Focus on Undernutrition


FoU (originally called Focus on Food) initially started 11 years ago from a pilot study conducted in six elderly care homes in Darlington. Three modes of implementation were evaluated to determine cost and clinically effective methods to prevent and treat undernutrition in care homes using MAG nutritional screening tool and guidelines. The three methods of facilitation evaluated were: in-house training workshops; distance learning packages; and no training (but provided resources).


Findings highlighted some key issues, following training the prevalence of undernutrition declined by 6% (44% to 38%). There was also an accurate detection and treatment of undernourished residents, because at baseline staff failed to identify 53% of residents at risk of undernutrition, but this reduced to 5% in the distance learning homes, 33% in-house training workshops but increased to 68% in the homes which recieved no training.


Training No Training Homes


Energy intakes


Supplement wastage


41% increase


Supplement 91% usage


decline 0%


Homes 33%


reduction 31%


increase 70%


The FoU service is unique because of the seamless approach it has to tackling undernutrition within the community. The service promotes that adult patients in County Durham and Darlington are screened and treated for undernutrition, whether in care homes, own homes, GP surgeries or community hospitals. This was not happening previously, despite national policy. FoU adapt their service delivery to meet the varying needs of staff, using the same message to ensure equitable and seamless care is provided to patients. As a result of the FoU service the prevalence of undernutrition has declined and use of nutritional supplements significantly decreased, resulting in improved patient outcomes and cost savings


The aims of FoU service are two-fold: to promote the timely detection and treatment of undernourished patients, and the appropriate prescribing and monitoring of nutritional supplements. This is by the delivery of accredited training and support to health and social care community staff on how to identify and treat undernutrition using an adapted layout of ‘MUST’ tool which has been endorsed by BAPEN. Treatment is by promoting a food first approach followed by the appropriate prescribing of oral nutritional supplements.


FoU has worked in partnership with key organisations to ensure that identification and treatment of undernutrition is firmly incorporated into commissioning frameworks. This has included partnership working with the strategic health


authority to develop a regional community CQUIN for undernutrition, social services to incorporate into local care home funding contacts and resident agreements, and the local NHS provider organisations to develop a clinical policy for undernutrition in community.


FoU is used as an example of best practice by:


• National Patient Safety Agency (NPSA) • Institute of Innovation and Improvement, • National Prescribing Centre (NPC), • British Dietetic Association • Social Care Institute for Excellence (SCIE) • Royal College of Nursing


The innovative work of FoU has enabled


County Durham and Darlington to lead the way nationally on identifying and treating undernutrition from a regional perspective. The service is continuously evolving. FoU is currently developing a new website and two e-learning packages for use in care homes and NHS community staff which mimic the accredited distance learning and master classes presently delivered in these areas. Due to the national interest in the service, FoU is now available nationally (since April 2011) as a toolkit to implement the service into another organisations via licensing.


FoU toolkits presently available for national use include the care home training toolkit and catering course toolkit. See Figure 1. A license to implement the service is now


available to NHS trusts, care home providers and other organisations across the UK. The annual license enables an organisation to use the FoU resources within a specified territory. The underlying principle of the FoU approach to licensing out the resources is to provide both the resources and a full support service for other organisations. The FoU team wishes to ensure that each organisation gains the full benefit of their experience, through their help and assistance to ensure that an organisation obtains the full benefits of the FoU approach.


Dr Mike Stroud told delegates from across the country at the Darlington conference: “It’s an extraordinary achievement which has been made here. It seems obvious. If you don’t feed people they will become ill and die. Nutrition really is at the heart of quality care and yet it is done well in some places, like around here, but not in others.” To find out more about Focus on Undernutrition please contact: info@focusonundernutrition.co.uk or visit: www.focusonundernutrition.co.uk


Care Home Toolkit • License for an organisation to use within specified territory for 12 months


• Reference copies of all resources • The toolkit is designed for another organisation to take off the shelf and implement locally without any development requirements


• The toolkit includes: quality manual for delivery, quality standards, all training materials, standardised processes and resources for all aspects of FoU delivery, evaluation processed


• Care home training bundles • The care home training is designed for both registered and non-registered healthcare staff


• Accredited by the Teesside University as level 4 certificate (10 credits), endorsed by BAPEN


• Training is 2-hour interactive workshop delivered within the care home which uses and supports the use of the FoU adapted layout of ‘MUST’


• Workshops are interactive and include training on ‘MUST’ tool, how to measure ulna and MUAC, care planning, dietary interventions for undernutrition and appropriate use of nutritional supplements


• Following training delegates complete either distance learning workbook or e-learning


• The workshop can be delivered by dietetic support workers or dietitians


BAPEN In Touch No.62 August 2011 10


Figure 1:The Care Home Toolkit and the Catering Course Toolkit Catering Course Toolkit


• 2 days ‘train the trainer’ and ongoing support for their organisation


• License for an organisation to establish and deliver the catering course within a specified territory for 12 months


• An annual license allows up to 50 delegates to be trained per year


• 1 day ‘train the trainer’ and ongoing support for their organisation


• Tutor and teaching toolkits, which provide all the teaching materials, support processes and guidance to deliver the course


• Six session course designed for cooks and managers working within care homes


• Topics including: – Menu planning – Diabetes – High protein high calorie diets – Altered consistency diets – Dementia – Constipation and high fibre diets


• Delivered in the catering and hospitality schools at local colleges of further education in a series of half day sessions


• Each session is 1.5 hours workshop and 1.5 hours practical in the kitchen environment. Followed by assessment as weekly coursework is related to the specific taught topic


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