Managing Adult Malnutrition

Including a pathway for the appropriate use of
oral nutritional supplements (ONS)


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Sharing Best practice: Previous Award Winners

Using the Malnutrition Pathway Resources as tools to support
implementation of a nutrition training

The Nutrition Support Community Dietetics Team at the 5 Boroughs Partnership NHS Foundation Trust in NW England has utilised the Malnutrition Pathway materials as part of their ‘Nutrition Link Programme’.

  • READ MORE ABOUT THE 5 BOROUGHS NUTRITION LINK PROGRAMME

    BEST PRACTICE AWARD WINNER - GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST

    Great Western Hospitals NHS Foundation Trust has been given a best practice award for their work in implementing the 'MANAGING MALNUTRITION IN COPD' guide to assess the nutritional status, well-being and health care use of malnourished patients with COPD in the community. The study found that implementation of the pathway can significantly reduce malnutrition risk and health care usage.

    A project team consisting of the Community Dietetic Team Leader, Dietetic Assistant and Community Respiratory Nurse was formed to implement the Managing Malnutrition in COPD pathway, which was launched in 2016. The project aimed to evaluate the current nutritional management of malnourished COPD patients in the locality and assess whether this could be improved by implementing the pathway, while educating patients and healthcare professionals on the importance of nutrition in COPD and raising the profile of dietetics in this field.

    The project was led by the department's dietetic assistant. Nineteen COPD patients identified to be at high risk of malnutrition were managed as per the ‘Managing Malnutrition in COPD’ guide; receiving dietary advice in the form of the ‘Nutrition support in COPD’ patient leaflet, as well as a low volume, high energy, high protein oral nutritional supplement twice daily and were followed up at 6 and 12 weeks. ‘MUST’ score, health care use, health rating and COPD assessment test (CAT) score, over the 12 weeks before and after implementation, were recorded. Compliance with the oral nutritional supplement was assessed over the 12 weeks and patient satisfaction with the management of their malnutrition was measured at the end of the project.

    Implementation of the pathway led to a significant reduction in malnutrition risk (based on ‘MUST’ score) and significant improvement in CAT and mean health rating. The patients’ health care use reduced across the board; including a 50% reduction in hospital admissions and a 20% reduction in GP visits. Patient satisfaction with the management of their malnutrition was very high (96% ) as was their compliance with the low volume, high energy, high protein oral nutritional supplement (90% ).

    On the basis of these results and using average costs1 as well as the cost of ONS2 the team was able to estimate the cost savings of the project to the CCG. The results showed a total cost saving of £80.82 per patient which equated to a total saving of £1,535.58 over the 12 weeks.

    “These figures demonstrate the cost savings on a small pilot study,” says Natalie Kominek, Community Dietetic Team Leader at Great Western Hospitals NHS Foundation Trust. “Whilst we recognise the limitations of such a small study if we were to utilise CCG and prevalence data to estimate the number of adults with COPD and proportion of those likely to be malnourished within the CCG, we estimate that 676 adults with COPD in Swindon CCG may be malnourished or at risk of malnutrition and would benefit from appropriate management. Based on these prevalence figures, implementation of the pathway in all malnourished COPD patients could produce significant and sustainable cost savings for the CCG. With this in mind we are continuing to use the pathway with our COPD patients and have plans to expand its use across the whole community setting.”

    “This project is an excellent example of the work being carried out across the UK to tackle the issue of malnutrition in the community,” says Anne Holdoway, Consultant Dietitian and Chair of the Managing Adult Malnutrition in the Community panel. “We hope by sharing this best practice other professionals will be encouraged to implement such projects in order to ensure that vulnerable individuals, who are at risk of malnutrition, are screened early and receive appropriate and timely nutritional care in the community.“

    References
    Curtis, L. & Burns, A. (2015) Unit Costs of Health and Social Care 2015, Personal Social Services Research Unit, University of Kent, Canterbury.
    BRITISH NATIONAL FORMUARY ONLINE

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