Progress in the fight against malnutrition since BAPEN won the MNI - - PowerPoint PPT Presentation

Progress in the fight against malnutrition since BAPEN won the MNI Grant

Ailsa Brotherton Honorary Secretary, On behalf of BAPEN

A reminder of our national challenges in 2008

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Raising the profile of nutrition and hydration

• Persuading the Government and the

Department of Health to focus on malnutrition

• Developing national policy and system levers
• Creating a shift from professional bodies and

charities working in isolation with different visions, different campaigns and different messages to working together to develop ‘one voice’ with a strong ‘call to action’

• Patients and the public did not have easy

access to the information and services

• Lack of awareness of malnutrition amongst

both public and professionals

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What have we done since BAPEN won the award?

We set a clear strategy and vision

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1 2 3 4 5

Prevention of malnutrition and dehydration

Screening Identify malnutrition/ risk of malnutrition early through screening and assessment e.g. the ‘MUST’ Tool Treatment - ‘individualised’ care pathways Education and training for all care staff appropriate to setting, profession and responsibilities Management systems and structures to facilitate multidisciplinary nutritional care

We have aimed to embed 5 principles of good nutritional care in all settings

We described the problem, measured the prevalence

and made clear recommendations for action

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Hospitals Care Homes Mental Health Units

Centres (n=) Patients (n=) Centres (n=) Residents (n=) Centres (n=) Patients (n=)

2007 Autumn 175 9336 173 1610 22 332 2008 Summer 130 5089 75 614 17 185 2010 Winter 185 9668 148 857 20 146 2011 Spring 171 7541 78 523 67 543 Prevalence 25-34% 30-42% 18-20%

Data kindly supplied by Christine Russell, Chair of NSW

Change in screening practice on admission in hospitals

10 20 30 40 50 60 70 80 2007 (N=175) 2008 (N=90) 2010 (N=141) 2011 (N= 147 )

% C e n t r e s

0-25% patients 26-50% patients 51-75% patients 76-100% patients Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier

Data kindly supplied by Christine Russell, Chair of NSW

We provided a toolkit for key decision makers: commissioners and providers

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Tools

1) Assessment of population at risk of malnutrition 2) Assessment of current screening and provision of nutritional care 3) Development of nutritional screening, assessment and care pathways 4) Education and training: knowledge skills and competencies of staff 5) Service specifications and management structures for nutritional care 6) Quality frameworks for nutritional care 7) Quality indicators, monitoring and review

...based on the best available evidence

... and began to work with the DH national improvement programme to design highly reliable systems of nutritional care

IDENTIFY Design systems to screen all patients using a validated screening tool Operating Frameworks / CQUINs/CQC TREAT Develop a personal nutritional care plan Outcomes Framework /CQCTREAT TRAIN BAPEN e-learning modules E-learning for Health STRUCTURES AND PATHWAYS Continuity across boundaries Senior Leader Support PREVENT Work with Public Health, Local Government and Social Services

Aiming for good nutritional care for every patient,

• n every ward, on every day

....and the commissioners to further develop eBANS and HIFNET

We thought differently about Clinical Guidance and Education

Life Long Learning (LLL) programme in Clinical Nutrition and Metabolism BAPENs annual conference at UK DDF in 2012

How have we done it?

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Government & DH

• We convinced DH of the problem: they now accept that quality, safety

and the financial benefits from improved nutritional care are ‘a given’ and created a sense of urgency Quality Improvement

• Worked with Quality Improvement Scientists to embed nutrition and

hydration in DH QIPP work stream (Safe Care)

• Nutrition contributes to all 5 domains of the Outcomes Framework

Networking and collaboration

• We have worked with multiple partners: charities, professional bodies,

industry Spoken with one voice

• The Government/DH recognise BAPEN as a leading

multidisiplinary charity for tackling malnutrition in the UK

We have started to work differently

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What How

Convince people there is a problem Convince them there is a solution Invest in data collection and feedback systems Have the right kind of leadership

Overcoming challenges to improving quality

.... and to communicate differently

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We have discovered the potential of Social Media ..................

But we still have lots to do to complete the challenge and are keen to learn from ESPEN colleagues

Next steps......

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Working together across the UK towards an integrated national nutrition strategy

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• BAPEN
• BDA and PENG
• BPNG
• NNNG and RCN
• RCGP
• RCP
• NHS Trusts – acute,

community, mental health

• Care Homes
• Sheltered Housing

PINNT: Supporting people

• n artificial nutrition

Patient Association: CARE Campaign Carers UK: Care about Nutrition AGE UK

• Food Industry
• Clinical Nutrition
• Catering

Integrated Nutrition Strategy

Building a blue print for an integrated strategy and learning across the home countries

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Outline the Problem

• Develop shared ownership

for the vision

• Focus on Prevention
• Focus on self management

including self screening

• Accessibility of information
• Early diagnosis and

treatment

• Developing person centred

pathways of care Putting patients and the public first

• Excellent use of patient

stories

• Increased public

awareness

• Describe how this can

be delivered

• The case for change
• The campaign

Raising awareness

• Define the challenge
• Outline the purpose
• f the Strategy
• Outline the scope

and structure

Text in red = working towards/ future development

Building a blue print for an integrated strategy

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Improving Outcomes

• How does DRM differ

from other forms of malnutrition

• How to treat DRM

effectively

• The case for change
• Collation of the

evidence (ONS Dossier)

• How can we deliver it

Treatment of Disease related malnutirtion

• Commissioning

nutritional services – at national commissioning board level

• Commissioning

specialised nutrition services

• Incentive payments for

nutrition (national CQUIN)

Commissioning & Levers

• National outcome

measures

• NICE Quality

Standards

• Building the case for

further improvement

• The value of early

screening and treatment

• Role of GPs
• Role of community

services

Text in red = working towards/ future development

1) Malnutrition Task Force Older People (primarily England)

Two New Initatives

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2) Nutrition and Hydration Action Alliance (UK)

Some of the Partners: Abbott Nutrition , Apetito, Baxter , BDA , BSG BSPGHAN , Danone , Focus on Under-nutrition, Fresenius Kabi, Hydration Forum, ILC (UK) Mappmal (HospitalFoodie), NACC, NNNG, Nutricia, PINNT, RCN, RCP, Sustain

How will we structure and organise

• ur work?

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• Planning patient and public

engagement

Currently under discussion

Person centred care Malnutrition Task Force

• Focus on older people
• Forming a strong wider coalition of

committed partners ‘To ensure excellent nutritional care and hydration for every individual in every setting on every day’ Nutrition and Hydration Action Alliance

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...but what has really made the difference

My personal view....

Three critical factors for success

1) Visionary Chairs

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Professor Marinos Elia Dr Mike Stroud Dr Tim Bowling

.......Committed to action

2) highly committed, capable people with capacity to contribute

Having fun as well as working hard....

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3) ... and never losing sight of the reason for our work

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On behalf of BAPEN I would like to thank the MNI for the grant and I urge other Associations to apply

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BAPEN’s Core Groups