Sometimes the best ideas are the simplest ones…

July 7, 2017

One of the joys of writing these blogs is to raise awareness of examples of good practice to readers, to illustrate particular approaches in real practice, hopefully provoking thought as well as action. This week’s blog, still inspired by the sunshine and warm climate, returns to hydration.

No validated hydration screening tool available

Unlike the widely used malnutrition screening tool MUST, there is no validated screening tool for risk of dehydration, and no standard assessment to identify the level of support needed to drink. A simple and quick hydration screening tool that can be used in all care settings would be of great use, particularly when considering that dehydration is associated with adverse consequences such as increased risk of falls.

This led Naomi Campbell, Hydration Nurse Specialist and Chair of the National Hydration Network, to develop the ‘Reliance on a Carer (ROC) To Drink’ tool as part of her hydration work for Peninsula Community Health CIC.

ROC is a simple risk assessment tool that aims to reduce the risk of dehydration by systematically identifying the level of support needed to assist and encourage a person to drink.  ROC identifies the level of basic care needed to drink based on two critical points:

  1. Assistance needed to drink (considering both swallow ability and the physical assistance needed to lift/hold a drink safely to the mouth
  2. Encouragement needed to drink adequate fluids

ROC uses a RAG (red, amber, green) traffic light system to simply identify whether a service user requires a high, medium or low level of hydration care, and their level of dehydration risk. Service users can then be given a red, amber or green drinks coaster and placemat as a prompt to remind staff, at a glance, the level of support they require and identify those needing extra hydration care. Where ROC has been used in practice, care home staff have also found other ways to highlight the assessment tool colour rating, like using different coloured glasses or putting a coloured water drop sign discretely on the door of an individual’s room to aid communication across the whole care team.

User feedback obtained for ROC (as part of a wider  project to promote hydration in care homes from the Kent Surrey Sussex Academic Health Science Network) suggested that this was a readily accessible tool to help care homes assess the support required for an individual to safely drink, and their potential risk of dehydration.

Service users should be actively encouraged to drink

Although it may be considered that ‘assistance’ would be the main issue with hydration in care homes, in fact many service users may be reluctant to, or simply forget to, drink, often due to fear of incontinence. The need for encouragement to drink should be recognised even for a service user who is otherwise fully independent.

The important issue of malnutrition in the elderly has, in the past, largely been focussed on hospital food and nutritional status, particularly in hospital settings, with hydration often being less considered. However it is important, rain or shine, to keep hydration in mind, and ensure we consider it in the nutritional care of our service users.

More details of ROC are available from Simple Measure a not for profit social enterprise funded by Peninsula Community Health CIC

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Ayela Spiro

Nutrition Science Manager, British Nutrition Foundation


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