and, if necessary, to provide any required patient treatment.

For example, screening criteria for nutritional risk may be developed by nurses who will apply the criteria, dietitians who will supply the recommended dietary intervention, and nutritionists able to integrate nutritional needs with the other needs of the patient.

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Nutritional aspects of hospital accreditationNutrition therapy

On initial assessment, patients are screened to identify those patients who may be at nutritional risk. These patients are referred to a nutritionist for further assessment. When it is determined that a patient is at nutritional risk, a plan for nutrition therapy is developed and carried out. The patient’s progress is monitored and recordedin his or her record. Physicians, nurses, the dietetics service, and, when appropriate, the patient’s family, collaborate to plan and to provide nutrition therapy. 1. Patients assessed at nutrition risk receive nutrition therapy.2. A collaborative process is used to plan, to deliver, and to monitor

nutrition therapy.3. The patient’s response to nutrition therapy is monitored and

documented in the patient record.

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Nutritional aspects of hospital accreditationFood choices in hospital

A variety of food choices, appropriate for the patient’s nutritional status and consistent with his or her clinical care, is available.

1. A variety of food choices or nutrition, consistent with the patient’s condition, care, and needs, is regularly available.

2. Prior to patients being fed, all inpatients have orders for food in their records.

3. The order is based on the patient’s nutritional status and needs.4. The distribution of food is timely, and special requests are met.5. When families provide food, they are educated about the patients’

diet limitations.

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Let me show you some pictures

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Or another route …

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Nutritional aspects of hospital accreditationA few questions

• The transport and storage of food?

• Do we have guarantees about the storage and transport before thefood comes into the hospital?

• What about the temperature (not to warm or to cold)?

• What about sanitation? Is it clean enough?

• Are there requirements about light, moisture, ventilation?

• Is the storage environment dry enough?• Who is responsible for nutrition storage in the hospital? In the central

kitchen? On the ward? In the patients rooms? • What is the responsability of the patient and his family?• Which checks are essential? Which are desirable?• Which service do we want to provide?

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Nutritional aspects of hospital accreditationStorage and preparation … some requirements

The organization prevents contamination of food, linen, equipment, devices, and supplies.

• Staff and service providers store, prepare and handle food appropriately• The organization stores and handles linen, supplies, devices, and

equipment in a manner than protects them from contamination.• Staff and service providers use aseptic techniques when preparing,

handling, and delivering vaccines, parenterally administered medications, total parenteral nutrition, and diagnostic media.

• The organization follows national and international safety guidelines on work restrictions for staff or service providers with transmissibleinfections.

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Nutritional aspects of hospital accreditationStorage and preparation … some requirements!

The hospital reduces the risk of infections associated with the operations of food services.

Improperly stored and prepared food can cause illnesses, such as food poisoning or food infections.

1. The hospital stores food and nutrition products using sanitation, temperature, light, moisture, ventilation, and security in a manner that reduces the risk of infection.

2. The hospital prepares food and nutrition products using proper sanitation and temperature.

3. Kitchen sanitation measures are implemented to prevent the risk of cross contamination.

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Nutritional aspects of hospital accreditationWhat do want to achieve?

How far do we want to go? Just an inspiring example

https://www.youtube.com/watch?v=hWBTwwoiU8U

• Patients can choose what they want to eat (and at what time)

• Does it fit with the nutritionalneeds or diet restrictions?

• Patients can eat together with theirfamily

• Patients can choose where andwhen they want to eat

• Delivery after max. 45 minutes• Patients eat better and there is less

waste• …

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Nutritional aspects of hospital accreditationSuccessful Discharge of patients

Returning to Julia and Paul

As arrangements for discharge may take some time, the assessmentprocess and planning process are initiated as soon as possible after admission.

For example• a newly diagnosed Type 1 diabetic patient will need education related to diet

and nutrition and insuline injections• a patient admitted for an acute myocardial infarction may need cardiac

rehabilitation following discharge, as well as nutritional instruction.

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Don’t forget the other challenges for you

There are also other standards that apply to you

• How do we guarantee that all care givers have theappropriate skills and education?

• Do you have a job description? Do you know it? How do you/they evaluate how well you fulfill your job responsibilities

• Do you know the strategic goals of your organisation? How does your work fit into these goals?

• What is the policy about hand hygiene?

…

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Some points to conclude

• Nutrition is one of human basic needs and extremely important when people get ill (and/or in the prevention of diseases)

• Accreditation is a hospitalwide phenomenon! Not only the quality department is in charge!

• If we want to deliver good care, we have to work together with all professionals

• Also the dietician is in charge for the quality of care!• Please… don’t be a solo player…

→ Recommendation to network and share best practices, experiences or points you are struggling with → This is a great platform!

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Success!Vera De Troyer Vera.detroyer@zorgneticuro.beTwitter: @veradetroyer

https://www.uhasselt.be/patientsafety#tabs7