Meeting Quality Standards
Malnutrition Matters: Meeting Quality Standards in Nutritional Care – Next steps
AILSA BROTHERTON NATIONAL QIPP SAFE CARE PROGRAMME MANAGER
BAPEN launched its toolkit for commissioners and providers in May 2010 with an aim of driving large scale improvement in nutritional care across all settings. BAPEN’s Quality Group is now turning its focus to the implementation of the toolkit and is linking to Department of Health (DH) Initiatives
to promote the Toolkit. This article reports on the work being undertaken to integrate good nutritional care into the National QIPP (Quality, Innovation, Productivity and Prevention) Safe Care Work Stream.
Providing good nutritional care is no easy task. There are a plethora of nutritional guidelines and standards to support organisations in delivering good quality nutritional care but the barriers and complexities of implementation across healthcare systems are extremely challenging. For many organisations ensuring good nutritional care requires alignment of nutrition steering committees, multidisciplinary nutrition teams, new management approaches to facilitate nutritional care across acute and community settings and real developments in systems and processes, together with improvements in recording of clinical outcomes and patient experiences. This can also only be achieved with good clinical leadership and innovative approaches and the toolkit is designed to help health and care organisations to achieve this.
Good nutritional care revolves around four
main tenets: • Malnutrition must be actively identified through screening and assessment
• Malnourished individuals and those at risk of malnutrition must have appropriate care pathways
• Frontline staff in all care settings must receive appropriate training on the importance of good nutritional care
• Organisations must have management structures in place to ensure best nutritional practice.
The DH QIPP Safe Care Work Stream
What are we trying to accomplish by embedding nutrition and hydration into the safe care agenda? The White Paper ‘Equity and Excellence:
Liberating the NHS’ places a strong emphasis on safety and details how power will be devolved from Whitehall to patients and professionals. “Professionals will be free to focus on improving health outcomes so that these are amongst the best in the world. Improving the quality of care will become the main purpose of the NHS.” (DH, 2010) Nutritional care must be at the centre of high
quality, safe care to improve health outcomes. The QIPP Safe Care Work Stream has developed a
9 BAPEN In Touch No.58 August 2010
shared ambition to significantly reduce harm from pressure ulcers, catheter acquired urinary tract infection (CA-UTI), falls and venous thromboembolism (VTE) within two years. This will be delivered by a coalition of partners (including the NPSA, the NHS Institute, High Impact Action team, the Information Centre) and Strategic Health Authorities working together to support change at the frontline of care, accelerate momentum and avoid duplication. Within the evolving NHS structure outlined in
the White Paper, this programme will be co- designed with the system and will support front line staff to make changes to provide safe and personal care to every patient, every time. We will focus our efforts on a targeted portfolio of improvements which we believe will have a significant impact on the four harms identified above; good nutritional care must be at the centre of safe and personal care.
This programme plan takes us into new and challenging ways of working. We will need to embed a range of quality methods at all levels within the system, across all organisations. Our national partners, strategic health authorities (SHAs) and participating organisations will have to demonstrate an unparalleled commitment to deliver this agenda in a challenging environment. We will build on existing good performance and efficiency to create a culture of continuous quality improvement. Our goal is to develop a safer system in which every member understands their role in delivering safer care and works towards achieving that goal every day. Emphasis will be placed on improving systems, working towards excellence in every system, engaging all clinical and non clinical front line staff in improvement and using small tests of change to build momentum. Most importantly we will ensure shared learning from mistakes. Significant progress has been made over the last decade to improve the safety of healthcare. Demonstration programmes, such as the Safer Patients Initiative, Patient Safety First, Matching Michigan and Leading Improvement in Patient
Safety (LIPs) have provided a platform for leading edge organisations to raise their ambition for safety. We also have demonstrable evidence that we can make change at scale. The best example of this is the systematic improvement in infection control, which has been achieved through policy and practice coming together around shared goals. At the outset of these programmes many believed that the desired change was not achievable, but, by sharing and learning we have demonstrated that it is indeed possible to deliver safety improvement at scale. We now need to move further and faster, identifying some key safety issues which we can focus on to deliver our next wave of improvements.
Nutrition and hydration (alongside other basic systems of care) will be at the centre of our next wave of improvements, which will be delivered through a national improvement programme. The QIPP safe care team will work with a small team in each of the ten SHAs to implement the QIPP safe care programme. A supportive network of regional safety leaders will be recruited from the strategic health authorities, quality observatories, universities and local government. This supportive network will act as field agents to support frontline teams in the delivery of this ambitious programme of work, driving improvements in the delivery of nutritional care at scale and pace.
Programme Description Pre-work
Each SHA will establish a safe care programme support team (using staff with expertise in safety governance [PSATs]), high impact interventions and safety improvement (NHS III solutions or Quality Observatories). Each SHA programme team will work to recruit 10 organisations to participate in the QIPP safe care improvement programme. Each organisation will form an improvement team (up to 10 frontline healthcare professionals) to work across acute, primary and social care within a geographical location. This is crucial to the delivery of seamless nutritional care pathways.
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