HEALTHCARE DELIVERY Hospital survey: In 2011, 4,868
women and 4,232 men were surveyed. The age range was 18-106 with 56% of the patients aged 65 years and over. As in previous surveys, the 2011 results showed that women appear to be at greater risk of malnutrition with 28% affected vs 22% of men. While risk increased with age, there was substantial malnutrition risk present at all ages. Malnutrition was present in 22% of patients under the age of 60, 23% of those aged 60-79 years and 33% of patients aged 80 years and older. The results confirm that ‘malnutrition’
is common on admission to acute and community hospitals, all types of wards and in all age groups and diagnostic categories. Screening surveys suggest that there
has been some improvement in the establishment of policies on nutritional care over time. In this latest survey, 8 out of 10 hospitals reported having a nutritional steering committee, almost all centres had a nutrition screening policy and almost all centres audited screening practice at least once a year. Hospitals reported using a range of screening tools with 85% hospitals that responded using the ‘Malnutrition Universal Screening Tool’ (‘MUST’) – either alone or in combination with other tools. Care home survey: A total of 369
women and 206 men were surveyed, with a mean age of 80 years (88% of residents were aged 65 years and over). Those assessed to be at risk of ‘malnutrition’ included: • 26% of those aged less than 70 years. • 41% of those aged 70-84. • 52% of those aged 85 years and over.
The survey highlighted higher prevalence of malnutrition in nursing homes compared to residential homes, while malnutrition increased with age and occurred more frequently in women than men. Some 94% of centres used a screening tool for patients on admission and, of these, 92% used ‘MUST’. Mental health unit survey: A total of
296 women and 349 men were surveyed. Malnutrition was significantly greater in those aged 65 years and over compared to those less than 65 years (24% vs 15% respectively.) Prevalence was also
‘Improved nutritionalcare could result in substantial financialreturns – even a 1% saving could amount to an estimated £130 m per year.’
32 THE CLINICAL SERVICES JOURNAL Good nutritional care at a glance: do you have these in place at your Trust?
• Nutritional steering committee • Nutritional support team • At least one nutritional nurse
• Ward to board nutrition dashboard
Executive leader support Patients
at the heart of nutritional care
Education and training for frontline staff
• All frontline staff to receive education re: nutrition and hydration
• BAPEN nutrition screening module
• Harm free care hydration module
Nutritional care pathways
• Personalised nutritional care plan
• Food and fluid intake chart as appropriate
• Protected mealtimes • Red Tray system
• Ongoing monitoring • Discharge planning/care across boundaries
• All patients must be screened on admission
• Appropriate screening in outpatients
Screening and assessment
• Referral to dietitian/specialist nutritional service as appropriate
significantly greater in women than men. The overall prevalence of malnutrition was found to be 19%, which is substantially lower than that found in hospitals (25%-34%) and care homes (30%-42%) in all four surveys.
Identification and management Ultimately, screening for malnutrition is vital to identify individuals who are at risk. BAPEN states that screening should be undertaken across all health and social care settings and should: • Assess Body Mass Index. • Assess percentage unintentional weight loss.
• Consider the time period nutrient intake has been unintentionally reduced and/or the likelihood of future impaired nutrient intake.
‘MUST’ is a simple, validated, five-step nutrition screening tool, designed to identify the category of malnutrition risk. Recommended by NICE, details of ‘MUST’ can be sourced via BAPEN’s website (
www.bapen.org.uk). A management plan should be
implemented, according to the level of malnutrition risk, using first line dietary advice to optimise food intake and oral nutritional supplements (ONS) where necessary. Oral nutritional supplements (ONS) are an evidence-based strategy for the management of disease related
malnutrition and should be prescribed for patients identified as ‘high risk’ of malnutrition where they are unable to meet/improve nutritional requirements through diet alone, and in ‘medium risk’ individuals where first line dietary advice has failed to be effective.
New guidance At BAPEN’s ‘Organisation of Nutritional Care’ symposium, held at the Digestive Disorders Federation conference, Dr Mike Stroud launched new guidance to encourage all healthcare professionals to identify and appropriately manage malnutrition. ‘Managing Adult Malnutrition in the Community’ aims to support decision making to ensure quality of care for individuals at risk of malnutrition in primary care, encourage detection of malnutrition early through effective screening, and facilitate appropriate nutritional care (
www.malnutritionpathway.co.uk). The guide to managing malnutrition
according to risk and the pathway for using oral nutritional supplements (ONS) aims to put an end to inappropriate prescribing of ONS, but also to ensure that those who would benefit from ONS receive the support they require. Throughout the document, reference is made to concurrent dietary advice, the importance of monitoring and when to involve other members of the healthcare team, including dietitians.
NOVEMBER 2012
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