Quality standard

Quality statement 5: Dietary advice

Quality statement 5: Dietary advice

Quality statement

Adults, children and young people with renal or ureteric stones are given advice on diet and fluid intake.

Rationale

Renal and ureteric stones are painful and people who have had them want to prevent them occurring again. There are simple changes to diet and fluid intake that can be made to reduce the risk of stones recurring. Ensuring that people know what these changes are will reduce recurrence and the pain caused by stones.

Quality measures

Structure

a) Evidence of local arrangements to provide training to healthcare professionals on the advice they should give to people with renal or ureteric stones about diet and fluid intake to reduce the risk of stone recurrence.

Data source: Local data collection, for example, local service specifications and staff training records.

b) Evidence that information is available for people with renal and ureteric stones that contains advice on diet and fluid intake.

Data source: Local data collection, for example, information leaflets.

Process

Proportion of adults, children and young people with a new diagnosis of renal or ureteric stones who receive advice on diet and fluid intake.

Numerator – the number in the denominator who receive advice on diet and fluid intake.

Denominator – the number of adults, children and young people with a new diagnosis of renal or ureteric stones.

Data source: Local data collection, for example, local audit of patient records.

Outcome

Proportion of adults, children and young people who have had renal or ureteric stones who had further admissions or surgical treatment for a renal or ureteric stone.

Numerator – the number in the denominator who had a further admission or surgical treatment for a renal or ureteric stone.

Denominator – the number of adults, children and young people who have had renal or ureteric stones.

Data source: Local data collection, for example, local audit of patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and secondary care services) ensure that healthcare professionals have the time and resources to provide advice to adults, children and young people with renal or ureteric stones on diet and fluid intake at diagnosis or at a follow‑up appointment.

Healthcare professionals (such as GPs, general practice nurses, urologists, nephrologists, specialist urology nurses and dietitians) give advice to adults, children and young people with renal or ureteric stones at diagnosis or at a follow‑up appointment on how much water to drink, and what to eat and drink, to reduce the risk of getting stones again. They document in the person's notes that the advice was given and what format it was in. They make sure that the person has understood the advice, and tailor the advice on fluid intake if standard advice would put people at risk, for example, if they have heart failure or acute hyponatremia.

Commissioners (such as clinical commissioning groups and NHS England) ensure that services have the capacity and resources to provide advice to adults, children and young people with renal or ureteric stones on diet and fluid intake at diagnosis or at a follow‑up appointment.

Adults, children and young people with a stone in their kidney or ureter are given advice, when a stone is diagnosed or at a follow‑up appointment, on how much water to drink, and what to eat and drink. The aim of the advice is to reduce the risk of getting stones again. Healthcare professionals check whether the person understands the advice given.

Definitions of terms used in this quality statement

Advice on diet and fluid intake

Advice given at presentation or at a follow‑up appointment and before discharge that includes:

  • adults to drink 2.5 litres to 3 litres of water per day, and children and young people (depending on their age) 1 litres to 2 litres

  • adding fresh lemon juice to drinking water

  • avoiding carbonated drinks

  • adults to have a daily salt intake of no more than 6 g, and children and young people (depending on their age) 2 g to 6 g

  • not restricting daily calcium intake, but maintaining a normal calcium intake of 700 mg to 1,200 mg per day for adults, and 350 mg to 1,000 mg per day for children and young people (depending on their age).

[Adapted from NICE's guideline on renal and ureteric stones, recommendation 1.8.1]

Equality and diversity considerations

Adults, children and young people should be provided with information about diet and fluid intake to prevent renal and ureteric stones recurring. They should be able to easily read and understand the information themselves, or with support. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate.