The Malnutrition Pathway (Managing Adult Malnutrition in the Community), established by a multi-professional expert consensus panel, is developing an online area for sharing, recognising and promoting good practice.
Project to manage malnutrition in care homes
The City Healthcare Partnership Medicines CIC Services team recently used this area to share a summary of a project initiated amongst care homes residents in Hull. The team identified that nutrition support standards and procedures varied greatly. In many homes, it appeared that there was insufficient assessment, monitoring and review of the nutritional status of residents. In addition, once oral nutritional supplements (ONS) were prescribed, there was little support available and it was felt that GPs were often asked to supply ONS without being presented with any rationale behind the request.
A nurse-led policy project to improve the recognition and management of malnutrition in care homes through the implantation of standard screening and management plans based on national guidance, the NICE Quality Standard 24, was undertaken.
The project was carried out in 4 residential and 1 nursing homes, with data collected on 132 residents with a mean age of 83 years. A multi-professional team was involved in the project, including the care home support pharmacist and nurse.
The project consisted of 3 phases;
- A baseline audit to assess nutrition screening practices, use of nutrition support and healthcare use for 3 months.
- Implementation of local policy for monthly nurse led nutrition screening, followed by initiation and review of nutrition care plans, dependent on risk. The care plans included ONS and dietary advice for residents at high risk of malnutrition. Liaison with GPs to ensure they had all the relevant information to make an informed prescribing decision to commence, review and stop ONS was also an important part of the policy.
- Re-audit for 3 months to assess the benefit of implementing the local policy by comparing the data from the baseline audit.
Good nutritional care can save money
The re-audit, compared with the baseline audit, suggested significantly improved documentation of height, weight, nutrition screening and use of appropriate care plans. Healthcare resource use decreased, showing a reduction in healthcare professional contacts, hospital admissions and infections requiring antibiotics. Importantly, the estimated costs to screen and manage malnutrition were more than offset by the reduction in healthcare resource use costs. The total estimated saving was £187.91 per resident for 3 months (£751.64 annually).
The project demonstrated that screening and appropriate management of malnutrition can be improved by implementing a well implemented local policy.
The Malnutrition Pathway on http://www.malnutritionpathway.co.uk/
