Quality Improvement Guide BAPEN Launches a New Quality


Improvement Guide for Consultation Malnutrition Matters – Meeting Standards of Care for Nutrition and Hydration in Hospitals


AILSA BROTHERTON BAPEN Secretary


We know what good nutritional care looks like yet many Trusts are still struggling to deliver highly reliable nutritional care to every patient on every ward on every day. This, we believe, is largely due to the challenges of redesigning systems that span across the hospital, directorates, departments, teams and individuals. System redesign at a micro level (involving one area and one team) is relatively straightforward, at meso level (multiple departments or teams) is more difficult whilst macro level (organisational level) system re-design is complex and challenging and needs a systematic, structured approach for success.


BAPEN’s quality group members have been learning from improvement experts and have teamed up with colleagues in the NHS Midlands and East to try to implement system wide change. We are currently working on the development of an integrated nutrition pathway and are working with teams to organise our work in a structured and systematic way, with the aim of understanding how to deliver highly reliable nutritional care. The introduction of the Care Quality Commission’s Outcome 5,


‘Meeting Nutritional Needs’ standard has been key in ensuring that the delivery of excellent care in relation to providing nutrition and fluids has become a priority and all NHS Trust are now required to deliver minimum standards of care and be committed to continuous quality improvements in nutrition. In our experience, the Trusts who are most successful at delivering


good quality nutrition and hydration have two elements: • A clear vision for good nutrition and hydration from Board to Ward • A commitment to focus on system change to embed quality improvements in nutrition and hydration across the whole organisation and across boundaries, ensuring nutritional information follows the patient between settings. However, we appreciate that this is no easy task and requires focused


polices, multidisciplinary teams, clinical leadership, educational initiatives and new management approaches. This is why over the years BAPEN has developed a range of reports, research, educational tools and works in collaboration with the Department of Health to ensure it can support commissioners and providers in finding successful solutions. However, we have realised that writing about ‘what to do’ is in itself insufficient on our part. We need to work together to understand ‘how to accomplish’ excellent nutritional care. Our latest tool is therefore a new Quality Improvement Guide which


has just been for launched consultation. It provides a step by step guide to implementing basic good nutritional care across an organisation. Read and used in conjunction with the other reports and information contained in the ‘Meeting Nutritional Standards of Care’ resources pack the new Quality Improvement Guide will help the user identify any gaps in their current provision of basic nutritional care for all patients. The new Guide focusses on the four main tenants of good nutritional


and hydration care: 1. Malnutrition and hydration must be actively identified through screening and assessment


2. Malnourished or dehydrated individuals and those at risk must have appropriate care pathways


3. Frontline staff in all care settings must receive appropriate training on the importance of good nutritional care and optimal hydration


4. Organisations must have management structures in place to ensure best practice. Before you can begin to implement quality improvements in nutrition


and hydration across your organisation it is important that you understand your current strengths and weaknesses as there is often a temptation to rush in and make changes without really understanding where the current gaps in the system exist. In our experience, many Trusts have focused their energy on some areas and worked hard to implement screening (e.g. using ‘MUST’) but have not made provision for adequate nutrition and hydration education and training and importantly sustainability. The real challenge is to embed the improvements within an existing system so that they are sustainable. The new Quality Improvement Guide outlines the key steps that should


be taken by Trusts to deliver quality nutritional improvements and provides a range of supporting information and resources: 1. Understanding your baseline – where are you now? 2. Leadership 3. Change and Implementation Team 4. Integrate and sustain 5. Take it to the Top – your CEO must know 6. Do what needs to be done 7. Measurement 8. Scale up and spread 9. Assess your progress 10. Celebrate success. The Quality Guide is now available on the BAPEN website for consultation. We


are asking teams to test out the Guide in hospitals and to feed back any comments, suggested improvements, submit examples of your improvements (what has worked well and what hasn’t) before the publication of the final version.


The new Quality Improvement Guide, available on the BAPEN website, was produced on behalf of BAPEN by the BAPEN Quality Improvement Committee: Christine Baldwin, Tim Bowling, Ailsa Brotherton, Liz Evans, Anne Holdoway, Lyn McIntyre, Nicola Simmonds, Rhonda Smith, Mike Stroud (Chair), Vera Todorovic, Elizabeth Weekes.


BAPEN In Touch No.67 November 2012 6


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