Health Service Focus

10-Point Plan – Managing Malnutrition, Effectively

Source: NHE Nov/Dec 19 

Johnny Skillicorn-Aston, director of Engagement and communication, Conclusio

Following the discussions during the roundtable around malnutrition, the present panel called for a series of actions to help improve the situation.

Those actions included an accountability framework which outlines the process by which the threefold outcomes for patients, population and society will be measured and, critically, allocates the stewardship for the entire process.

Within the framework, the panel concluded that the following objectives were necessary – determining the outcomes which would define the goals of success for bringing down the incidence, impacts and consequences of malnutrition:

 Objective 1

• Identify those who are at risk of malnutrition and/or dehydration in a timely and reliable manner
• Identify malnutrition and/or dehydration in a timely and reliable manner

Outcome – Increase in the people who are at risk of malnutrition and/or dehydration for whom an intervention is provided to prevent them from becoming malnourished and/or dehydrated

Objective 2

• Manage (slow/stop/reverse) malnutrition and/or dehydration safely and effectively in a timely manner
• Empower and educate those who are or are at risk of being malnourished and/or dehydrated, as well as their carers, as equal partners

Outcome – Proportion of individuals identified as being malnourished and/or dehydrated who are no longer malnourished and/or dehydrated in an agreed amount of time (time period to be based on best practice)

• Proportion of individuals identified as being malnourished and/or dehydrated who are no longer malnourished and/or dehydrated (using BMI, muscle density, grip strength, MUAC, etc)

Objective 3

• To build the skills of and provide tools to stakeholders (clinical and non-clinical) to manage malnutrition and/or dehydration according to evidence-based best practice • To make best use of resources.

Outcome – Certified (NICE CG32) lead responsible for malnutrition at an ICS level (certification process to be defined) • Certified lead will expose all stakeholders (clinical and/or non-clinical) about basic management of malnutrition and/or dehydration • Agree the management outcomes these individuals should be held accountable for.

Panel member, Andrew Lane, chair of the National Pharmacy Association, said: “There is no doubt that if we do not make nutrition and hydration everyone’s business and give health and social care professionals the license and flexibility to perform their crucial role in prevention and case-management, we will continue to miss a real opportunity.” 

Overall, the conclusion of the panel’s thinking based on the out turn of the ‘Feeding Better Outcomes’ report showed a consensus for action in setting measurable, accountable objectives and people-centred outcomes.

The ‘Feeding Better Outcomes’ report cites a full range of recommendations, with some of the most pressing identified in order to create the right conditions for a national nutrition and hydration pathway.

These included the creation of a clinical standards board for the management of malnutrition in each of the new Integrated Care Systems (ICS), integrated approaches and a system-wide approach to malnutrition, fixed-point identification of need and unmet need, and the creation of a nutrition charter.

As the BSNA remarked at the close of the roundtable discussion: “As the number of adults being admitted to hospital with a primary diagnosis of malnutrition has more than doubled in the last decade, and those with a secondary diagnosis has trebled over the same period, it is vital that at both national and ICS level, greater leadership is given to ensuring appropriate nutritional care is embedded across all settings and for all patients at risk of malnutrition.  This is a vital step in improving care for those in need of nutritional support.”