Emeritus Professor of Clinical Nutrition, Barts and the London.

Digesting OFNOSH

Jeremy Powell-Tuck

What is the prevalence of MUST defined malnutrition in hospitals?

28%+ overall22% “high”

Council of Europe: 10 Key Characteristics of good nutritional care in hospitals

http://www.bda.uk.com/resources/071012CoEHospitalNutrition.pdf

1 All patients are screened on admission and re-screened weekly.2 All patients have a nutritional care plan: their needs and how they will be met 3 The hospital includes specific guidance on food services and nutritional care in its Clinical Governance arrangements.4 Patients are involved in the planning and monitoring arrangements for food service provision.5 The ward implements Protected Mealtimes …6 All staff have the appropriate skills .. and receive regular training on nutritional care and management.7 Hospital facilities provide and deliver an excellent experience of food service and nutritional care 24 hours a day, every day.8The hospital has a policy for food service and nutritional care which is patient centred and performance managed in line with home country governance frameworks.9 Food service and nutritional care is delivered to the patient safely.10The hospital supports a multi-disciplinary approach to nutritional care

Raise awarenessProvide acceptable

guidance Encourage nutritional

screeningProvide trainingClarify standards and

strengthen inspection and regulation

"Good nutrition and hydration are vital to help people maintain good health, recover from illness and get back on their feet

Paul Burstow, Minister of State for Care Services and Lead for Older People and Care Services

The cost of disease-related malnutrition in the UK……

Cost of malnutrition in UK >£7billion

Intervention is effective in reducing length of stay in surgical and non-surgical patients

Effects of Malnutrition

Impaired immune responseReduced muscle strength, and fatigueInactivityLoss of temperature regulationImpaired wound healingImpaired regulation of salt and waterPeriodsFoetal and Infant programmingSpecific nutrient deficienciesImpaired psycho-social functionGrowth, sexual development, neuro-cognitive development, bone health

OFNOSH http://

www.bapen.org.uk/ofnsh/index.html

Access to previous websites and reports

Collation of them into a coherent whole

Definition of rolesAspirational “five

year plan”

OFNOSHBAPEN.org.uk

OFNOSHBAPEN.org.uk

All admissions: hospital food. Ward nurses and medical teams screen patients.

Some patients require oral nutritional supplements: may require assessment by dietitians

Enteral feeds: dietitians

Nutrition support team Parenteral Nutrition

The many

The few

Organisation of Food and Nutritional Support in Hospitals: OFNOSH

from Food to Parenteral Nutrition

26%

NCEPOD Report on PN: a Mixed Bag 3138 cases, 1548 full

returns, 74 case note returns, 326 questionnaire returns, 1190 no data returned

Good practice 19%No NST involved 47.3%PN not indicated 29%Inadequate assessment 54%Unreasonable delay

recognition 16%Unreasonable delay starting

9%Avoidable metabolic

complications 51%Avoidable complications 46%

Creating the cultureNursesDoctorsCatering staffPharmacistsDietitians

Digesting OFNOSHBe awareUse the website criticallyCreate discussion and collaborationFacilitate senior strategy discussions and

implementation

Some websites to look at Nutrition Now:

http://www.rcn.org.uk/__data/assets/pdf_file/0006/187989/003284.pdf

NICE Guideline: http://www.nice.org.uk/guidance/index.jsp?action=download&o=29978

Council of Europe Resolution 10 key characteristics of good nutritional care http://www.bda.uk.com/resources/071012CoEHospitalNutrition.pdf

Essence of Care http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_119969

How might progress be made?Essence of care: benchmarking (Food and Drink)Better Hospital FoodProtected mealtimesEstablish/strengthen DieteticsEstablish steering committeeCreate multiprofessional NSTAppoint nutrition nurse specialist(s)Develop out-patient services – home and

community linksDevelop/formalise education and trainingDevelop specialist teams