County Durham and Darlington NHS Foundation Trust places cookies on your computer to improve our website. These cookies don't collect information that identifies a visitor and are all anonymous.� They are used to measure its performance and to provide enhancements to you while using the site. To find out more about the cookies we use, see our privacy policy. Close
High Contrast

How does F4 supports patients’ nutrition and hydration needs during their hospital stay?

Assessment and monitoring:

Every patient is weighed and screened for their risk of undernutrition (weight loss) within six hours of admission. This is then repeated on a weekly basis.

For patients who are identified to be at risk of undernutrition:

  • A leaflet 'eating to meet your nutritional needs in hospital' is given to the patient and/or carer.
  • A coloured magnet with the F4 symbol is placed by the patient's name on the name board outside the ward bay. This informs healthcare staff the patient requires additional snacks and drinks.
  • A food chart magnet with a red edge is also placed by the patient's name. This informs staff the patient requires their food and fluid intake to be monitored for four days. It also informs staff that some patients may require assistance or support with meals. After four days the magnet may be removed if the patient is eating an average of over three quarters of their meals.
  • Healthcare staff will monitor the patient's food and fluid intake on record charts at the bottom of the bed for four days. Following a review, these may be stopped or continued. The patient and their carers/friends can also complete the food record charts.
  • If the patient receives their meals on a red tray, this informs healthcare staff the patient requires support/encouragement at mealtimes. All patients with a red tray will have food record charts completed during their hospital stay.

Dietary treatments:

All patients who are identified at risk of undernutrition will receive additional nourishing snacks, fortified milkshakes and fortified dishes every day to help them achieve their nutritional requirements and improve their nutritional health:

  • When the patient is given their menu card to choose their meals, at the bottom next to the F4 logo a box will be ticked. This is completed by the healthcare staff. This informs both the catering staff and healthcare staff that the patient requires additional snacks and drinks.
  • At lunch and supper the patient will always receive the fortified soup and fortified dessert options identified on the menu card by F4 in the diet code area. These dishes contain extra calories and nutrients to ensure every mouthful the patient eats is full of nourishment.
  • If the patient would like the orange juice or an additional dessert, they can identify this on the menu card so both options will be provided.
  • Two nourishing snacks will be provided to the patient to eat between meals. At lunchtime the patient's tray will also include a mousse (75g) to eat during the afternoon. At supper the meal tray will include a small snack such as a scone, malt loaf, cake, cheese and biscuits.
  • Two fortified milkshakes (125mls) will also be provided on the lunch and supper trays to enjoy between meals. 


  • It is important for patients to drink adequate amounts while in hospital. If a patient becomes dehydrated it can affect their health and prolong their hospital stay.
  • It is important for patients to try to drink at least eight cups of fluid daily. This can be any type of fluid (not alcohol).
  • To support patients to achieve their fluid requirements, during every drinks round two drinks will be offered, both a cold drink (a sugar free fruit drink) and a hot drink (tea and coffee). It is important that patients try to drink both of these drinks to improve their hydration.
  • If a patient is identified at risk of undernutrition, choosing nourishing drinks can help boost their nutritional intake as well as hydration. For example:
  • One cup of milky coffee (latte) provides the same calories as eight cups of tea
  • One glass of fortified milkshake (125mls) provides the same calories as 18 cups of tea

'I would like to thank all the staff for my treatment and their professionalism.'

Patient, Cardiology Department, Bishop Auckland Hospital