Malnutrition in Care Homes
NHS England has issued new guidance, Commissioning Excellent Nutrition and Hydration, to raise awareness of the importance of good nutrition and hydration as part of care.
Numerous reports highlight that malnutrition is a problem and continues to be one across all settings. In care homes, for example, it is estimated that 35% of people admitted to a care home setting will be at risk of malnutrition, and care home residents have a higher risk of dehydration compared to those in the community. Yet nutrition and hydration are integral to health and well-being.
There is, therefore, a need for an integrated, well communicated nutrition care strategy, to improve not only the experience of people in all care settings, but also their clinical outcomes.
The guidance, published this month, urges commissioners to
- Include a focus on preventing malnutrition and dehydration;
- Develop nutrition and hydration care pathways;
- Ensure the issues are in the contracting, quality assurance and performance and monitoring of commissioned services;
- Ensure the process is taking an integrated approach that provides an all-encompassing approach.
It also highlights examples of work which is already underway. Among examples of activities promoted by the guidance are:
- A scheme run by Greenwich Clinical Commissioning Group which has been using Quality, Innovation, Productivity and Prevention (QIPP) to help improve nutrition; improved medicines management has helped reduce inappropriate usage of supplements in nursing and care homes, and savings have been used to pilot community dietitian services in GP practices to identify and screen patients at risk and review oral nutrition supplements.
- A ‘food first’ approach in Chiltern CCG and Aylesbury Vale CCG has been used in care homes to reduce leg ulcers, while a study at flu clinics which weighed patients over 80 years found a correlation between practices which did not have recent weight records for their 80+ year old patients and a high level of previously undetected malnutrition.
- NHS East and South East England Specialist Pharmacy Services has produced a community pharmacy audit based on hydration messages to patients with urinary tract infections to prevent acute kidney injury (AKI).
What needs to happen next
Two messages are very clear within this report; one is the focus for commissioners to understand the needs of their local population, and the need to shape local services to meet these needs.
The second is the need to connect and work across sectors and settings. it is suggested that by 2018 commissioners establish a nutrition and hydration group with membership that includes representatives from health and social care and agree a work plan, including systems that support the integration of nutritional and hydration care across pathways.
Care home staff have long recognised that it is often at the point of transition between care settings that critical nutrition information about patients’ care needs is lost. Effective communication of needs is a vital part of transition for example between care home and hospital in order to ensure that individuals receive appropriate and safe nutritional care and assistance.
The new guidance was developed in collaboration with NHS clinical commissioning groups, local authorities, patient groups, expert nutrition groups; representatives from the catering industry, the Care Quality Commission (CQC), NHS Trust Development Authority (TDA), the Department of Health, as well as people who use healthcare services and their carers.
It is hoped by its authors that this practical guide will encourage local dialogue to improve nutrition and hydration and as a consequence realise other important benefits such as reducing risk of falls and making best use of nutritional supplements.
You can read the Guidance – Commissioning Excellent Nutrition and Hydration 2015-2018 in full by clicking HERE.
Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor
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