THE PAN DORSET MALNUTRITION PROGRAMME

Malnutrition and dehydration among the adult population is a serious issue. It affects the health and wellbeing of a large number of people and has a significant associated cost. Public Health England issued the following guidance highlighting the issues. Commissioning Excellent Nutrition and Hydration 2015-2018.

Malnutrition is preventable through early intervention and The Malnutrition Programme is a fantastic example of joint working across the health and social care partners (The Malnutrition Programme, overview, objectives and outcomes

Recognising this problem in 2012 Dorset created a partnership between Dorset HealthCare, Dorset Council, Bournemouth, Christchurch and Poole Council, Public Health Dorset, Tricuro and Dorset CCG. Working together, and using the principles of co – production the partnership looked at available evidence and best practice and developed the Pan Dorset Malnutrition Programme to address the problems. You can read the original share of this work HERE

All documents and guidance were produced jointly by all partners. 

Due to the high levels of malnutrition within the community The Malnutrition Programme was developed for all those clients/ patients who live at home (not Care Homes or Hospitals). It consists of all front line staff screening for malnutrition, inputting the data into a 'MUST’ / Nutritional Screening Electronic Form and following agreed care pathways. These Care Pathways ensure the sharing of data and if completed correctly no patient/client can slip through the net and not cared for appropriately.  Guidance notes for completing the ‘MUST’ / Nutritional Screening Electronic Form

Any user of the electronic form can also create new users, amend incorrect forms and run reports. Guidance notes for Administration of the ‘MUST’ / Nutritional Screening Electronic Form

The role of the Health and Social Care Co-ordinators is pivotal to the Care Pathways HSCC Flowchart

Resources used to support the care pathways 

• Build Yourself Up

• Build Yourself Up - easy read version

• Swap it Don’t Stop it

• Easy read - Swap it don't stop it 

• Malnutrition Task Force - small appetite

• Eating and Drinking Well Supporting People living with Dementia

• Dorset Luncheon Clubs

• Dorset Meal Providers 

The Programme started slowly at one GP practise, then expanded to the locality and has been live across Dorset since 2019. Due to the innovative work we received some funding from the Wessex Academic Health Science Network (WAHSN) to support the expansion.

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

Prior to going live in Bournemouth and Poole we worked Dorset HealthCare to enable SystmOne “MUST” data to download directly into the Malnutrition Programme Electronic System. This prevented DHC staff needing to double input. There are now approx. 500 screenings entered into the Malnutrition Programme Electronic System each week which in turn raise approximately 60 automated emails a week.

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.

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. This was solved with the downloading of data direct from SystmOne into the Malnutrition Electronic system. However for the download to occur DHC need to input “MUST” data fully which is not always the case. 

GP practices were slow to come on board but we feel the evidence is slowly winning them over.

The time to provide on-going training is limited so an on line training course has been developed and is situated on each of the Partners training platforms. 

Sustainability There has been minimal funding for the last year and will run out in towards the end of 2021. It is anticipated that by then the Programme will be part of the day to day work of all the partners and therefore very limited over view work will be required which will completed by a couple of champions across the county. 

Further Information For more information please contact Sue Hawkins, Pan Dorset Malnutrition Programme Manager, [email protected]

  • Acute
  • Acute > Nutrition
  • Acute > Patient Safety
  • Leadership and Management
  • Leadership and Management > Service Design/Innovation
  • Leadership and Management > Service Design/Innovation > Service pathway improvements
  • Leadership and Management > Service Design/Innovation > service improvements
  • Community Services
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