Nutrition and Hydration an on-going issue Caroline Lecko Patient - - PowerPoint PPT Presentation

Nutrition and Hydration an on-going issue

Caroline Lecko Patient Safety Lead

Three million people are living at risk of malnutrition in the UK, with the cost estimated to be £13 billion every year (BAPEN 2009)

• Malnourishment in older people has a

significant impact on their quality of life

• Disease, illness and social

circumstances can put people at further risk

• BAPEN (2009) reported:
• 3 million people (UK)are

malnourished with 1/3rd over 65

• 93% are in the community, 5% in

care homes, 2% in hospital

• 28% of those admitted to hospital

are at risk of malnutrition

• 30-42% of those admitted to

residential care homes are at risk

• f malnutrition

BAPEN Nutritional Screening Week

Establishing prevalence of malnutrition in adults on admission to care across the UK

• 2007 (Autumn) - 1 in 4 of all adults across all age groups admitted to

hospital and care homes in the UK at risk of malnutrition

• 2008 (Summer) - 1 in 3 adults on admission to hospitals and more than 1

in 3 adults admitted to care homes in the previous 6 months were affected by malnutrition

• 2010 (Winter) – results were the same as in 2008
• 2011 (Spring) – 1 in 4 adults on admission to hospital and 1 in 3 adults

admitted to care homes in the previous 6 months were affected by malnutrition

Prevalence and consequences

• f malnutrition in the UK

SECONDARY CARE

  complications   length of stay   readmissions   mortality

CARE HOMES 41% of recently admitted residents HOSPITAL 25% of admissions PRIMARY CARE

  hospital   dependency   GP visits   prescription

costs SHELTERED HOUSING 10-14% of tenants HOME General population (adults) BMI <20kg/m2 : 5% BMI <18.5kg/m2 : 1.8% Elderly: 14%

Prevalence of malnutrition

Slide kindly supplied by Rhonda Smith

Let’s look at some of the common harms where poor nutritional care is a contributory factor...... ...remembering that good nutritional care is often at best fragmented and at worst non existent

Poor wound healing impacts on patients lives everyday “The pain I suffered was immense, it was hard to move and yet I was told that was the best thing to do.”

“My granddad died with an infected Grade 4 pressure ulcer acquired in care.... ...when I close my eyes and think about it I can still smell his rotting flesh.”

We know our patients and their families live with the consequences of poor nutrition and hydration ...... and the resulting harms ……….. Bill 64 Years Post surgical pressure ulcers Brenda 85 years Post surgical DVT (16 years on) John 71 years In-patient fall post hip replacement

“The starting point for improvement is to recognise the need”

We have known about the importance of malnutrition since the King’s Fund report in 1992 We know how to detect and treat malnutrition yet..... ....we continue to fail to do so

Professor John Lennard-Jones, the founder Chairman of BAPEN (from1992-1995)

"Our aim is to prevent malnutrition as a result of illness whenever possible, when it occurs to treat it by the most cost-effective regimen, and in doing both greatly improve the outcome of illness for patients.” We still have a lot of work to do....

Thank you to Natalie Curvis, Quality Improvement lead at Salford Royal Hospitals NHS Foundation Trust for permission to use slides

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“Dehydration is a common,

• ften preventable and

potentially lethal problem among both institutionalised and community dwelling older adults.” (WHO, 2002)

Is dehydration a ‘big’ issue?

• A review of the NRLS considered all reported

patient safety incidents from inception of the NRLS (2001) to 31 March 2012 identified using ‘dehydration’ and ‘over-hydration’ as key words within the free text.

• 7856 incidents were identified meeting these

search criteria.

• All reported deaths (142), severe harm (257) and

a sample of 50 each of moderate, low and no harm incidents were reviewed

• Whilst the search terms included over hydration

all of the 368 incidents reviewed reported harm associated with dehydration

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A couple more…… patient admitted from private nursing home grossly dehydrated and with mouth and dentures thickly coated . mouth appears not to have been cleaned for some time Pt admitted with dehydration and likely left basal pneumonia . Pt has had respite care in ……….. Nursing home for the past month . Family concerned with level of care given to the patient stating that fluids and diet not being given also issue around medications especially tinzaparin injections as patient has no bruising on the abdomen . .

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Reviewed degree of harm

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Death, 18 Severe, 32 Moderate or less, 217 Unclear, 102

Reporting care setting

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50 100 150 200 250 300 Acute Community Mental Health 272 81 15

Themes

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20 40 60 80 100 120 140 160 114 30 22 7 150 15 32 17 35 20 3 5 2 15 1 26

Some examples….. Inappropriate Care.. Patient was brought from a Nursing home very dehydrated. Unable to take medication for 2weeks, not eating or drinking.. Client was admitted to A&E very dehydrated , bruised and pressure sores . Son alleged staff at ……. have neglected her and abused ? physically . Her health has declined sharply since she was admitted for respite . . Telephone call from care connect , stating that they had a received a phone call from a nurse to report that a patent had been admitted and that there ward suspect the care home of serious neglect , the patient was found to have a grade 4 pressure sore

• n his sacrum , knees , sepsis and dehydration and

that the patient was unlikely to survive .

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Consequences of dehydration

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Pressure Ulcers Falls Urinary tract infections Incontinence Constipation VTE Cognitive impairment Acute Kidney Injury Reduced quality of life Increased healthcare costs

Yet we know there is good practice

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And we know that there are examples of

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• Reduction in urinary tract infections
• Reduce laxative usage
• Less frequent GP visits
• Improvements in memory

BUT…. We need this information to collected consistently and reliably to demonstrate that good hydration impacts on peoples quality of care and can reduce costs

Five steps to preventing dehydration Recognise the signs of dehydration Educate staff on the importance of good hydration, the signs and symptoms and the role they have in ensuring good hydration Educate residents, service users and carers on the importance and benefits of good hydration Review your service and look at ways of improving

• hydration. Be innovating and bold.

Measure improvements to demonstrate benefits in the health and well-being of individuals and reduction in the costs associated with dehydration

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National Drivers (and there’s a few…)

• Malnutrition Task Force
• Nutrition and Hydration Action

Alliance

• DH Improving Hospital Food
• NICE Quality Standards
• PS100
• CQC DANI

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http://costsectorcatering.co.uk/ps100- group-launch-startling-report-cost-obesity- and-malnutrition-uk-0

NICE Quality Standards (30 Nov 2012)

Statement 1. People in care settings are screened for the risk of malnutrition using a validated screening tool. Statement 2. People who are malnourished or at risk of malnutrition have a management care plan that aims to meet their nutritional requirements. Statement 3. All people who are screened for the risk of malnutrition have their screening results and nutrition support goals (if applicable) documented and communicated in writing within and between settings. Statement 4. People managing their own artificial nutrition support and/or their carers are trained to manage their nutrition delivery system and monitor their wellbeing. Statement 5. People receiving nutrition support are offered a review

• f the indications, route, risks, benefits and goals of nutrition support

at planned intervals.

CQC DANI – social care

• 500 Inspections completed by end of October 2012
• National Report of finding to be published Feb 2013
• Considered 5 outcomes:
• 1 – Respecting and involving people
• 5 – Meeting nutritional needs
• 7 – Safeguarding
• 13 – Staffing
• 21 – Records

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Examples of nutrition related issues

• Outcome 1 – use of inappropriate language

“feeder”

• Outcome 5 – No menu plans or monitoring of

nutritional value of meals provided

• Outcome 13 - Insufficient numbers or inadequate

deployment of staff at all times e.g. mealtimes

• Outcome 21- Food and Fluid charts not

completed

• Lower levels of compliance with outcome 5 when

the evening meal was included

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NHS | Presentation to [XXXX Company] | [Type Date] 33

LET’S BE THE GENERATION THAT ELIMINATE AVOIDABLE MALNUTRITION AND DEHYDRATION

BE THE CHANGE YOU WANT TO SEE IN THE WORLD

Get involved Nutrition and Hydration Week 2014 17 – 23 March 2014 #NHW2014

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Many thanks caroline.lecko@nhs.net @celecko

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