What’s New


Following Support of Dignity Action Day The NACC Announce a New Publication that will ensure Dignity through Mealtimes


Crohn’s and Colitis – Care improving but services fall short in key areas


The third round of the UK Inflammatory Bowel Disease Audit, carried out in 2010, shows that care for patients with ulcerative colitis (UC) and Crohn’s disease (CD) has improved across a wide range of measures since the previous two rounds in 2006 and 2008.


• Mortality for patients admitted with UC has halved over the 3 rounds of the audit


• Readmission rates have lowered • The percentage of patients being seen by an inflammatory bowel disease (IBD) nurse specialist during their admission has doubled since the first round.


Dignity Action Day (held this year on 1st February 2012) spotlights the importance of continually upholding the dignity of people receiving care. The new publication from the National Association of Care Catering (NACC) – How to Comply with CQC’s Outcome 5: Nutritional Needs – offers all community and residential social care providers the tools and know-how to ensure dignity through mealtimes.


Produced in collaboration with the English Community Care Association (ECCA), the publication embeds nutritional wellbeing with best practice. It is a valuable resource document, packed with information, guidance and practical tools, and focuses on the importance of mealtimes as part of the care service, as well as nutritional content.


The NACC supports the aims of Dignity Action Day to ensure that people in care are always treated as individuals, and are given choice, control and a sense of purpose in their daily lives. It recognises that mealtimes are significant occasions for those receiving care, both physically and emotionally, and the manner in which they are organised and delivered is vital in ensuring that dignity is upheld.


Martin Green, Chief Executive, ECCA,


comments: “Everyone has a role to play in ensuring that mealtimes are enjoyable experiences for those in receipt of care services. The social aspect is as important as the nutritional content, and they should not be task orientated. Only by the mealtime being person centred can dignity be ensured. If it is enjoyable then, ultimately, the nutritional care will be excellent. An enjoyable meal recognises what people want, and how, where and with whom they want it.”


Karen Oliver, Chair, NACC concludes: “The


Care Quality Commission’s (CQC) Essential Standards of Quality and Safety are clear. Dignity is a core component of any provision of care and inspectors will certainly expect providers of health and social care to demonstrate their compliance. Our publication offers care professionals a practical resource that will help them meet these standards and ensure that mealtimes succeed in providing both nutritional wellbeing and dignity.”


For further information: www.thenacc.co.uk 3 BAPEN In Touch No.64 March 2012


There is however still room for improvement, particularly in the following areas: • More patients need to be tested for infections, including Clostridium Difficile (CDiff)


• All patients should be given heparin where appropriate to prevent blood clots


• More patients should see a specialist IBD nurse during their stay in hospital, who can advise and screen patients if anti-inflammatory treatment (Anti-TNF) is prescribed


• All CD patients should see a dietitian to prevent malnutrition


• Patients should receive more help to give up smoking and stay stopped to prevent the risk of worse outcomes.


Inflammatory bowel disease is increasing and now affects one in 200 people in the UK, with profound life changing effects. The total cost of IBD to the NHS was estimated at £720 million in 2006. The UK IBD Audit (2010) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) with additional funding from Healthcare Improvement Scotland. The audit is co-ordinated by the Clinical Effectiveness and Evaluation unit (CEEu) of the Royal College of Physicians of London on behalf of a collaborative partnership between gastroenterologists (the British Society of Gastroenterology), colorectal surgeons (the Association of Coloproctology of Great Britain and Ireland), patients (Crohn’s and Colitis UK), physicians (the Royal College of Physicians of London) and paediatric gastroenterologists (The British Society of Paediatric Gastroenterology, Hepatology and Nutrition). The 2010 audit covered over 3,000 patients admitted with each condition.


When


comparing results from hospitals who participated in the previous two audits, 2,000 admissions each for UC and CD were directly comparable and their data is used here: Ulcerative colitis key findings: • The amount of people dying from UC has reduced by half since 2006 (1.7% to 0.8%)


• The percentage of people admitted to hospital in the two years before the audited admission has reduced from 51% to 34%, most likely as a result of more responsive outpatient services


• Stool samples are now being sent significantly more frequently for both Standard Stool Cultures (SSC), (66% to 81%) and Clostridium Difficile Toxin (CDT), (54% to 75%) for UC patients admitted with diarrhoea


• There has been a significant reduction in the number of stool samples positive for CDT (4.2% to 1.6%) for patients admitted with diarrhoea in 2010.


• Prophylactic Heparin is being prescribed more frequently (54% to 87%). 2% (66/3049) of patients had a blood clot during their admission in the third round


• The prescription of bone protection for patients discharged on steroids has increased (41% to 70%) as recommended in the BSG Guidelines for the management of IBD in adults.


Crohn’s disease key findings: • The use of Anti-TNF therapy for patients admitted with CD has doubled over 3 rounds but use remains at a relatively low level overall (3.9% to 8%)


• For CD there has not been the same increase as observed for UC in the rates of stool samples sent for Standard Stool Cultures and Clostridium Difficile Toxin in patients admitted with diarrhoea, in fact the rates increased between rounds 1 and 2 and decreased in round 3


• 34.7% of patients with IBD were taking 5- ASA (anti-inflammatory) drugs, but these are only effective in UC, not CD


• 63.3% of patients in 2010 (1978/3122) were not taking any form of immuno- suppressive drugs on admission, so are missing an important form of treatment


• Significantly more patients are being weighed during their admission (51.4% to 74.7%)


• The number of patients seen by a dietitian during their admission has continued to rise across rounds but remains at a low rate overall (35.8% to 39.7%)


• Just under a third of patients with CD admitted to hospital are smokers. This has not changed over the 3 rounds of the IBD Audit (31.5% to 31%).


Dr Ian Arnott, Consultant Gastroenterologist,


Western General Hospital and UK IBD Audit Clinical Lead, said: “The third round of the UK IBD audit has demonstrated very significant improvement in the care of IBD patients.


The


audit is widely supported by clinicians from around the UK and clinical teams have worked hard to realise these gains. Further rounds of the audit are needed to encourage and promote further improvement in the quality of care for patients with IBD.”


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