The Programme Dorset has a Nutritional Care partnership that consists of Dorset County Council; Tricuro; Dorset CCG; NHS; and Dorset Public Health.
The partnership has a Nutritional Care Strategy for Adults https://www.dorsetforyou.com/adult-nutrition
As 93% of malnutrition is in the community it was decided to concentrate on early intervention and prevention.
We have done this by nutritional screening, using the Malnutrition Universal Screening Tool or alternative questions, all those visited at home by Dorset Health Care, Dorset Council care teams, Tricuro Reablement, attend a Tricuro Day Service, stay in Tricuro Respite care or are being discharged from a Community Hospital. We started slowly at one GP practise, then expanded to the locality and from November 2017 we will be live across Dorset County.
Due to the innovative work we received some funding from the Wessex Academic Health Science Network (WAHSN) to support the expansion.
To achieve this we jointly developed:
• A guidance document ( also in Easy Read) for those at risk of malnutrition https://www.dorsetforyou.gov.uk/media/153603/Build-Yourself-Up—November-2016/pdf/Build_Yourself_Up_-_Nov_2016.pdf
• Clear care pathways to be followed https://www.dorsetforyou.gov.uk/media/218806/Care-Pathways-December-2016/pdf/Care_Pathways_December_2016.pdf.
• An electronic form, accessibly by all staff involved, to record screenings and steer the user through to taking the appropriate actions. These guidance notes show screen shots, how simple it is to complete and how it directs you to following the care pathways. https://www.dorsetforyou.gov.uk/media/219776/Guidance-notes-for-care-pathways-form/pdf/Guidance_Notes_Electronic_Form__HC_1st_Option.pdf
Prior to going live in each locality we:
• Presented to local Health and Well-being boards, GP locality meetings and wherever possible Practice Manager meetings
• Completed training of between 100 and 200 hundred staff in each area
• Monitored completion
• Attended follow up sessions
Outcomes – Purbeck area Public Health completed the first evaluation after 10 months:
• We trained 128 health and social care staff (93% of those employed in the area). Of these 83 % increased their knowledge of malnutrition, 98% had a clearer understanding of how their role was important to identifying malnutrition and 93% were confident to complete “MUST”.
• In 10 months 398 different people were nutritionally screened of these 107 (29%) were found to be at risk of malnutrition. Of the 107 at risk 29 service users had an improved “MUST” scores and 39 service users were putting on weight. 74% of those found to be at risk of malnutrition were screened by staff not previously completing “MUST”.
• We have calculated the cost avoidances for the area and annually this equates to approx. £50,000 cost avoidances for Health Care, as yet there is no national data to enable them to add the savings from social care.
• Considering the pilot wasn’t fully live until the summer and that reducing the risks of malnutrition tasks time the results are outstanding.
The outcomes of the Purbeck and Christchurch localities have been produced by the WAHSN and the poster below gives a summary.
Issues Clearly it hasn’t been as plain sailing as it sounds, the main issue is for Dorset Health Care as they have needed to double input data.
Our IT teams are presently working on how this can be reduced.
GP practices were slow to come on board but we feel the evidence is slowly winning them over.
Sustainability It has been agreed that in 2018/19 each locality will have Champions that will be responsible for local administration and reports and that Tricuro will provide further training.
Further Information For more information please contact Sue Hawkins, Catering Solutions Manager, Tricuro E mail: [email protected] Tel: 01305 225930