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MUST – “Acute and Community approaches”

MUST – “Acute and Community approaches”. Tina Howe Specialist Dietitian Nutrition Support Team Leader. Community : How we got to where we are. 2008 RCN Nutrition now Project 2009 MUST rolled out 2010 Nursing home project. Where we are now. MUST April 2010 – March 2011

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MUST – “Acute and Community approaches”

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  1. 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

  2. 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

  3. Where we are now MUST April 2010 – March 2011 16 training sessions in community hospitals 20 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

  4. Ward A 100% patients MUST completed 100 % accurate Ward B 80 % MUST completed 69% accurate Mistakes with Calculating the BMI and % weight loss AUDIT May 2011Community Hospital The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

  5. Before MUST introduced Each 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

  6. Acute :How we got to here March 2010 Two major trust wide audits to assess prevalence of malnutrition within Trust RBH 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 The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

  7. 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 Key Nutrition Standards

  8. Monthly Nutrition Audit Findings

  9. 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

  10. 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

  11. “Are we seeing fewer Patients admitted to hospital who are malnourished?”“Are we seeing fewer patients discharged from hospital who are malnourished?” The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011

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