Malnutrition Prevention
Programme
Salford
Kirstine Farrer
Sarah Cleverly
The Five Principles
Raising awareness
Working together
Identifying malnutrition
Personalised care,
support and treatment
Monitoring and evaluating
Setting the scene
Who we are
Salford Steering Group
Name
Job Title
Place of work
David Haynes
Chief Executive
Age UK, Salford
Jean Rollinson
Director of Service Development
Age UK, Salford
Kirstine Farrer
Consultant Dietitian
Salford Royal NHS FT
Brenda Blackett
Lead Nutrition Nurse
Salford Royal NHS FT
Katie Foster/Tony Ward
Team Leader, Community Dietetics
Salford Royal NHS FT
Sarah Cleverly
ICP Project Manager (Care Homes)
and Mental Health Lead.
Integrated Care Programme
ICP Project Manager (MDGs in the
Community)
Integrated Care Programme
Claire Vaughan
Head of Medicines Management
Salford CCG
Paul Walsh
Integrated Commissioning Manager
Salford City Council
Julia Wood
AQuA Affiliate
Stephanie Webb
( Greater Manchester West NHS Foundation
Trust)
(Salford Royal NHS FT)
Overview of Salford City
• Total population is 218,000
• Eight neighbourhoods
• Although there are diverse levels of affluence, Salford is ranked as one of
the most deprived local authority areas in England with life expectancy
lower than the England average
• Population of people aged 65 and over is 35,000
• Number of older people is forecast to rise by 28% by 2030
• Large Orthodox Jewish community
• 14% (nearly 5000) of people aged 65 and over may be at risk of
malnutrition (using BAPEN prevalence tool)
Our approach
• Governance
– Integral part of integration agenda in Salford
– Monthly reporting to the ICP Alliance Board
• Methodology
– Model for Improvement using PDSA cycles
• Workstream Remits & Action Plans
Launch Event - May
Project Launch Event
Aims
• To share the work of the MTF and drum up enthusiasm
• To understand the current state and identify gaps
• To help shape the priorities for taking the work forward
On the day
•
•
•
•
•
Over 80 people in attendance
Presentations – understanding the scale of the problem
Interactive group work – scenario planning
Video – developed for the event: https://www.youtube.com/watch?v=SFIzFMw6iJ8
Pledge Tree
Outcomes
•
•
•
•
Great evaluation
Learning developed into workstreams
Pledges
Film clip – developed at the event:
https://www.youtube.com/watch?v=Z7tH6Z91mKs&feature=youtu.be
Work Stream Remits
1. ICP Standards of Nutritional Care Across Organisations to reflect the NIHCE Quality
Standards
2. Nutrition and Dysphagia Education for Staff across Salford ICP
3. Raising Awareness
4. Working with Community and Primary Care
SALFORD WORKSTREAM REMIT:
ICP Standards of Nutritional Care Across Organisations
Reflect the NIHCE Quality Standards
Context
As part of the ICP it is important that all organisations are delivering the same standard of care
Purpose
Objectives
•
•
•
Statement 1: People in care settings are screened for the risk of malnutrition using a validated screening tool
Statement 2: People who are malnourished or at risk of malnutrition have a management care plan that aims to meet their nutritional requirements
Statement 3: All people who are screened for the risk of malnutrition have their screening results and nutrition support goals (if applicable) documented and
communicated in writing
•
Statement 4: People managing their own artificial nutrition support and/or their carers are trained to manage their nutrition delivery system and monitor their
wellbeing
•
Statement 5: People receiving nutrition support are offered a review of the indications, route, risk, benefits and goals of nutrition support at planned intervals
All NIHCE statements to be integrated into ICP (Integrated Care Programme) Standards as part of the Salford Quality Assurance Framework by March 2015 to be
considered when commissioning high quality nutrition support services across the City.
Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care. Support and
treatment, monitoring and evaluation
Scope
N/A to paediatrics, for adult services only
Resources
Outputs
Success measures
Deliverables
• Robust IT systems in place at Salford Royal FT
(SRFT) to provide data to support measure 1 and
2
• Tangible areas you can hold or point to, e.g.:
• current pathway mapped (April)
• proposed pathway/protocol designed
(Ongoing)
• robust systems in place for implementation
and review/measurement (ongoing)
Hard Success Measures:
•>95% of patients screened using ‘MUST’ on admission to hospital through monthly reporting (BB, KF,
SC)
•>95% of patients over 65 years of age who score 2 consecutive high ‘MUST’ scores within 10 days of
admission to be seen by dietitan (KF)
•All over 75 years to have a BMI recorded as part of the GP contract (FT)
•All care and nursing homes to have nutritional standards and KPIs agreed and assessed by April
2015 (SC, PW, KF)
•SRFT Catering Strategy to be completed by March 2015
Soft Measures:
•Survey of all home enteral tube fed patients to be completed by March 2015
•Improved patient survey results on hospital food
Team structure and roles
All key people identified by initials above.
BB – Brenda Blackett
KF – Kirstine Farrer
SC – Sarah Cleverly
PW – Paul Walsh
K Fo – Katie Foster
FT – Francine Thorpe
Others to involve
Report to Mal Waters via ICP governance framework and monthly Steering Group Meetings
Progress
BMI
• Salford Royal Foundation Trust
– MUST Tool can now be used electronically at Salford Royal
Foundation Trust. The functionality enables automatic
calculation of weight loss and BMI
– Data obtained from Salford Royal shows a median 93% of
patients screened within 6 hours of admission using MUST
– Catering Strategy underway – locum dietitian appointed and
is working on analysis of hospital menus and to ensure Salford
Royal meets new EU legislation regulations.
• Salford Care Homes Practice
– Assesses Care Home residents BMI on admission to a care
home and at the 6 month review. N=1100.
Hospital admissions with malnutrition as a diagnosis by age band, Salford and
Greater Manchester
Apr10/May11 to Apr13/May14 (4 year pooled)
Hospital admissions relating to malnutrition, Salford,
May 2010/April 2011 - May 2013/April 2014
Salford
Greater Manchester
England
45
Salford
Greater Manchester
300
40
250
35
Rate per 100,000 population
Rate per 100,000 persons
30
25
20
15
10
200
150
100
50
5
0
0-4
0
May10/apr11
May11/apr12
May12/apr13
May13/apr14
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Age band
50-54
55-59
60-64
65-69
70-74
75-79
80-84
85-89 90 plus
Progress
Residential and Nursing Care Homes and Home Care Provider Standards
NICE standards in relation to nutrition have been included in the
development of the Salford Quality Assurance Framework
– go live date to be confirmed
Progress
Residential and Nursing Care Homes and Home Care Provider Contracts
Local provider contracts have been revised to include Key Performance
Indicators about nutrition
SALFORD WORKSTREAM REMIT:
Nutrition and Dysphagia Education for Staff across Salford ICP
Context
Purpose
As part of the ICP it is important that all organisations are delivering the same standard of care
Objectives
1)
2)
3)
4)
E-learning package on malnutrition and dysphagia to be completed by March 2015 and hosted by SRFT and City Council learning portals which are accessible
for providers in all sectors
Prepare a paper by August 2014 and present at ADNS meeting (Lead Nurses, Matrons and Assistant Director of Nursing) and clinical effectiveness by October
2014 the need to have Hydrations and Nutritional training mandatory for all SRFT staff, including nurses, medical staff, mealtime volunteers, cadets, and
healthcare assistants etc
Establish if SRFT electronic patient record can calculate ‘MUST’ automatically for nursing staff by August 2014
Work collaboratively with ICP to produce a Salford patient focused (“Sally Ford” simple diet information sheet that patients, health workers and volunteers across
the city can access
Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care. Support and
treatment
Scope
Outputs
Training available to all staff via e-learning package across the city
Points 2 and 3 only pertinent to SRFT staff
Diet information sheet available to download as a PDF file from AgeUK Salford website, SCCG website, Salford council website and SRFT website
Deliverables
Success measures
•Funding agreed by Salford CCG for e-learning via innovation fund, draft of
the package should be available by September 2014 (K Fo and Laura
O’Shea SALT manager SRFT)
•Once developed organise publicity campaign/comms strategy (K Fo)
•Publicity campaign/comms developed once e-learning package ready to go live
4) Leaflet
• To meet with patient groups to ensure simple, clear advice is provided
in leaflet (July)
• To draft leaflet (Aug) and complete (Sept)
• Add to websites (Oct)
• Full launch (by November)
•All medical staff to have completed NG competency training within a year of it
becoming mandatory
• In SRFT all nursing and HCA staff to have mandatory training on dysphagia and
nutrition within a year of it becoming mandatory
•Leaflet downloaded and being used
Risks – lack of knowledge of resource and engagement by staff
Resources
Team structure and roles
K Fo – Katie Foster – Team Leader, Community Dietetics
SC – Sarah Cleverly – Project Manager, ICP
BB – Brenda Blackett – Lead Nutrition Nurse, SRFT
KF – Kirstine Farrer, Consultant dietitian
Leaflet:
Colette McLaughlin (Appropriate Prescribing Dietitian)
Katie Foster (Team Leader – Community Dietetics)
AgeUK Salford Team
Stephanie Webb and Bernadette Alder – MDG workstream
Others to involve
Report to Mal Waters via ICP governance framework and monthly
Steering Group Meetings
Progress
Diet sheets developed for acute and community settings
written by older adults, dietitians and speech and language therapists
Mandatory Training
Paper written to outline the need for malnutrition and hydration to become mandatory for
health care assistants and nursing staff at Salford Royal FT.
Meeting currently being arranged.
Progress
E-learning Package
50 minute lesson plus assessment
(30 questions, 80% right to pass)
SALFORD WORKSTREAM REMIT:
Raising Awareness
Context
Purpose
Necessary to have consistent messages about malnutrition across staff groups and the community
Objectives
Support and promote a minimum of 30 local community services
To help older people to recognise the causes of poorer eating; direct people to appropriate information, advice or professional services and/or by providing social meals
or access to them
Provide a supported shopping service to 40 people
To prompt discussions, information sharing and to test out models which can help reconnect people with an interest in food and address some underlying practical and
social reasons why people under-eat
Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care. Support and
treatment, monitoring and evaluation
Scope
Community services will include day centres, social and lunch clubs, supermarkets, cafes and other settings or amenities where groups of older people naturally visit or
meet. This target does not include statutory health and registered care settings which will be targeted separately.
Shopping services will include older people, carers and families; staff and volunteers of the above services. Patients, professionals and volunteers in NHS and registered
care settings are excluded.
Outputs
Deliverables
Community Services
•
Agree content and volume of Salford information ‘pack’,
including any referral pathways (by July)
•
Produce pack and schedule for community service
presentations and distribution (by August)
•
Undertaken presentations and distribution as per Schedule
Supported shopping service
•
Agree model for testing supported shopping service (by
August)
•
Confirm target group to test the model (by July)
•
Secure support of supermarkets to deliver supported
shopping service (by August)
•
Secure (identify and / or recruit) volunteers and service
testers (by Sept)
•
Secure suitable transport and book supported shopping
service (by Sept)
•
Review learning and plan future trips accordingly (by Oct)
Success measures
Community Services
•50% of identified Community Services have received and are displaying
and using the materials supplied (Dec 14)
•100% of identified Community Services have received and are displaying
and using the materials supplied (March 15)
Supported Shopping Service
•15 volunteers and 20 older people have been confirmed to test the
shopping service (by Oct 14)
•One shopping trip undertaken (by Nov 14)
•Second shopping trip (by Feb 14)
Risks
•Availability and cost of accessible transport may cause barriers to
encouraging the target group to participate
•Supermarkets may impose conditions which create complexities or add
cost
•Attracting, recruiting and sustaining necessary levels of trained volunteers
may create delays
Training
Training for Community Services
managers will be built into the
information and presentation pack
Training for volunteers will include:
• Age UK Salford’s induction
• Information session on the
objectives of the supported
shopping service
• Practical information on the
supermarket and needs of
identified shoppers
Resources
Team Structure & Roles
Others to involve
Report to Steering Group
Input from Jean Rollinson, Katie Foster, Stephanie Webb
Progress
Shopping Trip
•
•
•
First shopping trip took place in November – six people in
attendance
Preparation included:
• Targeting appropriate older people to attend
• Discussions with ASDA regarding preparation for the day
• Pull up poster purchased to have on show at the event
to encourage others to find out more
• Leaflets available
• Development of Top Tips Booklet which includes:
• floor plan of ASDA in Swinton
• information on what to look out for in each aisle
• Attendees rewarded with a cup of tea and biscuit for
participating
• Staff on hand to support (community dietitians, dietetic
assistants, Age UK etc)
Film clip developed:
http://communityreporter.net/videos/malnutrition-taskforce-trip-asda
Progress
Little Pot of Health Innovation Fund
• Representatives from Communities Together (an
income
generating
community
anchor
organisation) and a group of older people
attended the launch event in May.
• Successful application to the CCG Little Pot of
Health Innovation Fund by Inspiring Communities
Together.
• Funding will be used to raise awareness of ‘simple
messages’ about malnutrition in the form of post
cards and fridge magnets. These will be designed
to complement the design of the posters created
for use in GP practices.
• The postcards will have simple messages on one
side and on the reverse there will be an invitation
and voucher for people to come to Age UK
Salford’s Critchley House and Café where they can
have a free drink and cake and collect their free
fridge magnet.
Progress
Little Pot of Health Innovation Fund
The aim is to:
• keep count of the number of postcards taken
for the GP practices
• keep count of people presenting a voucher at
Critchley House and taking a Fridge Magnet ( in
return for a very simple question about their
understanding of the issues around
malnutrition)
• try and test out the use of Flo as a way of
keeping people regularly updated with key
messages about nutrition via text alerts on their
mobile phones
Progress
Raising awareness
Use of Twitter @AgeUK Salford
The Salford Together
Nutrition Armband
Salford Royal NHS Foundation Trust 2014 ©
SALFORD WORKSTREAM REMIT:
Community and Primary Care
Context
Purpose
Increase awareness and educate GP practices
Share information on nutrition with patients attending their GP practice
Objectives
•
•
•
•
•
To work in collaboration with 10 nominated GP practices re: sip feed prescribing and in conjunction with AgeUK and ICP to develop displays for the practices
Devise ONS pathway in conjunction with CCG medicines management
Dietetic team to write information for GPs on food fortification
GP contract BMI for >75 years to allow us to define prevalence of malnutrition in Salford
To increase awareness and educate GPs on Salford’s Managing Malnutrition in Community Policy
Links to MTF workstreams: raising awareness, working together, identifying malnutrition,
personalised care. Support and treatment,
monitoring and evaluation
Scope
Working in collaboration with 10 GP practices, MDTs within the ICPs, Medicines Management, Dietetics and AgeUK
Outputs
Deliverables
• ONS pathway developed and ratified March 2014
Patient Information Displays
• Agree draft content of information displays (sept 14)
• Produce information/laminate posters (Sept 14)
• Launch first display and audit (Oct 14)
• Information displayed in all GP surgeries (Jan15)
GP Staff Education
• Meet with 10 GP practices to educate on Salford’s Malnutrition
Policy (Sept14)
• Audit current sip feed prescribing practice (Sept 14)
• Re-audit 5 GP sip feed prescribing practice (Mar 15)
Success measures
Hard Success Measures:
•100% of the 10 nominated GP practices & MDG practices in ICP to have displays
•Audit patient information display to ensure its effectiveness
•ONS pathway agreed and ratified
•Improvement in GP awareness of malnutrition by re-auditing compliance with Salford Malnutrition Policy
•Increase BMI recording
Soft Measures:
•Content of display to be agreed
•Information to be written and agreed pertaining to food fortification for GP info
Risks:
•Lack of engagement by GPs
•Staff changes
Resources
Team structure and roles
Stephanie Webb – Project Management from
ICP
Claire Vaughan – Medicines Management from
CCG
Katie Foster – Team Leader – Community
Dietetics
Jean Rollins – AgeUK Salford
Kirstine Farrer – Consultant dietitian SRFT
Francine Thorpe – Head of Quality and
Innovation, CCG
Patient displays
Colette McLaughlin (appropriate prescribing dietitian)
Katie Foster – Team Leader – Community Dietetics
Student dietitians – TBC
AgeUK Salford
Stephanie Webb and Bernadette Alder – MDG
workstream
Auditing GPs:
Colette McLaughlin – appropriate Prescribing dietitian
Katie Foster – Team Leader – Community Dietetics
Claire Vaughan – Head of Medicines Management
Others to involve
Report to Steering Group
Progress
Patient Information Displays
•
•
•
10 practices identified as part of their high
sip feed prescribing
Content of displays
• Draft content developed and
evaluated by the dietetic assistants
with the practices
• Posters and Leaflets previously
outlined will be included
• Floor plans and isle information for
both ASDA and Morrisons
3 practices have displays to date.
Progress
GP Staff Education
•
•
Initially working with the practices within the Multi Disciplinary Groups within Swinton and Eccles
- 10 GP practices originally identified but now widening this remit. A further 10 practices outside
of Swinton and Eccles who are high prescribers of sip feed have been identified.
Community dietitians to work with these practices
BMI Recording
•
•
In-depth analysis of recording of BMI has been undertaken by Public Health. Public Health
attending the January Steering Group to discuss implications.
The Multi Disciplinary Groups in Swinton and Eccles are now routinely recording a person’s BMI
as part of the Shared Care Record.
Challenges and Achievements
Our Challenges
and Achievements
Challenges
Achievements
•
Developing a cohesive group – definitely
overcome this challenge!
•
•
Working across boundaries
•
•
Governance/accountability
•
•
Conflicting priorities
•
Group has developed and firm relationships are
now formed which ensures the sharing of
knowledge, skills and sense of humour!
The Salford Task Force membership represents
all sectors of health, mental health, CCG, and
third sector - Age UK, and includes a variety of
professional backgrounds including Dietician,
Occupational Therapist, Nutrition Nurse
Specialist, Project management, Pharmacist,
and a Commissioning Manager.
Governance - The Task Force is accountable to
the Salford Integrated Care Programme Alliance
Board, and provides update reports monthly, so
is now getting the messages heard.
Conflicting priorities will be an issue for all but
this work is now embedded
Next Steps
Next Steps
• Sustainability – meeting dedicated to this in January
• Local Celebration event in March – Nutrition and Hydration Week
Any Questions?