I M P R O V I N G N U T R I T I O N … . . I M P R O V I N G C A R E .
D R A L A S TA I R M C K I N L AY
N H S G R A M P I A N
Why does malnutrition matter?
Malnutrition Matters
It is commonIts is treatableImproving nutrition has benefits for patients and
their quality of care and safety.
Ignore malnutrition and it will bite you.
Malnutrition is commonBAPEN Nutrition Week Survey 2010
10,044 individual patients
9668 age over 18 years with a MUST score
Medium risk malnutrition 14%
High Risk 21%
Total 34%
BAPEN Nutrition Week Survey 2010
By Country England 35% Wales 33% NI 38% Scotland 27%
By admission: Emergency 39% Elective 24% Not known 34%
Summary –
Malnutrition is still common Associated with illness The isolated, elderly etc
Care Homes:BAPEN Nutrition Week Survey 2010
148 Homes in the UK1010 residents857 with MUST Scores
Medium risk 15%
High risk 23%
High and Medium risk 37%
Care Homes:
BAPEN Nutrition Week Survey 2010
By Country: England
37% NI
31% Scotland
45% Overall
37%
In previous studies :
Malnutrition unrecognised in 66% Most areas now use
MUST MUST is only of value if
it is completed correctly And if it is acted upon
Cost:
Malnutrition is associated with poorer outcomes: Higher length of stay Higher Mortality Reduced Healing of bed
sores Reduced quality of life?
Not known
Financial Costs
BAPEN Estimates (UK): £13 billion per annum – NHS / Social Care Scotland - £1.3 billion
Not all can be recovered If we saved 10% → £130 millon 1% → £13 million NICE estimates fourth largest cost–saving area
What have we achieved in Scotland?
Food, Fluid and Nutritional Care Standards 2003 2010: All Health Boards
had improved Current status – unclear
They remain published – They have not been rescinded
The Integrated Program for Improving Nutritional Care (INCHP) :
Established in 2007. AIM: to support NHS staff to
introduce the Nutritional Care in Hospitals Standards.
Nutrition Champions: Major contribution to implementing
new practice An effective, informal network
Health Facilities Scotland.
Health Facilities Scotland.
Publication of national catering and nutritional services specification “Food in Hospitals”.
Commissioned the NUTMEG system to allow the nutritional analysis of menus.
Introduction of self-assessment tool to monitor progress of "Food in Hospitals."
Working with care homes.
Ongoing work regarding nutrition in care homes.
National report "Eating Well in Care Homes for Older People“
published 2009
The Scottish Government established the Care Commission
Now Social Care and Social Work Improvement Scotland)
In 2002 to regulate care services.
NHS Education for Scotland (NES)
NES has developed educational resources.
“Nutritional Care and Fluids” module for Foundation Level Doctors. Part of the "DOTS"
system. Will also be accessible
via the Nutritional Care website
(www.nutritioncare.scot.nhs.uk)
Improving Nutritional Care Programme Priorities
"Making Meals Matter“.Self-management (long-term conditions).Improving Transitions: between hospital and
community.Achieving Sustainability.
Case Study 1:
Making Meals Matter:
Improving ward processes.
Aim: to improve the effectiveness of mealtimes for 95% of patients in test areas
Led by nutrition champions and ward staff in NHS Greater Glasgow and Clyde and NHS Fife.
"Making Meals Matter" pack developed including poster, outlining key elements of effective mealtimes.
Making Meals Matter pack will be made widely available.
Case Study 2:
"Making Meals Matter": volunteers at mealtimes.
Aim: to ensure that 95% of patients receive the support they require to eat and drink at mealtimes.
Led by NHS Ayrshire and ArranProgress:
Volunteers recruited and trained. Risk mitigation processes
established. Evaluation undertaken. Risk assessments completed. Testing currently underway.
Case study 3:
Helping people with long-term conditions to self manage their nutritional care.
Aims : 80% of people with COPD attending pulmonary rehabilitation clinic to demonstrate an increased knowledge and understanding of nutrition. Led by NHS Forth Valley and NHS
LanarkshireProgress:
Patients being supported to develop their own care plans.
Introduction of the MUST screening tool.
Case Study 4:
Improving transitions between care home and hospital.
Aims: to improve communication relating to nutritional care in 95% of people being admitted to or discharged from care homes. Led by NHS Grampian
Progress: Identified test sites, Development of communication tool
to record nutritional information at the point of admission and discharge.
Summary
Sustainability remains a significant challenge Integrating nutritional care into day to day practice Developing new ways to motivate and interest clinical
teams Effecting change
Change is often difficult to see: Acorns do become oaks Individual Brush strokes can produce a big picture.
Thank you