Preventing Under-nutrition in Hospitals and Aged Care - Melbourne 2016

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Juliet Fisher
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1 QRC: 2631 Price One Day : $451 inc. GST Two Days: $671 inc. GST Date Mar 2016 Venue Hotel IBIS - Therry Street Therry Street, Melbourne, VI, 3000 CPD Hours 11 Hours 0 Mins Preventing Under-nutrition in Hospitals and Aged Care - Melbourne 2016 Nursing Conference Need for Program Evidence suggests that under-nutrition and malnutrition are strongly linked to poor patient or resident outcomes and even death. National Standards have been introduced to improve the management of nutrition. All nurses have a duty of care to ensure appropriate nutrition is provided. Failing to establish a culture where nutrition is supported and prioritised may prove very costly to both patient and organisation. There are many adverse patient outcomes that can be prevented through proper food and fluid intake. These include: infections; fractures resulting from falls; wound and skin breakdown, and delayed healing. Reducing length of stay, readmission rates and improving patient satisfaction are also tied to good nutrition. Formal CPD that introduces nursing strategies to reduce under-nutrition and malnutrition is needed to reduce the burden of this preventable cause of poor health outcomes. Purpose of Program The purpose of this conference is to improve patient, resident and organisational outcomes by enhancing nurses knowledge about latest evidence-based strategies to prevent under-nutrition and malnutrition across all health settings. Learning Outcomes At the conclusion of this program it is expected that the participants will be able to: Identify how the pathophysiology of under-nutrition and malnutrition may cause detrimental patient outcomes, and initiate preventive action Combine best evidence with clinical expertise to appropriately select nutritional interventions that are aligned with patient preferences

2 Promote an organisation-wide culture that prevents unplanned weight loss resulting from malnutrition Build rapport with interdisciplinary team to deliver holistic healthcare in a collegial manner that is conducive to shared values and patient satisfaction Program Schedule Day One 8:30AM Registration for Day One 9:00 Kathryn Marshall Poor Nutrition = Poor Outcomes - A Quality and Safety Concern? Safety, quality and nutrition have not traditionally been thought of as one. However, this session will explore how failure to provide adequate nutrition in healthcare is strongly linked to poor patient outcomes. Includes: How big a problem is under-nutrition and malnutrition in healthcare? What Standards exist and are they being complied with? How does this relate to accreditation? How is quality and safety linked to nutrition? 9:45 Sandra Iuliano-Burns In Sickness and in Health...What Happens to the Body? Nutrition is intrinsically linked to our health and our wellbeing. In times of health, the body is very effective at regulating metabolism. But what happens if the body is under-nourished or malnourished? This session explains the physiological changes that occur in a person who is malnourished and will help you understand why its effects are so concerning. Includes: How does the body normally meet its energy needs? What happens to metabolism when a person is malnourished or under-nourished? How can undernutrition and malnutrition cause a cascade of catastrophic effects e.g. infections, fractures and impaired wound healing? 10:30 Morning Tea Sandra Iuliano-Burns Recognising Malnutrition - Giving it the Attention it Deserves? Traditionally, the mention of malnutrition may conjure up images of diseases such as scurvy and rickets. However, under-nutrition and malnutrition is a modern problem plaguing our community and found in healthcare settings across the country. This session includes:

3 What is the difference between malnutrition, under-nutrition and sarcopenia? How are these conditions screened? Who is most at risk for developing sarcopenia? Which tools are most effective at identifying those at risk of unplanned weight loss e.g. MNA? 11:45 Sandra Iuliano-Burns Feeding Dependence and Malnutrition - What's the Connection? The relationship between feeding dependency and malnutrition is important to consider in a range of settings, particularly Residential Aged Care Facilities (RACF). This session explores the issue of feeding dependency and asks whether feeding assistance is the only solution. Includes: Are nutritional outcomes poorer in residents who have a feeding dependency? What about portion control? How can nutrition be improved in patients with a feeding dependency? What are the solutions and does this always have to involve extra staffing? 12:30PM Lunch Break 1:30 Kathryn Marshall Hungry in Hospital The introduction of the EQuiP National Standards has shone a new light on nutrition in hospitals. Many patients are already undernourished on admission to hospital, often due to their underlying illness. Alarmingly, the potential for exacerbation during their stay may be significant. This session looks at how malnutrition can manifest in a hospital setting and considers strategies to prevent its occurrence. Includes: Everyone's responsibility - How has screening for malnutrition changed? How does illness affect the body's energy requirements? What causes someone to lose weight during a hospital admission and what can be done to address this? What is the impact of malnutrition on healthcare resources? How can attitudes towards the provision of food be prioritised by staff? 2:15 Dr Jenny Gowan Should I Give this Tablet? A Look at Medicines and Nutritional Deficiencies The relationship between medicines and malnutrition is complex. Some medicines may have a negative effect on nutritional status, whilst others may reverse this effect. This session looks at a range of medicines and disease-related factors that affect nutrition and includes: Can some medicines be a cause of nutritional deficiencies and when is supplementation required? Does unplanned weight loss affect the safety and efficacy of some medicines? How do disease-related factors affect a person's ability to take oral medications? What guidance is available for giving oral tablets and capsules in people with a swallowing disorder?

4 3:15 Afternoon Tea 3:30 Dr Tim Crowe Delayed Wound Healing and Malnutrition - Partners in Crime? The burden of delayed wound healing is having a significant impact on healthcare systems across Australia. It is understood that the effects of under-nutrition or malnutrition on wound healing is particularly destructive. This session takes a close look at the evidence that links good nutrition to improved patient and organisational outcomes relating to wound healing. Includes: How does under-nutrition relate to delayed wound healing? Do people with special diets or food allergies have an additional risk? Is nutrition for chronic wounds different to that for acute wounds? What is the evidence for nutritional supplements and are they effective? 4:15 Close of Day One of Program Day Two 9:00AM Commencement of Day Two 9:00 Maria-Irini Avgoulas Curry, Souvlaki, Sushi, Spaghetti and Chips - Cultural Considerations Is there anything more off-putting than being served a plate of food that you have never eaten before when your appetite is poor? Good nutrition appreciates a person s cultural values and practices relating to food. This session considers how integrating culture with nutritional interventions leads to better outcomes. Includes: How does cultural naivety in healthcare settings lead to under-nutrition? How can you tailor meals to suit everyone s cultural values? Respecting patient preferences - the key to success? 9:45 Kate Fetterplace Foods in Tubes - Enteral and Parenteral Nutrition Nutritional support, in the form of enteral nutrition (EN) or parenteral nutrition (PN) may be indicated for a range of reasons in order to ensure adequate nutrition. This informative session will review the current evidence regarding best-practice enteral nutrition and includes: Psychosocial implications of EN and PN Should all under- or malnourished patients receive EN? What about PN? How should nasogastric tube placement be checked? What guidelines exist for the management of PEG tubes in RACF? What formulations are suited to which people and what about rates of delivery?

5 Troubleshooting for blocked tubes and safety considerations 10:45 Morning Tea 11:15 Sarah Gilliland Addressing Malnutrition in People with Cancer Patients with cancer are at high risk of malnutrition and the consequences of this are significant from both a patient and an organisational point of view. This session provides a range of evidencebased practical strategies to address malnutrition in people with cancer. Topics to be covered include: What causes malnutrition in patients with cancer? What are the consequences of malnutrition? What strategies have been shown to be effective? What is the role of the multidisciplinary team? 12:00 Sharon Er Improving Oral Nutrition - Solutions for People Following Stroke Achieving effective food intake following a stroke is known to improve patient outcomes. This has many benefits including faster rehabilitation and fewer demands on an organisation s resources. This session looks at nursing and allied health strategies that avoid under-nutrition and malnutrition and its cascading effects on those who have experienced a stroke. Includes: How big a problem is under-nutrition and malnutrition post stroke? What are the potential causes of under-nutrition in this group of people? How do stroke-related factors such as dysphasia impair the intake of nutrients? What is the evidence for patient-centred nutritional interventions and what are they? How is nutrition incorporated into the ACSQHC Acute Stroke Clinical Care Standard? 12:45PM Lunch Break 1:45 Zoe Youl Simple Solutions - Practical Nursing Considerations As nurses are responsible for caring for the whole person, we are in a great position to enact simple but significant changes that can improve the mealtime experience. Key to this is the development of a culture that values nutrition and understands how nutritional outcomes lead to improved patient outcomes. This session looks at a range of practical solutions: Mealtime setup - dentures, glasses, utensils and crockery Documenting food charts Mealtime time-outs - minimising interruptions How do you create culture that values nutrition and encourages collaboration between interdiscliplinary teams? knowledge

6 advocacy protocols 2:30 Julie Orr Liquid Supplementation and Oral Nutrition in Older People As we age, the ability to eat safely and effectively may be diminished. In addition, certain diseases, such as dementia, increase caloric requirements. Whilst supplement use must not replace a proper diet, they may be required to enhance food intake. Appropriate selection and use of oral supplements is crucial if cost-effective care is to be administered. Includes: When may nutritional supplements be needed? How are they chosen? What are practical tips for ensuring patients consume them? What is the cost of oral supplementation and how do you know they are working? 3:15 Afternoon Tea 3:30 Julie Orr Would You Eat That? An Interactive Menu Review Have you ever looked at the plate of food in front of your patients and residents and been utterly disgusted? Would you want to eat what's on their tray? Did you know that there are Standards in place that require regular reviews of menus? This final session will walk you through a review of a hospital and residential aged care menu. You will look at whether the menu is providing nutrition and consider: What does this menu look like on a plate? Have flavour and texture been optimised for a palpable eating experience? What nutrients are sufficient and what are lacking? Is this menu worthy of your patient? 4:15 Close of Day Two of Program Presenters Sandra Iuliano-Burns Dr Sandra Iuliano-Burns (PhD) is a researcher at the University of Melbourne based at Austin Health. Her work focuses on the benefits of improved nutrition on falls and fracture risk in the elderly, especially those in aged care. Her current trial involves 60 aged-care facilities throughout metropolitan Melbourne and regional Victoria and it is providing valuable insight into the rates of malnutrition in the elderly in aged care, the causes, effects and potential remedies.

7 Kathryn Marshall Kathryn is an Accredited Practising Dietitian with over 20 years experience in clinical dietetics and is currently working at Royal Melbourne Hospital as a Senior Dietitian. Previously Kathryn has worked at Peter Mac as the project dietitian for the state-wide Malnutrition in Victorian Cancer Services project where she has overseen two point prevalence studies across Victoria and as the nutrition lead for the original Better Care for Older People toolkit in Kathryn has recently completed a Masters in Public Health (Monash University) and was a recipient of the VHA Allied Health Post Graduate Oncology Scholarship in Jenny Gowan Jenny, a practicing pharmacist, is a teaching associate at Monash University, Melbourne. She is a member of the PSA Branch committee, the Expert Group for Therapeutic Guidelines Respiratory, an editorial board member of AUS-DI, SHPA "Don t Rush to Crush", and the Guidelines Committee for the Australian Asthma Handbook (AAH). Jenny is an accredited consultant pharmacist who conducts her own company, which focuses on medication reviews in the home and aged care facilities, plus education, writing, training, and consultation. Jenny works regularly in community pharmacy plus sessions in a GP clinic at a Community Health Centre. She has published over 350 educational articles. Jenny has presented talks at many Australian and international conferences to GPs, nurse practitioners, nurses, podiatrists, pharmacists, and other health professionals. In 2013, she was awarded the Australian Pharmacist of the Year by the Pharmaceutical Society of Australia and, in 2016, the AACP-MIMs Australian Consultant Pharmacist of the Year. Tim Crowe Tim Crowe is a nutrition academic within the School of Exercise and Nutrition Sciences, Deakin University, and is also an Advanced Accredited Practising Dietitian. He teaches in nutrition and dietetics in the areas of nutritional physiology and biochemistry as well as the applied role of nutrition in disease prevention and management, particularly obesity, diabetes and cancer. He is actively involved in several areas of nutrition research, including specialised nutrition in the prevention of surgical complications, malnutrition identification and nutrition support in wound healing. Maria-Irini Avgoulas Dr Maria-Irini Avgoulas is currently employed at La Trobe University in Melbourne, Australia and holds the role of Associate Lecturer /Deputy Course Advisor - BHSc: Public Health and Rehabilitation Majors in the School of Psychology and Public Health. Maria-Irini is also part of The Food for Life, Health and Performance Research Group; The Sport, Exercise and Rehabilitation and Building Healthy Communities (RFA) at La Trobe University. An affiliate member of the Emerging Research Group on Language and Wellbeing at Deakin University. Dr Avgoulas is a Academic Member of ATINER - Athens Institute for Education and Research in Athens, Greece and a member of Polydromo Group, which is based in the Faculty of Education of the Aristotle University of Thessaloniki, Greece. Maria-Irini's previous clinical experience includes several years of working in health (acute hospital settings and in-patient psychiatry). Kate Fetterplace Kate Fetterplace is a Senior Dietitian at The Royal Melbourne Hospital and specialises in critical care nutrition and nutrition support. She graduated from Monash University in 2005 with a Bachelor of Nutrition and Dietetics and is currently completing a Master of Applied Science (Research) at La Trobe University. Kate has over 10 years' experience in the area of nutrition support and specialises is Parenteral Nutrition and management of critically ill patients. Kate has a passion for research and improving patient care and is currently undertaking a research project titled Targeted Full Energy and Protein Delivery in Critically ill Patients: A randomised control trial. Sarah Gilliland Sarah Gilliland is a Senior Clinician Dietitian for the Head and Neck Services at Peter MacCallum Cancer Centre.

8 Zoe Youl Zoe Youl is a Critical Care Registered Nurse, Nurse Planner and Event Education Manager at Ausmed Education. In this role, she manages Ausmed's Event Education Team which coordinates the content development for Ausmed's 300+ conferences and seminars run nationally around Australia for nurses and midwives. Before commencing at Ausmed Education, Zoe worked as a Critical Care Registered Nurse in Intensive Care at a large private hospital in Melbourne. She values the ability of education to enable personal and professional growth, is a passionate teacher and has experience as a Sessional Academic teaching undergraduate nursing students. Zoe is a member of the Australian College of Nursing (ACN), the Australian College of Critical Care Nurses (ACCCN), the Australian Nurse Teachers Society (ANTS) and the Association for Nursing Professional Development (ANPD). She holds a postgraduate qualification in Clinical Nursing (Intensive Care) and is currently undertaking a Master of Nursing (Leadership and Management). Zoe was recently appointed the Victorian Branch Representative of the ANTS National Committee. Zoe is committed to improving the health and lives of all people through the development of effective and meaningful education whilst also promoting the impact of unique nursing roles. Julie Orr Julie Orr is a Senior Dietitian at Leading Nutrition, an aged care specialist dietetic consulting organisation. Julie has developed extensive aged care knowledge and experience during her 10 years at Leading Nutrition. She is a passionate aged care dietitian who is keen to assist in the prevention and treatment of malnutrition in aged care. Sharon Er Sharon Er is currently the stroke and neurology unit dietitian for Western Health at Sunshine Hospital.

Center for Quality Aging

Center for Quality Aging Nutritional Issues in Long-Term Care: Research Findings and Practice Implications Sandra F. Simmons, PhD Associate Professor of Medicine, Vanderbilt VA Medical Center, GRECC Goals