Project thumbnail

Evaluating Integrated Approaches to Undernutrition Screening & Care Planning

The Wessex AHSN is supporting a number of projects aimed at evaluating integrated approaches to undernutrition screening and care planning. Both our pan-Dorset Malnutrition Programme (see below) and our OPEN Eastleigh project have been featured in a recent Public Health England review, published in February 2017, entitled "Helping older people maintain a healthy diet: A review of what works".

Pan-Dorset Malnutrition Programme

Dorset launched its Joint Nutritional Care Strategy for Adults in May 2013 which began as a partnership initiative to provide the highest levels of good practice in nutritional care for vulnerable adults.

One of the initial projects was a pilot implementing nutritional care pathways for health and social care teams in the community linked to a single GP practice. A significant number of vulnerable adults were screened with a particular focus on nutrition and identified as at risk of undernutrition. These individuals were unlikely to have been identified prior to the project, as the majority of staff had not previously been trained to undertake nutritional screening. An electronic data collection form was then developed to support this work.

The initiative was rolled out across five GP practices in Purbeck in 2015, and then into the Christchurch locality in early 2016, involving a total of 13 GP practices. The Purbeck pilot was one of five national Malnutrition Taskforce pilots.

The successes and positive outcomes of piloting this work in Purbeck and Christchurch has led to the roll out of this integrated approach for community based undernutrition screening and nutritional care support pan Dorset, starting in early 2017.

Between the start of the initial pilot and April 2018, a total of 3586 people have been screened for undernutrition, with approximately 25% of people at 'medium' or 'high' risk of undernutrition (using the 'MUST' screening tool). 69% of people screened in the Purbeck and Christchurch pilots had been screened by teams not screening prior to the intervention. A total of 631 health and social care have been trained to screen and treat and care plan for undernutrition.

Evaluating a new integrated procedure for nutritional screening and care planning in Southern Health NHS Foundation Trust

We are currently involved in a service development project for integrated community teams (ICTs) within Southern Health NHS Foundation Trust, to implement a new procedure for nutritional screening and care for older people, drawing on our OPEN toolkit. The new procedure will first be implemented by ICTs in Andover, Winchester and Basingstoke, with plans to roll out across the Trust if successful. The project has involved the following elements to date:

Development of a care pathway (developed through consultation with a multidisciplinary team) to bring more of a community focus, better suited to screening and treating patients living in their own homes
Development of bespoke undernutrition leaflet, based on the OPEN undernutrition leaflet
Training was developed and delivered to staff in each of the three locations by dietitians, with 118 staff being trained between May and July 2017
A baseline questionnaire to gauge knowledge and confidence around screening and care planning was administered before and after the training sessions (carried out in early 2017)
Creation of a new page on the Southern Health intranet to host the information for staff about the new procedure, patient resources and useful links

In addition to understanding the effectiveness of the model with respect to staff knowledge and patient outcomes, it is also important to understand factors that may help or hinder implementation of the new model, and embedding it as a routine aspect of care. Funded by the Burdett Trust for Nursing, led by Professor Jane Murphy (Bournemouth University), the ‘Implementing Nutritional Screening in Community Care for Older People’ (INSCCOPe) project explores the implementation and embedding of the new model. The project is informed by Normalization Process Theory (NPT). The ambition of the project is to maximise the potential for scalability and cost effectiveness of this new model, by providing an evidence base to support implementation across diverse settings in the health service.

The initial findings from the INSCCOPe project generated some key recommendations, including the appointment of staff 'nutrition champions', engaging with senior organisational leadership, and the adoption of an e-learning programme (including investigating making undernutrition training mandatory for all staff). To address these recommendations, a dietitian 'project lead' was recruited for six months (from April to October 2018). The effectiveness of the new procedure was then be re-assessed in Autumn 2018 as part of the Healthy Ageing programme and is currently being written up.

An article on the project and initial findings was published in Complete Nutrition in November 2018. A poster showing the baseline data was produced and presented at the BAPEN conference in November 2017. A PDF version of this article and poster can be downloaded from the resources section.

For more information on this service development project, please contact us at nutrition@wessexahsn.net. For further information about the INSCCOPe project, please contact Prof Jane Murphy at jmurphy@bournemouth.ac.uk