Digesting OFNOSH
Jeremy Powell-Tuck
Emeritus Professor of Clinical Nutrition,
Barts and the London.
What is the prevalence of MUST
defined malnutrition in hospitals?
 28%+ overall
 22% “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 awareness
 Provide acceptable guidance
 Encourage nutritional screening
 Provide training
 Clarify 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 diseaserelated malnutrition
in the UK……
Cost of malnutrition in
UK >£7billion
Intervention is effective
in reducing length of stay
in surgical and nonsurgical patients
Effects of
Malnutrition
Impaired immune response
Reduced muscle strength,
and fatigue
Inactivity
Loss of temperature
regulation
Impaired wound healing
Impaired regulation of salt
and water
Periods
Foetal and Infant
programming
Specific nutrient deficiencies
Impaired psycho-social
function
Growth, sexual development,
neuro-cognitive development,
bone health
OFNOSH
 http://www.bapen.org.u
k/ofnsh/index.html
 Access to previous
websites and reports
 Collation of them into a
coherent whole
 Definition of roles
 Aspirational “five year
plan”
OFNOSH
BAPEN.org.uk
OFNOSH
BAPEN.org.uk
Organisation of Food and Nutritional Support in
Hospitals: OFNOSH
The many
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
The few
Nutrition support team
Parenteral Nutrition
from Food to Parenteral Nutrition
26%
NCEPOD Report on PN:
3138 cases, 1548 full returns,
a Mixed Bag
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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
culture
Nurses
Doctors
Catering staff
Pharmacists
Dietitians
Digesting OFNOSH
 Be aware
 Use the website critically
 Create discussion and collaboration
 Facilitate senior strategy discussions and
implementation
Some websites to look at
 Nutrition Now:
http://www.rcn.org.uk/__data/assets/pdf_file/0006/187989/003284.pd
f
 NICE Guideline:
http://www.nice.org.uk/guidance/index.jsp?action=download&o=2997
8
 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/Publi
cationsPolicyAndGuidance/DH_119969
How might progress be made?
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Essence of care: benchmarking (Food and Drink)
Better Hospital Food
Protected mealtimes
Establish/strengthen Dietetics
Establish steering committee
Create multiprofessional NST
Appoint nutrition nurse specialist(s)
Develop out-patient services – home and community links
Develop/formalise education and training
Develop specialist teams