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BAPEN Conference Speak with Passion


and Keep it Simple! This was the advice from Rachael Masters as keys to success in firing up colleagues and embedding nutritional care across sectors. “It is vital,” added Rachael, “to link nutrition


into all and any national initiatives that are doing the rounds – CQUINs, QIPPs, CQC regulations – use them all to demonstrate your business case and the absolute need for quality nutritional care both in community and acute settings.” Entrepreneurial Rachael also revealed


that her project – now an established brand in its own right – Focus on UnderNutrition – will be marketed as a tool from April 2011. Interest has already been secured from private care homes, pre-registration courses and SHAs. “If you speak with passion it works,” concluded Rachael. “You have just got to keep going, publish data wherever you can, and demonstrate your worth. Just remember that ‘Stressed’ spelt backwards is ‘Desserts’!”


Source:A Mixed Bag: an enquiry into the care of hospital patients receiving PN, NCEPOD 2010


Testing Out the BAPEN


Commissioning


Toolkit BAPEN’s recently published Commissioning Toolkit is another resource for providers to help assess where they are on the quality agenda. Pamela Coulthurst, Lancashire Teaching Hospitals NHS Trust, was given the task of testing out just how useful it is.


“The initial barrier for me was that the level of


detail provided in the Toolkit seemed daunting but once I got into it that proved helpful not a hindrance,” said Pam. “My other main concerns related to our own local situation and included lack of access to commissioners, lack of core data, poor contact with the community dietetic team and variation in practice across wards and sites. Where was I going to get the data I needed and how on earth was I going to get started?” The benefits of working through the Toolkit were however considerable, concluded Pam. It helped identify gaps, provided a better understanding of current practice and has driven innovative ways of capturing data. It certainly also brought into sharp focus the need for and relevance of performance indicators, CQC evidence and benchmarking, and how important it is to standardise data collection and practice. To check data currently being collected, Pam examined the records of 50 patients. This exercise revealed that whilst 66% of these patients had a ‘MUST’ score of 2 only 50% of those had fully complete records. Room for improvement in record keeping, an area flagged as vital by the CQC.


‘MUST’ Made Even Easier Over the years there has been some resistance to


the use of ‘MUST’ based on the perceived difficulty of calculating BMI and conversion of imperial to metric measures. That potential barrier has now been taken away completely by the introduction of the online ‘MUST’ calculator. Simply punch in the relevant information on the relevant page on the BAPEN website, and the calculations are done for you producing a ‘MUST’ score. As Professor Elia reminded delegates, that is of course only the start of the nutritional


Quality delivery of PN? Not according to NCEPOD


BAPEN was challenged by Dr James Stewart, Clinical Physician from Leicester Royal Infirmary and lead for NCEPOD (National Clinical Enquiry into Patient Outcome and Death), to drive improvement in the quality of PN care in hospital. Reporting the results of ‘A Mixed Bag’ project, Dr


Stewart shared results that many delegates found, if not shocking, at least highly disappointing. 877 cases were reviewed by a multi-disciplinary team with nearly a quarter assessed as requiring improvement


in both clinical and organisational terms. Good practice was identified in only 19% of adult cases with inadequate consideration of enteral nutrition in one in three cases. Unreasonable delays were identified in recognition of need and in starting PN once need identified. Poor documentation of nutritional issues was also highlighted in the project and in the report, and issue that will undoubtedly be picked up by CQC inspectors.


care journey, as the most important thing is what happens next – the implementation of the appropriate care plan based on the ‘MUST’ score revealed.


Professor Elia also announced the launch of the new e-learning module to help train staff working in the care and community sectors in the use of ‘MUST’. Like its companion module designed for hospital staff, case studies and care plans are included matched to the work place and experience of staff, patients and residents.


Professor Marinos Elia provided an update on nutritional screening and introduced the new online ‘MUST’ calculator.


BAPEN In Touch No.59 December 2010


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