Last year, as part of continence awareness week, University Hospitals of Leicester NHS Trusts (UHL) adult continence team launched their ‘taste the difference challenge’. The team worked collaboratively with ward staff and housekeepers in Leicester’s Hospitals, to promote and offer decaffeinated tea and coffee to inpatients across the trust. The campaign aims were to educate staff and patients about the benefits of switching to decaffeinated tea and coffee for a healthy bladder and gathering patient feedback (e.g. could patients taste the difference, and would patients make the switch to decaffeinated once they knew the health benefits). 

How does caffeine irritate the bladder? 

Caffeine is considered a mild diuretic, increasing blood flow to the kidneys and increasing the amount of fluid and sodium filtered in the renal cortex, resulting in increased urine production. It also stimulates the detrusor smooth muscle and lowers the threshold of the bladder filling phase resulting in increased urinary frequency and urgency (Jura et al, 2011).  

It is suggested that stopping or reducing caffeine to under 100mg per day (one cup of percolated coffee) can reduce urinary urgency and nocturnal enuresis (Le Berre et al, 2020). 

Why is switching to decaffeinated tea and coffee a good idea? 

Apart from reducing overactive bladder symptoms such as urinary urgency, there are other health benefits including: 

• Reduction in sleep disturbance and insomnia 
• Reduction in tachycardia and palpitations 
• Helping to prevent dehydration and headaches 
• Reducing indigestion 
• Lowering risk of osteoporosis (caffeine may prevent absorption of calcium) (NHS inform, 2021).  

The UHL continence team launched a ‘taste the difference challenge’ following an acute ward based pilot project, which was experiencing an increase in inpatient falls related to toileting. In UHL, falls associated with toileting equate to 1:4 (between 2020-2021) and research suggests a high correlation between falls and lower urinary tract symptoms in hospital (Roggeman et al, 2020). 

What did the project involve? 

The pilot considered a holistic approach to falls related to toileting and continence. After observations of care and talking to staff, it was identified that decaffeinated drinks were not routinely offered during drinks rounds. Staff did not know the benefits of switching to decaffeinated tea and coffee, such as reducing urinary urgency which could potentially reduce a person’s risk of falls. 

We asked housekeepers to proactively offer patients decaffeinated tea and coffee, and patient feedback indicated that most patients could not taste the difference. A resource pack was also developed for the ward which included coasters, posters and patient information leaflet to explain the benefits and promote decaffeinated tea and coffee (figures 1, 2, 3 and 4).

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5. Sarah with the patient feedback form.

What was found during the challenge? 

During the challenge, the team collated nearly 700 pieces of patient feedback (figure 5) which included over 50% of patients saying they could not taste the difference and over 76% patients reporting they would switch to decaffeinated once they knew the health benefits. 

A recommendation was made to the trusts chief nurse and executive board to consider making decaffeinated tea/coffee served as default with caffeinated tea and coffee remaining as an alternative option for patients. The trusts leadership team decided to support the initiative and on 14th February 2022, the switch to serving decaffeinated tea and coffee was launched. Importantly, this meant whilst promoting the health benefits of decaffeinated hot drinks as standard, the choice for patients to choose caffeinated drinks would still be there. 

Feedback from patients after the launch of decaffeinated tea and coffee 

Patients attending UHLs outpatient continence clinic with an overactive bladder, who have switched to decaffeinated tea or coffee, have asked whether their urinary symptoms have improved.  Results indicate 63% of patients reported an improvement in overactive bladder symptoms. 

One month after the trust launch of decaffeinated tea and coffee, the continence team visited each ward and spoke to housekeepers and nursing staff for feedback on how the switch to decaffeinated drinks was received by patients. Overwhelmingly, feedback was positive. Most patients could not taste the difference, and some hospital staff reported to switching to decaffeinated themselves, having learnt of the health benefits.   

Caffeine withdrawal 

Out of approximately 10,000 patients, just nine complained of caffeine withdrawal over a four week period.  Withdrawal symptoms can include headaches, fatigue, low energy, irritability, anxiety, poor concentrations, depressed mood and tremors (Ogeil and Philips, 2015). The severity of these symptoms will depend on a person’s normal levels of caffeine consumption, and it is up to the patient whether they continue caffeine cessation at this point. For patients aiming towards cessation, but are struggling to manage withdrawal symptoms, a caffeine reduction plan is suggested.  

There are different methods available to help patients reduce or stop their caffeine intake whilst minimising caffeine withdrawal effects, including exercise to increase mood and alertness and keeping a journal of caffeine intake (Behling and Winters, 2021).  

In the absence of any standardised caffeine reduction plan, ward staff were provided with a patient leaflet suggesting a reduction of caffeine intake by half a cup a day, over a seven-day period, until the patient is drinking less than five caffeinated drinks a week, and then at this point to trying to stop.  Alternatively, Evatt et al (2016) suggests a five-week caffeine reduction strategy, consuming 75% of their normal caffeine in the first week, 50% in the second week, 25% during the third week, 12.5% during the fourth week, and as little as possible in the fifth week. 

Reduction in inpatient falls 

An early review of Datix incident reports since the roll-out of decaffeinated tea and coffee, has shown a 30% reduction in the number of falls occurring on the way to the toilet. Whilst it has not been established if there are any other variables contributing towards this reduction, it is important to highlight that switching to decaffeinated tea and coffee will reduce urinary urgency, therefore reducing the risk of rushing to the toilet is likely to reduce patients' risk of falling. 

What is next for the challenge? 

The ‘taste the difference challenge’ has since been trialled in another community hospital trust and following their own challenge in Memory Cafés for people living with Dementia, Age UK in Leicestershire now serve decaffeinated tea and coffee in their Memory Cafés. 

The ‘taste the difference challenge’ is a simple and fun way to promote decaffeinated tea and coffee, and can be transferred to any hospital, community group or residential care home setting. The potential benefits of switching to decaffeinated products in any environment could be significant and include improving a person’s health, potentially reducing falls, and improving patient dignity through lower continence pad usage. The UHL continence team hope to share the benefits with other organisations or groups who might be interested in taking part in their own challenge. 

 

A shorter version of this article was first published by Bladder and Bowel UK https://www.bbuk.org.uk/