The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

MUST – “Acute and Community approaches”

Tina Howe

Specialist Dietitian

Nutrition Support Team Leader

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

Community :How we got to where we are

2008 RCN Nutrition now Project

2009 MUST rolled out

2010 Nursing home project

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

Where we are nowMUST

April 2010 – March 201116 training sessions in community hospitals20 training sessions to community nurses

15 sessions to nursing homes

April 2011 – September 22 training sessions

community nurses, intermediate care teams, cardiac nurses, Physiotherapists,

5 training sessions to Nursing Homes on food fortification

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

AUDIT May 2011Community Hospital

Ward A 100% patients

MUST completed100 % accurate

Ward B80 % MUST

completed 69% accurateMistakes with

Calculating the BMI and % weight loss

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

Before MUST introducedEach Year• 1011 inpatients seen in community hospitals • 43 Dom visits carried out.

After MUST• 351 inpatients seen• 498 Dom visits / telephone reviews carried

out

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

Acute :How we got to here

March 2010Two major trust wide audits to assess prevalence of

malnutrition within TrustRBH prevalence around 30% of all in patients

Only 24% of all in patients have a MUST carried out within 24 hours

2 out of 3 at risk in patients not identified

Key Nutrition Standards

Screening for malnutrition : It’s a MUST

75% patients have a MUST screen completed within 24 hours of admission to Trust

75% completion of Nutrition Care Bundles

All hospital in patients must be screened using Malnutrition Universal Screening Tool (MUST) within 24 hours

All patients with a MUST score of 1 or more will be commenced on Nutrition Care Bundle

All Patients with a MUST score of 1 or more will have nutritional care plan

Monthly audits on use of MUST/Care Bundle

All patients with a MUST score of 2 or more to be refereed to die titian within 24 hours

Monthly Nutrition Audit FindingsPercentage of patients screened with MUST tool

0

10

20

30

40

50

60

70

80

90

100

Mar-10

Apr-10

May-10

Jun-10

Jul-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11

Per

cen

tage

%

24h

48h

Trust target

In Summary Progress we have made

Establishment of Nutrition Champion Network

Three Divisional Nutrition Quality Forums

A key focus on the use of MUST

Implementation of the Nutrition Care Bundle and Nutrition Care Plan

Monthly Auditing

Promoting protected mealtimes, right meal, right time , right help

Putting Nutrition on Trust ward/dept agendas

Excellent role modelling

The Way Forward : Key Priorities next 12 months

Continue to drive up MUST assessment within 24 hours of admission- need to be aiming for 90%

To commence the ‘Facilitating Adult Patients to eat and drink’ programme, pilot on two elderly care wards

Hydrant pilot – pilot Kennet/Loddon and Burghfield Ward

Pre-op fasting times

Access to snacks particularly in paediatrics

The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

“Are we seeing fewer Patients admitted to hospital who are

malnourished?”

“Are we seeing fewer patients discharged from hospital who are

malnourished?”