CONDITIONS & DISORDERS
ONS IN CARE HOMES AND THE COMMUNITY: NUTRITION REVIEW AND STAFF EDUCATION Maria Cazzulani RD Community Dietitian, Derby Teaching Hospitals Maria has training in the specialist areas of body composition, assessment of nutritional status and in using ‘MUST’. She has clinical experience in older people’s nutrition, undernutrition and COPD.
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In Association with the BDA's Older People Specialist Group
Care homes play an important role in the cycle of malnutrition and patient admission to hospital. They are well placed to detect risk and prevent undernutrition in the elderly. Derby Hospitals Community Dietetic Team completed a pilot project within five Derbyshire nursing and care homes around the education of care home staff. This article provides an overview of the work done by the hospital dietetic team to date. There is no universally accepted definition of malnutrition, but one of the most commonly used is, ‘a state of nutrition in which a deficiency, excess, or imbalance of energy, protein and other nutrients, causes measurable adverse effects on tissue/body form, function and clinical outcomes’.1 For many older people, malnutrition is characterised by low body weight or weight loss, meaning simply that some older people are not eating well enough to maintain their health and wellbeing.2 Of the 11.6 million older people in the UK, over a million are estimated to be malnourished or at risk of malnutrition.3 Older adult care home residents are especially vulnerable to the effects of disease-related undernutrition and malnutrition, with 30 to 40% of UK adults at medium to high risk within six months of admission.4 Critically, once a malnourished patient has been identified, then malnutrition can be managed by dietary advice to optimise oral intake as well as with the use of oral nutritional supplements (ONS).5 The efficacy of the use of ONS in malnourished patients is well understood; however, their use may not always be appropriate or acceptable and other methods, such as food fortification, may result in either equal or better outcomes for considerably lower costs.6 Based on this premise, in 2016, Derby Hospitals Community Dietetic Team ran a pilot project within five Derbyshire nursing and care homes based on the education of care home staff.
The outcomes of the pilot were: improved nutritional state of patients measured by an improved Body Mass Index (BMI) and Malnutrition Universal Screening Tool (‘MUST’) score; increased percentage weight gain; reduced length of stay in hospital if admitted; and reduced spend on ONS prescribing. Following the success of the initial pilot project, one dietitian and three dietetic assistants, part of the Derby Hospitals Community Dietetic Team, were funded by South Derbyshire Clinical Commissioners Groups (CCG). OVERVIEW OF PROJECT
Care home residents within the 38 care homes included in the project, were initially screened for nutritional status using the ‘MUST’ tool and current prescription of ONS. Data collected during the initial screening was repeated three and six months after commencement of the intervention. Clusters of residents at care homes were randomly assigned to either ‘intervention’ or ‘wait’ group. Such a design is often acceptable to communities which would not be comfortable with a ‘no-treatment’ group. The intervention consisted of two phases: • Training of care home staff in Food First approach including ‘MUST’ training. • Assessment of nutrition action plans and appropriateness of current ONS prescriptions. www.NHDmag.com July 2018 - Issue 136
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