HEALTHCARE DELIVERY Key recommendations


BAPEN outlined a number of recommendations, following the publication of the fourth annual Nutritional Screening Week (NSW) report: • Patients or residents admitted to all institutional care settings should be screened using a validated screening tool such as ‘MUST’ and repeat measurements made at intervals according to care settings, using accurate and reliable instruments.


• Scales on all wards and in all care settings should be calibrated annually.


• Staff involved in nutritional screening should be trained and be competent to undertake screening and implement care plans.


• The results of nutritional screening should be linked to care plans, which may vary according to local resources and policies.


focusing on hospital food. “We also need the new executive


agency, ‘Public Health England’, to make malnutrition among patients, the elderly and the vulnerable, the focus of an early awareness campaign, and the National Commissioning Board to develop clear outcome measures to monitor prevalence of malnutrition and the quality of nutritional care that is provided.” Anne Holdoway, chair of the


Parenteral and Nutrition Group of the British Dietetic Association, welcomed the Government’s acknowledgement of the importance of good food and nutrition for patients in hospital, ensuring that patients get the right nutrition and that it is ‘personalised’. She said: “Registered dietitians are leading on many initiatives across the UK and collaborating with catering teams and healthcare professionals to ensure that hospital diets are nutritious and appropriate for the diverse patient groups. “Sadly patients are still denied access to


individual advice as a result of lack of resources and low numbers of dietitians employed in the hospital and community sector. With less than 7,000 dietitians working to fulfil the needs of the entire UK population, patients are unable to receive the education and information


• Nutritional information relating to subjects identified as malnourished should be included in communications on discharge from hospital and mental health units.


• Access to nutrition advice and nutrition support teams should be available in all care settings.


• The practice of nutritional screening should be audited regularly.


• Consistent strategies to detect, prevent and treat malnutrition should be in place in all care settings, including the community, where most malnutrition originates.


To access the full report visit: http://www.bapen.org.uk/pdfs/nsw/ nsw-2011-report.pdf


‘Malnutrition is common on admission to acute and community hospitals, all types of wards and in all age groups and diagnostic categories.’


that would empower them to improve and self-manage their nutrition in the long-term.” Chair of the National Nurses’ Nutrition


group, Liz Evans agreed, adding: “It must be acknowledged that BAPEN screening week reports show the prevalence of malnutrition in the community and it is therefore vital that vulnerable patients are not further nutritionally compromised during their stay in hospital. While I am pleased that the Government acknowledges the importance of good, nourishing food as a key part of recovery, it is also important that there is recognition of the role that nurses play in the delivery of this part of treatment. “Food provision should not be seen as a


‘hotel service’ but as an integral part of a person’s recovery from illness. As such, organisational routines in hospitals should be arranged so that nurses can participate fully in feeding and hydrating patients. Sadly, despite innovations such as Protected Mealtimes and Red Trays, this is still not happening in many areas.”


‘At risk’ individuals BAPEN has stressed the importance of nutritional assessment of ‘at risk’ individuals, but who exactly is deemed to be at


risk? The organisation is keen to dispel some common misconceptions


– while poverty is often considered a major factor in malnutrition, BAPEN points out that disease is actually the


primary cause. Those most at risk of malnutrition include: • Individuals with acute and chronic conditions (e.g. cancer, COPD, inflammatory bowel disease, gastrointestinal illness, renal or liver disease).


• People with chronic progressive conditions (e.g. dementia and neurological conditions such as Parkinson’s disease and Motor Neurone Disease).


• Patients who have been recently discharged from hospital (e.g. post surgery, hip fracture, exacerbations of chronic disease).


• Individuals with increased debility (e.g. frailty, immobility, old age, depression).


• People with social issues (e.g. poor support, housebound, inability to cook and shop, poverty).


BAPEN’s fourth annual Nutritional ScreeningWeek (NSW) report has also highlighted the fact that malnutrition is not, as commonly believed, a problem that only affects the older generation. The screening week survey found that malnutrition also affects 26% of patients admitted to hospital aged between 20 and 29 years old. While prevalence of malnutrition was found to be lower than in previous surveys, the results showed that it still affects: • 1 in 4 adults on admission to hospitals. • More than 1 in 3 adults admitted to care homes in the previous six months.


• Up to 1 in 5 adults on admission to mental health units.


‘Malnutrition is not, as commonly believed, a problem that only affects the older generation. Malnutrition also affects 26% of patients admitted to hospital aged between 20 and 29 years old.’


NOVEMBER 2012


Although the survey looks specifically at those on admission to hospitals, care homes and mental health units, the results highlight the alarming rates of malnutrition affecting quarter of adults of all ages, admitted to hospital from their own homes.


THE CLINICAL SERVICES JOURNAL 31


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