Improving Nutritional Care in Bristol

Sharon Sexton

Medicines Management Dietitian

NHS Bristol

Current Situation

• Unidentified malnutrition• Low use of MUST/screening in community• Variable understanding of risks associated with

malnutrition• Limited dietary advice available/offered• Limited dietetic services across Bristol• Increasing spend on oral nutritional supplements

Initial Findings from training in Bristol Care Homes(delivered by Rachel Cooke)

• In one care home, just 3.5% of those screened were screened correctly

• In the home where screening was most accurate, 75% of those screened were screened correctly

Initial Findings from Training in Bristol Care Homes(delivered by Rachel Cooke)

• Average incidence of malnutrition: 45%

(17% medium risk, 28% high risk)

• ‘National average’ taken from results of the BAPEN Nutrition Screening Week survey 2010 (37% of residents at risk of malnutrition)

Objectives of Role

• Promote validated guidance

• Increased identification of malnutrition

• Increased screening for risk of malnutrition

• Pathway for treating malnutrition

• Appropriate prescribing

• Support for health professionals

• Training

Key Professionals

• GPs• Community nursing• Practice pharmacists• Dietetic teams• Intermediate Care• Care Homes

– Nursing staff– Catering staff

• Public Health

Developing Guidance on screening

• Primary Care Nutrition Working Group– Range of stakeholders

• NHS Islington guidance adapted with permission– Succinct– draft

The Guidance

• MUST (Malnutrition Universal Screening Tool)

• Care Pathway

• Guide to best practice in prescribing oral nutritional supplements– Range of information on starter packs/feeds

Distribution of guidance

• Meetings at all Bristol GP practices

• Distributed to community nursing teams

• Care settings

• Links with practice pharmacists

• Promoted through training

Conference Update

• Conference held 7th November 2012

• Care homes, community nurses, stakeholders

• Raise awareness of incidence of malnutrition

Key Themes

• Training provision should be ongoing and available for all teams

• Housebound without nursing input hard to reach and may be most vulnerable

Next Steps

• Adapt guidance based on feedback

• Offer further training to: – care homes– community nursing– Intermediate care– Reablement teams– Rapid response teams