Implementing NICE Clinical Guideline 32 Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. By supporting staff in care homes we achieved improvements in nutritional management of patients and the reduction in the number of Health Care Professionals consultations for these patients.
Aims and objectives
(1) Elia M, Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007 (public expenditure only). In Elia & Russell; Combating Malnutrition: Recommendations for Action. A report from the advisory group on Malnutrition led by BAPEN. page 39-46. 2009. BAPEN.
(2) Stratton RJ, Green CJ, Elia M. Disease-related malnutrition: an evidence-based approach to treatment. Oxford: CABI publishing; 2003.
(3) Russell CA, Elia M. Nutrition Screening Survey in the UK and Republic of Ireland in 2011: Hospitals, Care Homes and Mental Health Units. 2011. BAPEN.
Reasons for implementing your project
How did you implement the project
'MUST' was then implemented across the 5 care homes by a dedicated nurse supported by the care home medicines support team. This included monthly nutritional screening of all residents along with initiation and review of nutritional management plans as appropriate. Nutritional management plans included monthly screening for all residents, food fortification strategies for medium risk, and food fortification and oral nutritional supplements for residents at high risk according to 'MUST'. Referrals were made to a Dietitian if no improvement was seen in a resident after 4-6 weeks. The plans were very similar the guidelines within 'Managing Adult Malnutrition in the Community' produced by a multi-professional consensus panel published in 2012 (www.malnutritionpathway.co.uk). In addition care home staff were also educated on providing the nutritional management plans and kitchen staff were provided with food fortification training.
By designing and planning the project and including all key stakeholders from the outset, this, ensured the success of the project. The main barrier faced during the project was reluctance by GPs to stop or start oral nutritional supplements (ONS) for those patients when it was appropriate to do so. One reason for this is that the medicines management team in the PCT were previously working with GPs to reduce the prescribing costs of ONS which led to some GPs being unwilling to prescribe. Our care home support technician visited these GPs to explain the rationale behind the request for ONS and in every case this resulted in the patient receiving appropriate treatment.
- Increase of patients screened (from around 35% to 100%)
- Increase in frequency of nutritional screening
- Residents identified at high risk managed more effectively
- Reduced hospitals admissions by around 40%
- Reduced infections requiring antibiotics by around 30%
- Reduced Pressure ulcers by around 55%
- Reduced GP contact by around 3%
- Reduced Health care professionals contact by around 25%
Through undertaking the base line audit and re audit after implementing the NICE guidance we were able to show a cost saving per resident which would also show an improvement in quality of life and care.
The audit data is due to be presented at the ESPEN Congress in September 2013 and we plan to write up the data for full publication later this year. An executive summary can be found under the supporting material.
Key learning points
- Plan your project including timelines and outcomes
- Involve key stakeholders from the beginning to ensure 'buy in'
- Be realistic in your goals
- Monitor effectiveness through audit
- Share results with key stakeholders
- Think about how you will sustain any positive results
Using one dedicated nurse and one dedicated care home support technician helped to ensure consistency and also meant that there was very little issue with problems such as staff turnover and screening calculation inaccuracies.
Nutricia worked collaboratively with CHCP CIC care home medicines management support team Hull, to support the process of developing, setting up and implementing the nurse led service for identifying and managing malnutrition in local care homes