The Value of Working in Partnership with Care Homes to Provide a Unique and Sustainable Approach to Malnutrition

Transcription

1 The Value of Working in Partnership with Care Homes to Provide a Unique and Sustainable Approach to Malnutrition A presentation delivered by: Vittoria Romano, Registered Dietitian & Catherine Blanchard, Registered Dietitian

2 Aims & objectives Aim: To demonstrate the impact of the Food First Project s training programme on improving the quality of nutrition and hydration provision across care homes in Luton, Bedfordshire and Hertfordshire Valley. Objectives: To outline the reason for change. To showcase the Food First Project s achievements. To discuss the challenges encountered. To explore the future.

3 Introduction to the team

4 The Food First Project timeline 2009 Food First are commissioned by Beds PCT to reduce inappropriate prescribing of oral nutritional supplements (ONS) The GULP dehydration risk screening tool was developed. January- May 2012 The team won an award for Leadership at the Advancing Healthcare Awards. December 2012 The team won the East of England Award for the Hydration Swapper resource. December 2015 Commissioned by Hertfordshire Valley CCG to roll out the project. November 2010 Creation of the Food First care home award scheme Project extended to Luton PCT and additional commissioning to support prescribing of specialist infant formulas. June- August 2012 All older people care homes receive monthly contact from dietetic service with an open referral policy for clinical dietetics. March 2013 NHS England awarded Food First a 100,000 research grant to run a regional trial to evaluate the effectiveness of the Food First project. October 2016 Paediatric Specialist Dietitian has joined The Food First Project. We are now a team of 11!

5 Care home audits Unique 14 standards training (updated package April that 2016) focuses including: on behaviour & culture change Documentation. within care homes prioritising the importance of nutrition Screening and on hydration. admission. The Units Food of height First team and weight. work in line with Care Quality Commission (CQC) Gathering (2015) of Regulation monthly weights. 14: Meeting nutritional and hydration needs. Calculation of MUST. Two audits carried out each year (certificate review and 6 th month Care plans. interim). The team provide support with any standards not Oral achieved. nutritional supplements. Communication of service user needs.

6 Food First achievements 60% Raised the profile of dietetics within our NHS trust, the CCGs and local authorities. Since This Food has First led certificate to dietitians standards invited were to revised service in April user and 2016, stakeholder 60% care homes forums currently and hold the extension a certificate. of the training and education programme to >80 Hertfordshire Valley care homes.

7 Food First achievements 2009, 50% of care homes were using MUST and 25% of care homes were not using any nutritional screening tool. January 2011 to December service users were referred to the Food First Team. July to December % of service users referred for dietetic assessment were already prescribed Oral Nutritional Supplements. + 6 months + 1 year Now 100% of care homes in Luton and South Bedfordshire use MUST. 82% of service users had gained or maintained their weight on food alone. July to December % of service users referred were already on Oral Nutritional Supplements. C. Forbes et al. (2015)

8 Food First achievements Comparison to the East of England 2015 Number of service users at risk (medium and high) of malnutrition are similar across Bedfordshire and East of England. 50% less usage of ONS in Bedfordshire compared to the east of England. Reduced usage of ONS across Bedfordshire has not on service user s malnutrition risk.

9 Baseline in Herts Measure Correct Incorrect Not Documented Unable to Assess BMI 58% 16% 26% - Weight Change (Kg) 9% 40% 37% 14% % Weight Loss 11% 11% 66% 12% Total MUST Score 54% 11% 30% 5% Weight measurements: 89% of service users had a weight measured within the last 2 months. Care plans: 85% of service users had a nutritional care plan. 10% of service users had no nutritional care plan. 79.7% of care plans assessed were not in enough detail to pass Food First audit standards. Oral nutritional supplements (ONS): 17% of service users were prescribed ONS. Of these; 67% were not under the care of a Dietitian. *(Data collected from 78 homes containing 3155 service users).

10 Summary of service The Food First Programme required to: Provide training and auditing to older people care homes within Herts Valley CCG. Review any residents prescribed ONS that are not under a dietetics service. KPI s: 50 service users to be reviewed per month. 70% of inappropriate prescriptions of ONS to be stopped. 90% of care homes to be engaged with the project. 60% of care homes to be trained. To support and engage with GPs within area. Year 2 to report on clinical outcomes and achieve 10% of care homes certified. To be provided by: 0.1 WTE Band WTE Band WTE Band 4

11 Comparison with 1 year

12 Social Diffusion Theory Source:

13 6 Month Outcome Data (July 16-Feb 17) Pre-outcome data: Collected from 89 service users (excludes 45 who had passed away and 3 who moved out of area). Approximately 80% of service users required just 1-2 reviews (excluding outcome review). Almost 90% of ONS was stopped at the first contact. Over 40% had a MUST score of 0. Just over 20% had a MUST score of 1. 50% were receiving fewer calories per day than a standard primary care initiated prescription of 2 bottles per day. Reason why prescription was started was unknown in >70% of service users.

14 6 Month Outcome Data (July 16-Feb 17) Post outcome data: Almost 80% of service users met weight goal. Approximately 75% of service users maintained or gained weight at the 6 month follow up. 50% of residents MUST score was the same. Approximately 35% had improved ( MUST score lowered). No significant difference was seen between falls, pressure ulcers and hospital admissions.

15 Challenges High staff turnover: Regular in house training. Senior staff contact us to train new starters. Care homes engagement with the project: CQC regulation 14 Meeting nutritional and hydration needs. Food first certificate is recognised by local authorities in Luton and South Bedfordshire. Additional support; care homes can refer residents directly to our service. Keeping the project interesting. Emphasising low cost and readily available options for fortifying foods and drink. Varying literacy and numeracy levels: Training uses simple numeracy and literacy skills. Aides like calculators and hand outs. Technology: Computerised records not always calculating MUST correctly Reliance of Oral Nutritional Supplements (ONS): Comparison of nutritional content on nourishing drinks with ONS.

16 The Future Shaping the STP s Prevention Falls Digitisation - Health call self management and attending to people in need Resilient primary, community and social care certificate, CQC, Integration with local authorities where homes consistently fail to meet standards, community pharmacists for rapid intervention when ONS started without dietetic input Sustainable secondary care services develop malnutrition pathway across county

17 Any Questions??

18 References Food First- Food First Team (SEPT) South Bedfordshire Telephone: , Fax eories4.html C. Forbes et al. (2015) Nutritional outcomes of care home residents 6 months after Food First advice. Journal of Human Nutrition & Dietetics