Information for our health care providers

This page has been set-up to support colleagues working in health care provider organisations. Please note this page is under development so please do visit back for updates.

Aseptic technique

This page has been set-up for care home colleagues on aseptic technique. This page is under development sp please come back for further updates.

Catheter care

Catheter hygiene

  • Routine personal hygiene is all that is required to maintain catheter hygiene such as a daily bath, shower or wash.
  • Staff should always wear appropriate PPE, e.g. disposable apron and gloves when providing catheter care.
  • Before putting on and after removing gloves, staff should wash hands thoroughly and dry using paper towels. If none are available, the use of kitchen roll or a clean linen towel for use by the carer only and laundered daily is acceptable.
  • When assisting bathing, showering or washing, ensure the genital area is washed with soap and warm water and the external catheter tube is cleaned in a direction away from the body. Rinse to remove any soap and dry.
  • For females, it is important to wash the genital area from front to back to prevent contamination from the back passage (rectum).
  • The genital area and external catheter tube should also be washed, rinsed and dried following any incontinent bowel movement.
  • Inspect the urethral opening daily for signs of pressure damage and if any damage noted record in the service user’s records and inform the service user’s GP or Nurse.
  • Towels used to dry the genital area and catheter tube should be laundered after each use.
  • If the catheter is blocked or bypassing, contact the service user’s GP

Catheter bags

  • Catheter drainage bags may be body-worn, i.e. leg bag or free standing.
  • For mobile service users, a leg bag should always be used, held in place with an anchoring device and two leg straps to reduce the risk of damage to the urethra/bladder by the catheter/catheter drainage bag being pulled.
  • Move the catheter anchoring device daily, from leg to leg, to avoid pressure damage to the skin and bladder opening.
  • Position the urine drainage bag below the level of the bladder to allow good drainage. Incorrect positioning, even for a short time, is linked to back flow (urine in the tube or bag flowing back into the bladder) and higher rates of infection.
  • The catheter closed drainage system should only be opened for the connection of a new bag, as per manufacturer’s instructions - usually weekly. More frequent changes always increase the risk of infection.
  • Maintenance of a closed system is essential to prevent infection
  • Single use 2 litre night bags should be added for overnight drainage in service users with leg bag systems
  • Catheter bags must be kept off the floor (attach to a stand/hanger).

How to empty a catheter bag

A catheter drainage bag should not be emptied more often than necessary as this increases the risk of infection. However, the bag must be emptied before it becomes completely full, e.g. 2/3rds full, to avoid back flow of urine into the bladder.

  • Where possible, educate and encourage the service user to empty their own drainage bag, ensuring their hands are washed before and after emptying.
  • Staff should always wear disposable apron and gloves when emptying a catheter bag.
  • Before putting on PPE, staff should wash hands thoroughly and dry using paper towels.
  • A separate clean container should be used to empty the urine into.
  • Empty the bag into the container by releasing the drainage tap.
  • Avoid contact between the urine drainage bag tap and the container to prevent contamination and infection.
  • To prevent drips, a clean tissue should be used to wipe the tap after closing the tap.
  • Urine should be disposed of into the toilet.
  • After each use, the container should be washed with detergent and warm water and dried with disposable paper towels
  • Clean hands after removing and disposing of each item of PPE

How to change a catheter bag

Catheter bags, including leg bags, should be changed according to the manufacturer’s instructions - usually weekly. Each change should be documented in the service user’s notes.

  • Staff should always wear disposable apron and gloves when changing a catheter bag.
  • Before putting on PPE, staff should wash hands thoroughly and dry using paper towels.
  • Remove the new bag from its packaging and leave on a clean nearby surface, to reduce the risk of contamination.
  • Remove any leg bag straps.
  • Before starting to change the bag, empty the contents of the leg bag.
  • Remove and dispose of gloves, clean hands again and apply clean gloves.
  • Hold the catheter at the leg bag entry point with one hand to keep the catheter in position, reducing the risk of trauma. Use your other hand to carefully disconnect the leg bag from the catheter entry point. Do not touch the end of the catheter - this will help prevent contamination and infection.
  • Place the used leg bag into a waste bag/bin for disposal.
  • Remove the protective cap from the new catheter bag tube, do not touch the end of the tube. This will help prevent contamination and infection.
  • Insert the leg bag connection point into the catheter securely, avoid touching the catheter at the leg bag entry point or leg bag connection point.
  • Ensure the catheter bag is positioned below the level of the bladder and secure appropriately, e.g. leg bag with straps or on a catheter bag stand/hanger.
  • Clean hands after removing and disposing of each item of PPE
  • Always record the date when the catheter bag is changed.
  • Catheter valves are sometimes used for service users with urological conditions as an alternative to a leg bag. They need to be changed every 5-7 days as per manufacturer’s instructions and as advised by a practitioner, e.g. District Nurse, GP.

Overnight bags
If a person has a leg bag during the day, an additional larger linked drainage bag (night bag) should be used for overnight use. The night bag should be attached to the leg bag to keep the original system intact.

Overnight drainage bags connected to a leg bag should be single use The reuse of overnight bags is unacceptable practice .

Connecting the night bag

  • Staff should always wear disposable apron and gloves when connecting a night bag.
  • Before putting on PPE, staff should wash hands thoroughly and dry using paper towels.
  • Using a new night bag, remove the protective cover from the night bag connection, avoiding touching the connection point.
  • Attach the night bag connection to leg bag outlet point, ensuring it is inserted securely.
  • Open the leg bag tap to allow drainage into the night bag.
  • Ensure both the catheter bags are positioned below the level of the bladder and secure the night bag on the catheter stand/hanger.
  • Clean hands after removing and disposing of each item of PPE

Disconnecting night bag

  • Staff should always wear disposable apron and gloves when disconnecting a night bag.
  • Before putting on PPE, staff should wash hands thoroughly and dry using paper towels.
  • Drain any urine from the leg bag into the night bag and close the tap on the leg bag.
  • Secure the leg bag with straps.
  • Detach the night bag from the leg bag outlet point and the catheter stand/hanger.
  • Empty the night bag into the toilet through the valve or tear strip.
  • Place the empty night bag into a waste bag/bin for disposal
  • Clean hands after removing and disposing of each item of PPE


Taking a catheter specimen of urine (CSU)

A routine catheter specimen of urine (CSU) is not necessary from catheterised service users. A specimen should only be obtained if there are symptoms of a urinary tract infection (UTI).

  • Staff should always wear disposable apron and gloves when taking a CSU.
  • Before putting on PPE, staff should wash hands thoroughly and dry using paper towels.
  • Samples must be obtained from the self-sealing sampling port of the drainage tubing, not from the drainage bag.

Diagram to show how to collect a catheter specimen of urine

The diagram above is courtesy of the Nursing Times

  • Never collect a sample of urine from the drainage bag as this does not represent the microorganisms in the bladder and could lead to over prescribing of antibiotics.
  • Never disconnect the closed system to obtain a urine specimen.
  • Before taking the sample, clean the sampling port with a 2% chlorhexidine in 70% alcohol wipe and allow to dry.
  • Use a sterile syringe to access the sampling port and obtain specimen.
  • Transfer the specimen into a universal container containing boric acid preservative (red top).
  • Wipe the sampling port again with a 2% chlorhexidine in 70% alcohol swab and allow to dry.
  • Dispose of the empty syringe.
  • Clean hands after removing and disposing of each item of PPE.
  • Label the specimen container which should be taken to the GP Practice as soon as possible.

Urinary catheter passport

In Northamptonshire, a ‘Urinary Catheter Passport’ is issued when a person has had a urinary catheter inserted. The use of urinary catheter passports helps to provide continuity of care between health and social care providers in both community and hospital settings.

The Passport is given to the person to show at any GP or hospital appointments and GP or District Nurse home visits.

Please email to request a catheter passport for a resident.

Catheter care best practice

Having a urinary catheter in place increases the risk of a resident developing a urinary tract infection (UTI) as germs can travel along the catheter and into the bladder very easily. Therefore good catheter care is essential to protecting residents from developing a UTI.

Five top tips for good catheter care:

  1. The resident has a UTI
    If the resident is diagnosed with a urinary tract infection and they have a catheter in place – the catheter MUST be changed within 7 days of starting the antibiotics
  2. The catheter is blocked or not draining
    Do NOT try and flush the catheter, this increases the risk of causing an infection by pushing whatever is blocking the catheter into the bladder
    Remove and replace the catheter or contact the District Nursing or GP Practice team to do this
  3. Use a retainer strap to secure the catheter to the patients leg
    This retainer strap or statlock stops the catheter pulling which can cause trauma and then infection
    Change the retainer strap every 7 days and check skin integrity
  4. Do not put the overnight bag on the bed / mattress
    The overnight bag must be BELOW the bladder but off the floor to stop germs draining back up into the bladder from the catheter bag
  5. Use the countywide catheter passport
    This has really useful trouble shooting pages and contact details in it to help you mange patients with catheters
    Contact the NHFT Continence Service to order more catheter passports free of charge


Deterioration, falls and frailty

RESTORE 2 Handbook



  • Early identification of frailty assists those living with frailty to improve short and long-term health
  • 10 days in hospital for someone over 80 means 10 years of aging of their muscles
  • It is important to recognise that someone is living with frailty
  • To prevent unnecessary hospital admission
  • Inform care planning

Identifying frailty - clinical frailty scale

1. Very fit - People who are robust, active, energetci and motivated. They tend to exercise regularly and are among the fittest for their age.

2. Fit - People who have no active disease symptoms but are less than category 1. Often, they exercise or are very active occasionally, e.g. seasonally.

3. Managing well - People whose medical problems are well controlled, even if occassionally symptomatic, but often are not regularly active beyond routine walking. 

4. Living with very mild frailty - Previously "vulnerable," this category marks early transition from complete independence. While not dependent on others for daily help, often symptoms limit activities. A common complaint is being "slowed up" and/or being tired during the day.

5. Living with mild frailty - People who often have more evident slowing, and need help with high order instrumental activities of daily living (finances, transportation, heavy housework). Typically, mild frailty progressively impairs shopping and walking outside alone, meal preparation, medications and begins to restrict light housework.

6. Living with moderate frailty - People who need help with all outside activities and with keeping house. Inside, they often have problems with stairs and need help with bathing and might need minimal assistance (cuing, standby) with dressing.

7. Living with severe frailty Completely dependent for personal care, from whatever cause (physical or cognitive). Even so, they seem stable and not at high risk of dying (within ~6 months).

8. Living with very severe frailty - Completely dependent for personal care and approaching end of life. Typically, they could not recover even from a minor illness.

9. Terminally ill - Approaching the end of life. This category applies to people with a life expectancy<6 months, who are not otherwise living with severe frailty. (Many terminally ill people can still exercise until very close to death).

What do we connect with frailty?

  • Weight loss
  • Weakness
  • Slow walking speed
  • Decreased muscle strength
  • Lots of medicines
  • Older age
  • Multimorbidity
  • Low physical age
  • Falls
  • End of life
  • Self-reported exhaustion
  • Incontinence
  • Malnutrition
  • Immobility

Approach to managing frailty

Fit CFS 1-3

  • Healthy lifestyle
  • Nutrition advice
  • Social prescribing
  • Fire service safe and well check
  • Vaccinations

Mild frailty CFS 4-5

  • Holistic assessment
  • Management of long-term conditions
  • Aids, house adaptations 
  • Mobility - balance class
  • Consider personal hygiene needs and sensory impairment

Moderate frailty CFS 6

  • Comprehensive geriatric
  • Assessment (MDT involved)
  • Medication review
  • Advance care plan

Severe frailty CFS 7-9

  • Advance care plan
  • Review RESPECT & DNACPR discussions
  • Co-ordination of complex care services


Type 2 diabetes in adults: management

This guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood gluocse levels and identifying and managing long-term conditions.

Type 1 diabetes in adults: diagnosis and management

This guideline covers care and treatment for adults (aged 18 and over) with type 1 diabetes. It included advice on diagnosis, education and support, blood glucose management, cardiovascular risk, and identifying and managing long-term complications.

Enteral feeding

Feeding regime 

Supporting patients in the community

  • Enteral tube feeding
  • All people in the community having enteral tube feeding should be supported by a coordinated multidisciplinary team, which includes dietitians, district, care home or homecare company nurses, GPs, community pharmacists and other allied healthcare professionals (for example, speech and language therapists) as appropriate. Close liaison between the multidisciplinary team and patients and carers regarding diagnoses, prescription, arrangements and potential problems is essential.
  • Patients in the community having enteral tube feeding and their carers should receive an individualised care plan which includes overall aims and a monitoring plan.
  • Patients in the community having enteral tube feeding and their carers, should receive training and information from members of the multidisciplinary team on:
    • the management of the tubes, delivery systems and the regimen, outlining all procedures related to setting up feeds, using feed pumps, the likely risks and methods for troubleshooting common problems and be provided with an instruction manual (and visual aids if appropriate)
    • both routine and emergency telephone numbers to contact a healthcare professional who understands the needs and potential problems of people on home enteral tube feeding
    • the delivery of equipment, ancillaries and feed with appropriate contact details for any homecare company involved.

Administering medications


End of Life Care

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment. The ReSPECT process creates a summary of personalised recommendations for a person’s clinical care in a future emergency in which they do not have capacity to make or express choices. 

Such emergencies may include death or cardiac arrest, but are not limited to those events. The process is intended to respect both patient preferences and clinical judgement. The agreed realistic clinical recommendations that are recorded include a recommendation on whether or not CPR should be attempted if the person’s heart and breathing stop.


Epislepsies in children, young people and adults

This guideline covers diagnosoing and managing epilepsy in children, young people and adults in primary and secondary care, and referral to teriary services. It aims to improve diagnosis and treatment for different seizure types and epilepsy syndromes, and reduce the risks for people with epilepsy.


Facts on falls

  • Care home residents are three times more likely to fall than older people living at home
  • Injury rates are much higher for care home residents
  • 1 in 3 people admitted to hospital with a fractured hip live in a care home
  • Falls are costly and believed to cost the NHS £6 million per day
  • Falls are frightening and can affect confidence
  • Everyone has a part to play in reducing the risk

How do you assess the risk of falls?

  • History of falls - increases the risk of more falls - observe monitor and look for patterns to plan care needs
  • Medical conditions - stroke, Parkinson's disease, dementia, epilepsy, high/low blood pressure, heart condition, diabetes- how many of your residents have any of these? Ask GP to review as needed be aware and reduce modifiable risks. Ensure medication given as prescribed at correct time
  • Acute illness - infections, Covid, flu.- Early detection and seek advice, know your residents baseline
  • Pain - observe if pain relief effective, look for signs if resident not able to advise if in pain, check for side effect for pain relief medication
  • Identifying people at low medium or high risk will not reduce falls but addressing modifiable risks can
  • Looking at patterns for an individual to ensure person centred care planning to meet individual needs.
  • Seek the support from a health professional

How do you reduce the risk of falls?

  • Medication.- Medication should be reviewed, look for side effects and advise GP to review
  • Recent broken bones/fractures / do they have osteoporosis. - Consider this if a previous broken bone, refer to GP to review
  • Poor appetite/ poor fluid intake/ weight loss.- Ensure food fluids and snacks fortification of foods, record intake and set fluid target and monitor
  • Foot care - Refer to podiatry chiropody
  • Continence - Are they going more frequently or constipated. Monitor normal for your residents

Other ways to reduce the risk of falls


  • can they walk with an aid, or do they try to get up unaided? 
  • are they unsteady, do they shuffle or lean?
  • does the resident appear to stumble or trip?
  • check footwear to ensure its well fitting and supportive
  • are eyesight glasses clean and the correct prescription?
  • observe and monitor
  • encourage to wait on first standing
  • ensure they are in a high visibility area
  • encourage regular supervised mobility
  • undertake exercises to assist
  • do they need a walking aid is it fit for purpose?


  • even people with cognitive problems may still express they feel dizzy
  • consider checking lying and standing blood pressure
  • ensure your resident is drinking adequate amounts
  • ask them to stand for a few seconds before walking when first getting up
  • do they have a hearing aid they are wearing and does it work?
  • consider ear problems and refer to a health professional


  • are they able to express needs and ask for assistance
  • limitations and poor understanding of space around them
  • consider signage
  • provide reassurance and repeat information, prompts, clear instruction
  • ensure in a highly visible area
  • ensure bedroom is located nearer to staff activity

Look around the environment

  • is the call bell within reach and can the resident use it?
  • consider sensor mats and moving room nearer staff activity
  • ensure lighting is good and replace bulbs, floors are clear and dry
  • mop up spills immediately
  • ensure thresholds between rooms are not raised
  • is equipment needed for transfers? 
  • is the toilet, bed and bath the correct height? 
  • does the resident require stairs or a lift?
  • temperature- do your residents feel the cold?

Individual - person centred

  • Encourage  residents to be active, mobilise safely and make their own life decisions
  • Falls risks are different for each person – work with them to minimise the risk
  • Falls prevention is a ongoing process


  • The elderly have a reduced thirst sensation
  • Unable to communicate
  • Pre- existing medical conditions e.g. Diabetes, Stroke
  • Dementia - may forget to drink
  • Medications – e.g. Diuretics, Laxatives
  • Illness
  • Fear of incontinence due to drinking
  • Cannot physically go and get/make a drink

Urinary Tract Infections

  • Signs and Symptoms: Does the resident have 2 or more of the following as a NEW symptom?
  • Pain and burning on urination
  • Difficulty passing urine
  • Frequency/Cloudy /Smelly urine/Blood in urine
  • Abdominal pain/loin pain
  • Temperature > 38 degrees
  • Shaking/Rigors
  • Increased Delirium/Confusion
  • Obtain urine specimen and notify GP/ANP if these symptoms occur

Tips to Prevent Urinary Tract Infections

  • Fluid trolleys around the home
  • Interesting types of fluids
  • Reduce caffeineEncourage at least 1500mls per day
  • Good personal hygiene
  • Unperfumed soap and no TALCUM POWDER
  • Avoid constipation

Hand hygiene

Hand hygiene

The most important thing you can do to prevent the spread of infection in a care home is to keep your hands clean. This is called hand hygiene

Hand hygiene is essential to reduce the transmission of infection in care home settings. All staff and visitors should clean their hands with soap and water or, where this is unavailable, alcohol-based hand rub (ABHR) when entering and leaving the care home and when entering and leaving areas where care is being delivered.

The How to wash your hands video and Effective hand washing for staff and employees explains how to wash your hands 

What you need for hand hygiene

  • Liquid soap
  • Running water
  • Alcohol based hand rub (also known as ABHR)
  • Disposable paper towels

When hand hygiene should be performed

  • Before touching a resident
  • Before clean/aseptic procedures. If ABHR cannot be used, then antimicrobial liquid soap should be used
  • After body fluid exposure risk
  • After touching a resident
  • After touching a resident’s immediate surroundings
  • Before handling medication
  • Before preparing/serving food
  • After visiting the toilet
  • Before putting on and after removing PPE
  • Between carrying out different care activities on the same resident
  • After cleaning care equipment
  • After disposing of individual’s personal waste
  • After handling dirty linen

It is important that residents are routinely encouraged to perform hand hygiene and given assistance if required.

Before carrying out hand hygiene make sure:

  • Your arms are bare below the elbow
  • You take off all your hand and wrist jewellery (a single, plain metal finger ring is allowed but should be taken off (or moved up) during hand hygiene)
  • Bracelets or bangles which are worn for religious reasons, such as the Kara, can be pushed higher up the arm and secured in place
  • Your finger nails are clean and short
  • You cover all cuts or abrasions with a waterproof dressing
  • You have no artificial nails or nail varnish/products.

The four moments for hand hygiene poster can be used in your care home to show staff when hand hygiene should be done and the reasons why.

Choose the correct product

Liquid soap and water must be used:

  • If your hands look dirty; 
  • If you are caring for a resident who is being sick or having diarrhoea or has diarrhoeal illness such as norovirus or Clostridioides difficile then you must use soap and water for hand hygiene.  Do not use ABHR as it will not work in these cases.
  • Make sure you wet your hands before applying liquid soap
  • Use paper towels to turn off taps if the taps are not elbow operated mixer taps
  • Elbow operated mixer taps are considered to provide the best temperature and flow for optimum hand hygiene and should be considered for any new build, refurbishment or if they need repaired/changed.
  • When you have washed your hands  dry them thoroughly using paper towel and  dispose of the paper towel in a foot operated waste bin.

To make sure you clean your hands properly with soap and water you must follow the steps in the poster  How to hand wash step by step images . This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.

Alcohol based hand rub (ABHR)
Alcohol based hand rub (ABHR) is a gel, foam or liquid containing one or more types of alcohol that is rubbed into the hands to stop or slow down the growth of microorganisms (germs).

If your hands look clean then you can use ABHR for routine care. 

Do not use ABHR if you are caring for a resident who has sickness or diarrhoeal illnesses such as norovirus or Clostridioides difficile.  You must use soap and water as ABHR will not work.

To make sure you clean your hands properly with ABHR you must follow the steps in the poster ‘How to hand rub step by step images ’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.

Skin care

  • Use warm/tepid water to reduce the risk of dermatitis. Avoid using hot water.
  • After hand washing pat hands dry using disposable paper towels. Avoid rubbing which may lead to skin irritation/damage.
  • Use an emollient hand cream during breaks and when off duty.
  • Do not use refillable dispensers or communal tubs of hand cream as these become contaminated.
  • Staff with skin problems should seek advice from Occupational Health Department if available or their GP


When to wear PPE

Reducing unnecessary glove and apron use is more sustainable, protects staff hands from dermatitis and protects patients from cross-infection.

Use this checklist to make sure you are only using disposable gloves and aprons when clinically necessary. 

Do wear gloves and apron to:

  • Care for an infectious person
  • Apply creams
  • Handle soiled sanitary wear and linen
  • Deal with all bodily fluids
  • Dress wounds

Don’t wear gloves/apron to:

  • Replace washing hands    
  • Sit with resident/do activities
  • Serve food
  • Transfer or mobilise service user
  • Write notes - paper form or tablet form

For further information please contact Infection Prevention Control Care Home Team- 0300 027229/07541 645218  


Putting on and taking off PPE

The UK Health Security Agency has created a web page which outlines how to put on and remove PPE 


National infection prevention and control

These documents offer guidance on infection control for NHS healthcare staff of all disciplines in all care settings.

Malnutrition and nutrition

Malnutrition can be caused by either insufficient or excess eating, which can lead to complications. In this context we are referring to insufficient or under nutrition.

Older people are more at risk of malnutrition which can be a multitude of reasons, such as: medical conditions that affect the ability to eat and drink, reduced ability for self-care, frailty, and a risk of reduced cognition. The British Association of Parenteral and Enteral Nutrition (BAPEN) have identified that over 3 million people living in the community are at risk of malnutrition and that 1 in 4 people admitted to care homes are identified at high risk.

The outcome of reduced eating and drinking can cause the elderly to feel weak putting them at a higher risk of falling, reducing their ability to heal from infections and wounds and resulting in a low mood.

The key to ensuring the elderly have optimal nutrition status is identifying malnutrition early and treating accordingly. NICE guidance advocates that all residents admitted to a care home should be screened on admission and reviewed with appropriate nutrition support plans in place. 

The following sections are designed for care home staff to get an overview of malnutrition for care home residents including information on nutrition screening, care planning and how to refer to the local dietetics service.

Nutrition screening

The MUST tool, developed by BAPEN is the validated tool we use within the care home setting to identify malnutrition. The acronym MUST stands for Malnutrition Universal Screening Tool. The MUST score can be transferred from setting to setting and used regardless of age, sex or medical condition. The tool can be completed by any professional with the appropriate training. It is simple to complete, and, in the community, it looks at only 2 indicators- the person’s BMI and change in weight over the last 3-6 months. The tool looks at the outcome of a person’s ability or inability to eat and drink sufficiently.

Top tips:

  • Ensure the height of the person is accurate, it may be necessary to re-measure as height changes with age
  • If you have an unusual  weight from the previous measure, it may be inaccurate, therefore re-weigh
  • People who struggle to mobilise and are weak may not sit or stand well on the scale.

Locally the Nutrition and Dietetic Department in Northamptonshire have developed an on- line training package with 6 modules that care home staff can complete individually providing the necessary skill to complete the MUST screening tool. It is free to register and can be accessed at any time, please email

The BAPEN website provides direction on how to complete MUST and there is an online calculator that can generate the score once the height, weight and weight loss are entered.

Care planning

Once the MUST screening tool has been completed and the level of risk identified, a care plan can be developed to meet the needs of the resident. To make a plan that will work for the individual it is important to understand the following:

  • Food preferences
  • Dining preferences
  • Medical conditions requiring dietary adaptions
  • Dentition and ability to swallow
  • What support is required- assistance with setting up the meals, support or full assistance with eating and drinking.

When developing a care plan, it is important to have a good knowledge of how you can optimise a resident’s diet through food first dietary changes to make it more nourishing. These may  include nourishing drinks, using a little and often approach with high energy and protein snacks and food fortification. The sections below have more information.

Top tips:

  • For people that struggle to communicate, use pictures either on paper or an electronic device to identify preferences.
  • It is beneficial to have resident’s preferences easily accessible during the mealtimes as this will help staff to quickly understand what food and drink to offer.
  • Locally the Nutrition and Dietetic Department in Northamptonshire have developed an on- line training package with 6 modules that care home staff can complete individually providing the necessary skill to understand what is an appropriate plan of care. It is free to register and can be accessed at any time, please email

Guidance on menu development

It is a CQC regulation (14) that all care homes provide adequate nutrition and hydration. This can be achieved with a menu that provides sufficient nutrients for all care home residents and is the cornerstone of good nutrition. The NACC is a membership organisation, comprising of care suppliers and providers that provides guidelines and guidance on food service. 

For residents who are scored at high risk (according to the MUST tool), the core menu may not be sufficient, and it is the responsibility of the care home to offer additional foods and fluids. This can be achieved by fortifying foods on the menu and providing nourishing snacks and drinks between meals. On average the snacks and drinks should provide a minimum of 300kcals and have a source of protein. This is the first line diet approach when a resident’s nutrition score has changed, and it is the care homes responsibility to implement.

Top tips:

  • Breakfast can be the best meal of the day for elderly so offering a cooked item such as eggs, sausage, lentils will provide a good source of protein. Offer baked products such as pastries, croissants, and crumpets as energy dense options in addition to toast.
  • Offering a supper before bed can improve a resident’s intake as it can be a long time between tea and breakfast the next day.

Locally the Nutrition and Dietetic Department in Northamptonshire have developed an on- line training package with 6 modules that care home staff can complete individually providing the necessary skill to implement food fortification and nourishing drinks and snacks. It is free to register and can be accessed at any time, please email

Community dietetic support

A nutritional review may be required for some residents and the criteria for referral into the dietetic service is as follows:

  •  Following MUST 2 or above when all attempts on fortifying and improving food and fluid intake have been exhausted and there is continued weight loss unless resident is nearing end of life.


  •  If anyone is admitted to the care home on any type of nutritional supplement from hospital or community.

There are some residents that have a low BMI; however, are stable at their weight and have not been able to gain weight or it is not realistic to.

They will score a MUST of 2; however, it is not necessary to refer to the dietitian. The care home should continue with a robust nutritional care plan consisting of additional food and drink with and between meals and to provide the support the resident requires to complete meals as able. The aim is to deter further frailty and weight loss and optimise meal intake.

Care homes should refer directly to the dietetic department and inform the GP that a referral has been made. The GP surgery does not need to make this referral as this could cause unnecessary delays. The department accepts referrals made through the NHFT dietetics website 

A five-day food and fluid record is required and should be attached to the referral. Should the care home require a food record template, it is available on the website.

Once the referral has been received, it will be triaged and should there be evidence that the food first application has not been started or the resident has low weight but no weight loss, the referral will be rejected with guidance sent to the care home. If accepted, it may take up to 20 days to conduct the dietetic review which will be by telephone.

The dietetic staff will provide guidance on the most appropriate plan of care. If criteria is met for nutritional products on prescription, the dietetic staff will go over with the care  home staff what the options are, with agreement on the supplement that would best suit the resident. The aim is to be on the supplement for a short period of time, until the resident can transition back to meeting nutrition with the meals. The dietetic staff will write to the GP and the surgery will then issue the prescription. It is best to liaise with the chemist on  flavours to ensure the resident will enjoy the supplement and to derive the maximum benefits.

 Top tip:

  • Reviews will take approximately 15-20 minutes per resident and the dietetic staff will call either mid-morning or late afternoon to work around the care homes busy time periods.

Locally the Nutrition and Dietetic Department in Northamptonshire have developed an on- line training package with 6 modules that care home staff can complete individually providing the necessary skill to refer appropriately to the dietetic staff. It is free to register and can be accessed at any time, please email

To find out more about our service please take a look at the Dietetics page on the NHFT website wherethere is a care home section.

Nutrition support for adults

This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.


Obesity:identification, assessment and management

This guideline covers identifying, assessing and managing obesity in children (aged 2 years and over), young people and adults.

Medicines management

Managing medicines in care homes

National Institute for Health and Care excellence (NICE). Managing medicines in care homes, Social care guideline [SC1].

This guideline covers good practice for managing medicines in care homes. It aims to promote the safe and effective use of medicines in care homes by advising on processes for prescribing, handling and administering medicines. It also recommends how care and services relating to medicines should be provided to people living in care homes.  

National Institute for Health and Care excellence (NICE). Giving medicines covertly. A quick guide for care home managers and home care managers providing medicines support.

The British National Formulary (BNF) describes the uses, doses, safety issues, medicinal forms and other considerations involved in the use of medicines.

The electronic medicines compendium (emc) contains up to date, easily accessible information about medicines licensed for use in the UK, including patient information leaflets (PILs).

Care Home Advice Pharmacy Service (CHAPS) documents can be accessed via the Northamptonshire Integrated Care Board (NICB) website.

Mouth care

Mouth care

Helping residents to have good mouth care can reduce the risk of chest infections and hospital admission due to pneumonia

The McKenzie Center provides ten steps to brushing your teeth on its website including a diagram

Resident’s dentures must be cleaned twice a day. There is further information about how to clean dentures, including a diagram and downloadable factsheet on the Dental Health Services website

For further information please contact Infection Prevention Control Care Home Team- 0300 027229/07541 645218        


Successful management of UTIs

Successful management of UTIs requires a coordinated focus on prevention, early and accurate diagnosis, and appropriate treatment. If left unmanaged, UTIs can lead to severe infection, sepsis and in some cases death.

  • Antibiotics can be lifesaving, but antibiotics are not always needed for urinary symptoms. It is important for people to only take antibiotics for a UTI if they are needed. This is because taking antibiotics can cause side effects, for example nausea and diarrhoea and can damage the ‘friendly’ bacteria that normally live in the intestinal tract and the skin and protect us from infection.
  • Taking antibiotics when they are not needed can also make the bacteria that cause infections to become resistant to that antibiotic, meaning that the antibiotic might not work if it is needed for a true infection in the future.
  • Antibiotics should only be taken if a healthcare professional prescribes them for that infection. Antibiotics should always be taken as directed on the medicine label.
  • A healthcare professional may prescribe a short course of antibiotics if a UTI is confirmed. Three-day courses of antibiotics are usually effective for women, but a longer course is needed for men or those with a urinary catheter

People at risk of the impacts of a UTI

  • UTIs and catheter associated UTIs are one of the leading causes of E. coli and Gram-negative bloodstream infections and are a significant cause of death and serious illness, especially amongst the older population.
  • Older adults are more likely to be admitted to hospital with a UTI.
  • To ensure an accurate diagnosis in older adults, avoid using urine dipsticks to check for a UTI, as they become more unreliable with increasing age. This is especially true for adults living in care homes and those with a urinary catheter.
  • These groups are at greater risk of having bacteria present in the bladder/urine without an infection. This “asymptomatic bacteriuria” is not harmful, and although it causes a positive urine dipstick, antibiotics are not beneficial and may cause harm.
  • In some cases, a specimen of urine is sent for laboratory testing to inform which antibiotics are needed for treatment.

Identifying a UTI

Urinary tract infections (UTIs) affect the urinary tract, including the bladder, urethra, or kidneys. Sometimes a urinary tract infection can develop into a severe infection that can cause a person to become very ill and they may then need to go to hospital.

What are the symptoms of a UTI?
A person with a UTI may have signs and symptoms including:

  • Needing to pee more frequently, suddenly, or more urgently than usual.
  • Pain or a burning sensation when peeing.
  • Needing to pee at night more often than usual.
  • New pain in the lower tummy.
  • New incontinence or wetting themselves that is worse than usual.
  • Kidney pain or pain in the lower back.
  • Blood in the pee.
  • Changes in behaviour, such as acting agitated or confused (delirium). This could be a symptom of a UTI but could also be due to other causes, which need to be ruled out.
  • General signs of infection, like a fever, a high temperature or feeling hot and shivery, with shaking (rigors) or chills.
  • A very low temperature, below 36°C.
  • A person may experience fewer of these symptoms if they have a urinary catheter.

Preventing UTIs

  • Support those in your care to drink enough fluids. Regular drinks, like water, boost hydration. The NHS Eatwell Guide recommends that people should aim to drink 6 to 8 cups or glasses of fluid a day. Water, lower-fat milk and sugar-free drinks, including tea and coffee, all count.
  • Sometimes people don’t like to drink as they are worried about getting to the toilet. If someone you care for is less able to access the toilet, ensure they are provided with support to do so at regular intervals, so that they feel confident to keep well by drinking enough. If needed, a continence professional can support with a continence assessment.
  • Help might include choosing the right type of drink that they like, at the right temperature, in the right kind of cup or glass.
  • Support those you care for to keep the genital area clean and understand the importance of personal hygiene, showering daily where possible, especially if they suffer from incontinence.
    • Check and change incontinence pads often. If they are soiled, they should be changed right away.
    • Wipe from front to back when they go to the toilet.
    • Avoid using irritating products such as scented soaps, gels, and sprays around the genital area.
  • Avoid the use of urinary dipsticks to diagnose UTIs in older adults and those with urinary catheters as they are unreliable. In some cases, a specimen of urine is sent for laboratory testing to inform which antibiotics are needed for treatment

What should you do if you think someone you care for has a UTI?

Contact a healthcare professional, this could be the local GP, a senior nurse, the community pharmacist, walk-in centre or NHS 111 service if you think someone you care for may have a UTI.

How to avoid a UTI posters for carers

How to avoid a UTI poster (A4) - black and white[pdf] 547KB

How to avoid a UTI poster (A4) - colour [pdf] 545KB

Wound care

This page is under dveleopment. Please check back shortly