Wellbeing
such as breakfast cereals with milk, soup, fruit and vegetables.
which recommends 1.5 litres of fluid. There should also be increased provision when the weather is warm, for example, as this affects hydration.
Individualised care
Care actions are specific, measurable and achievable when they are person specific. A simple exercise that can dramatically improve hydration is to consider the size of the glasses that residents are drinking from. Moving from a 150 ml cup to a 280 ml mug, for example, can almost double consumption. The Food Standards Agency recommends a daily intake of six to eight glasses of water or other fluids.
As hydration is only partially covered in care training, care home staff will require more in-depth education and awareness for their role. As it stands, training beyond the simple induction is not mandatory, so disparities in practice can still occur.
Hydration should not be over complicated. It is best to keep hydration policy brief but relevant, ensuring that staff read the key documents and reports in this area so that their knowledge ticks all the right boxes. It is important to select the right training and then link the training to protocols and procedures. It should be relevant to both staff and residents. Until there is an accepted mandatory standard of hydration training, ensuring these steps are taken is absolutely vital.
Whether training is delivered online or face to face, key information provided should include the context with relevant statistics on hydration and dehydration. Those undertaking training should also understand what hydration is in the most basic terms and what dehydration can mean for the body.
Protocols and procedures should be clear so that staff are aware of each resident’s fluid goal and how much fluid is contained in different glasses and cups. When establishing goals, generic guidelines may be taken from documents such as Eating Well for Older People,5
A simple exercise that can dramatically improve hydration is to consider the size of the glasses that residents are drinking from
It is essential that staff are aware of the guideline amounts of fluid required for adequate hydration, the key symptoms and signs of dehydration and the causes and risk factors. Staff must also understand the steps that should be taken to screen, monitor and intervene in a way that is centred on and specific to each individual.
Education
There are many sources of information that can give staff insight into hydration. Key organisations such as the National Association of Care Catering (NACC) and the Health Foundation can provide useful guidance.
It can be difficult to assess hydration, and many people do not realise that they are dehydrated as they have become so used to feeling below their best. If the care staff are themselves showing signs of dehydration, they may be less able to spot dehydration in residents. One way to prevent this issue from arising is to implement a “no drink, no meeting” staff hydration policy. It is crucial to make hydration easily accessible for staff members too, not just in staff rooms but across the entire care home.
It can often be difficult to assess hydration, and many people do not realise that they are dehydrated as they have become so used to feeling below their best
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A further element in applying good practice is to educate and involve residents so that they understand the benefits of being well hydrated. This means involving them in training and in the designing of protocols, remembering to keep these relevant to each individual. A succinct A5-sized leaflet can be used to include the most important details in a clear and appealing manner. Resident education is often overlooked and it is therefore unsurprising that they can be unaware of how important it is to stay hydrated. The individual choices made each day can greatly improve levels of hydration. For example, moving to a different brand of tea can make a big difference. For individuals who are not able to access drinks themselves, making hydration accessible is key. This can be done by ensuring that regular check ups and support to facilitate drinking are incorporated into care approaches; this should include hourly or half hourly checks, especially for individuals who can only manage small sips.
Accessible hydration for those who are mobile is also essential. There are many drink solutions that are attractive and appropriate, such as dispensers, carafes and jugs that can be placed in accessible areas, such as outside lifts or in lounges. Alternating coloured jugs in rooms is a simple way to monitor hydration levels, as well as using water bottles with easy suction, which are easy for residents to hold and use. It is essential that drinks are accessible at all times. Residents can be provided with
www.thecarehomeenvironment .com • May 2017
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