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MUST – “Acute and Community approaches”. Tina Howe Specialist Dietitian Nutrition Support Team Leader. Community : How we got to where we are. 2008 RCN Nutrition now Project 2009 MUST rolled out 2010 Nursing home project. Where we are now. MUST April 2010 – March 2011 - PowerPoint PPT Presentation
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The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
MUST – “Acute and Community approaches”
Tina Howe
Specialist Dietitian
Nutrition Support Team Leader
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
Community :How we got to where we are
2008 RCN Nutrition now Project
2009 MUST rolled out
2010 Nursing home project
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
Where we are nowMUST
April 2010 – March 201116 training sessions in community hospitals20 training sessions to community nurses
15 sessions to nursing homes
April 2011 – September 22 training sessions
community nurses, intermediate care teams, cardiac nurses, Physiotherapists,
5 training sessions to Nursing Homes on food fortification
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
AUDIT May 2011Community Hospital
Ward A 100% patients
MUST completed100 % accurate
Ward B80 % MUST
completed 69% accurateMistakes with
Calculating the BMI and % weight loss
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
Before MUST introducedEach Year• 1011 inpatients seen in community hospitals • 43 Dom visits carried out.
After MUST• 351 inpatients seen• 498 Dom visits / telephone reviews carried
out
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
Acute :How we got to here
March 2010Two major trust wide audits to assess prevalence of
malnutrition within TrustRBH prevalence around 30% of all in patients
Only 24% of all in patients have a MUST carried out within 24 hours
2 out of 3 at risk in patients not identified
Key Nutrition Standards
Screening for malnutrition : It’s a MUST
75% patients have a MUST screen completed within 24 hours of admission to Trust
75% completion of Nutrition Care Bundles
All hospital in patients must be screened using Malnutrition Universal Screening Tool (MUST) within 24 hours
All patients with a MUST score of 1 or more will be commenced on Nutrition Care Bundle
All Patients with a MUST score of 1 or more will have nutritional care plan
Monthly audits on use of MUST/Care Bundle
All patients with a MUST score of 2 or more to be refereed to die titian within 24 hours
Monthly Nutrition Audit FindingsPercentage of patients screened with MUST tool
0
10
20
30
40
50
60
70
80
90
100
Mar-10
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11
Per
cen
tage
%
24h
48h
Trust target
In Summary Progress we have made
Establishment of Nutrition Champion Network
Three Divisional Nutrition Quality Forums
A key focus on the use of MUST
Implementation of the Nutrition Care Bundle and Nutrition Care Plan
Monthly Auditing
Promoting protected mealtimes, right meal, right time , right help
Putting Nutrition on Trust ward/dept agendas
Excellent role modelling
The Way Forward : Key Priorities next 12 months
Continue to drive up MUST assessment within 24 hours of admission- need to be aiming for 90%
To commence the ‘Facilitating Adult Patients to eat and drink’ programme, pilot on two elderly care wards
Hydrant pilot – pilot Kennet/Loddon and Burghfield Ward
Pre-op fasting times
Access to snacks particularly in paediatrics
The Community Health Services for Berkshire East and Berkshire West are part of Berkshire Healthcare NHS Foundation Trust as of 1st April 2011
“Are we seeing fewer Patients admitted to hospital who are
malnourished?”
“Are we seeing fewer patients discharged from hospital who are
malnourished?”
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