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Why does malnutrition matter?

Why does malnutrition matter?. Improving Nutrition ….. Improving Care. Dr Alastair McKinlay NHS Grampian. Malnutrition Matters. It is common Its is treatable Improving nutrition has benefits for patients and their quality of care and safety. Ignore malnutrition and it will bite you.

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Why does malnutrition matter?

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  1. Why does malnutrition matter? Improving Nutrition ….. Improving Care. Dr Alastair McKinlay NHS Grampian

  2. Malnutrition Matters • It is common • Its is treatable • Improving nutrition has benefits for patients and their quality of care and safety. • Ignore malnutrition and it will bite you.

  3. 10,044 individual patients • 9668 age over 18 years with a MUST score • Medium risk malnutrition 14% • High Risk 21% • Total 34% Malnutrition is common BAPEN Nutrition Week Survey 2010

  4. By Country • England 35% • Wales 33% • NI 38% • Scotland 27% • By admission: • Emergency 39% • Elective 24% • Not known 34% BAPEN Nutrition Week Survey 2010

  5. Summary – • Malnutrition is still common • Associated with illness • The isolated, elderly etc

  6. 148 Homes in the UK • 1010 residents • 857 with MUST Scores • Medium risk 15% • High risk 23% • High and Medium risk 37% Care Homes: BAPEN Nutrition Week Survey 2010

  7. By Country: • England 37% • NI 31% • Scotland 45% • Overall 37% Care Homes: BAPEN Nutrition Week Survey 2010

  8. 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

  9. Cost: • Malnutrition is associated with poorer outcomes: • Higher length of stay • Higher Mortality • Reduced Healing of bed sores • Reduced quality of life? • Not known

  10. 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

  11. 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2003 • 2010: All Health Boards had improved • Current status – unclear • They remain published – They have not been rescinded

  12. 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 The Integrated Program for Improving Nutritional Care (INCHP) :

  13. Health Facilities Scotland.

  14. 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." Health Facilities Scotland.

  15. The Scottish Government established the Care Commission Now Social Care and Social Work Improvement Scotland) In 2002 to regulate care services. • Ongoing work regarding nutrition in care homes. • National report "Eating Well in Care Homes for Older People“ • published 2009 Working with care homes.

  16. 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)

  17. Improving Nutritional Care Programme Priorities • "Making Meals Matter“. • Self-management (long-term conditions). • Improving Transitions: between hospital and community. • Achieving Sustainability.

  18. 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 1: Making Meals Matter: Improving ward processes.

  19. Aim: to ensure that 95% of patients receive the support they require to eat and drink at mealtimes. • Led by NHS Ayrshire and Arran • Progress: • Volunteers recruited and trained. • Risk mitigation processes established. • Evaluation undertaken. • Risk assessments completed. • Testing currently underway. Case Study 2: "Making Meals Matter": volunteers at mealtimes.

  20. 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 Lanarkshire • Progress: • Patients being supported to develop their own care plans. • Introduction of the MUST screening tool. Case study 3: Helping people with long-term conditions to self manage their nutritional care.

  21. 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. Case Study 4: Improving transitions between care home and hospital.

  22. 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.

  23. Thank you

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