Measuring Nutritional Care: screening, nutritional care processes, outcomes and patient experienceEvery provider organisation is required by the Health and Social Act 2008 (Regulated Activities) Regulations 2014 (Regulation 14) to make sure the individuals in care have enough to eat and drink to meet their nutrition and hydration needs and receive the support they need to do so. Individuals “must have their nutritional needs assessed and food must be provided to meet those needs. This includes where people are prescribed nutritional supplements and/or parenteral nutrition” (Source: CQC website)
Despite best efforts of many organisations and individuals, the costs associated with malnutrition, within the UK have continued to rise; a cost likely to continue to increase without a different approach. The personal cost to individuals and their families is also significant, with an increased mortality rate, increased admissions to hospital, increased pressure ulcers, falls and infections and an overall decrease in quality of life. Combating malnutrition in the UK remains a significant challenge requiring a mind-set shift in how we work together to find innovative solutions.
Why is there a need for a new measurement tool with a different approach?
We know from the national nutrition screening week data that the prevalence of malnutrition remains high (with 24-30% of patients admitted to a UK hospital malnourished or at risk of malnutrition). Whilst numerous nutrition initiatives (many of them national) such as ‘protected mealtimes’ and ‘Nutrition Now’ (Royal College of Nursing), and the publication of numerous standards, including the NICE guidance, have helped to raise the profile of nutrition, these figures show more has to be done, not just in hospitals but across a range of care settings.
Why do we need to measure nutritional care?
Measurement helps us prove we have made a difference, and identify where change or intervention is needed. Without it, we run the risk of good work being lost under the burden of poor evidence. The BAPEN Nutritional Care Tool offers a unique opportunity to support local organisations in measuring and evidencing their nutritional improvement work in high priority areas. We envisage this will become an important source of an organisation’s evidence to provide assurance to the regulators of compliance to Regulation 14.Purpose and benefits of the BAPEN Nutritional Care Tool
Building on the work undertaken during the Nutrition Screening Weeks, which really helped create a country-wide picture of the prevalence of malnutrition in the UK, BAPEN has developed a new web-based Nutritional Care Tool which will enable organisations to monitor nutritional screening, the effectiveness of nutritional care they provide and patient experience. We appreciate that the complexities of delivering good nutritional care make measurement fraught with difficulty. However, we believe that measurement is key to delivering further improvements in the quality of nutritional care . We have therefore developed and tested a new measurement tool. This tool utilises quality improvement methodology (i.e. these data are intended to identify improvement opportunities within an organisation, not performance management or research). The tool therefore includes;
- Process measures; screening and care planning
- Outcome measures – weight loss (trackable over time for the duration of admission)
- Patient experience measures of nutritional care received
- The Tool is free to all NHS and social care organisations
- Completion takes approximately 5 minutes per individual.
- The data are instantly available to frontline teams to monitor care and deliver improvements.
- Improvements in nutritional care can be delivered whilst the patient is still in your care
- The Tool is completely voluntary so it is up to you how frequently you use it and the scale of use
What underpins the BAPEN Nutritional Care Tool?
There are a number of key principles that provide the foundation for measurement using the BAPEN Nutritional Care Tool:- Measurement will be undertaken with a true ‘measurement for improvement’ ethos and not used for judgement or punitive purposes
- Measurement will be undertaken to support learning and spread of best practice through sharing and publication, but not benchmarking unless there is a request from members to do so when the dataset is sufficiently large and robust.
- We will gather just as much data as is required to identify change and ensure that any additional data collection burden is kept to a minimum
What will happen to the data we enter?
One of the key elements of our approach to measurement using the BAPEN Nutritional Care Tool is to share data and encourage you to utilise your data locally to identify areas for improvement and drive conversations about change and how it can be achieved. The BAPEN Nutritional Care Tool looks to support this vision by using simple visualisations of the data collected to help you to answer two key questions:1. Are we making improvements in nutritional care? 2. What is the variation in nutritional care in our system?
To help us do this, we have developed a simple dashboard which shows key measures in the form of run charts and funnel plots for each organisation. We are fully committed to the open and transparent agenda and therefore therefore you can see the data for all organisations who submit information using the BAPEN Nutritional Care Tool; this is because we want to encourage sharing and peer support in analysing and understanding the data. Please note that there are no comparisons or league tables shown and these will not be added; this is because the BAPEN Nutritional Care Tool was designed for measuring improvement and not for making judgements.
Where next?
The site http://www.data.bapen.org.uk/ has everything you need to get started with using the BAPEN Nutritional Care Tool. You can review the data items collected here
Dr. Mike Stroud
BAPEN President