DDF June 2015: BAPEN has designed and is launching the first 'Nutritional Care Tool' which enables organisations to measure the nutritional care they provide and so robustly demonstrate both compliance to nutrition related care regulations and the areas where improvements are required. The Tool will be available at www.data.bapen.org.uk from 24th June and is free for all NHS and social care organisations.
Measuring nutritional care is complex and fraught with difficulty which is why many organisations have had to rely heavily on auditing of nutritional screening alone whilst failing to focus on measuring the quality of nutritional care that is actually delivered. The new Nutritional Care Tool, developed by BAPEN with support from its Core Groups (NNNG - the National Nurses Nutrition group, PENG - the Parenteral and Enteral Nutrition Group of the British Dietetic Association and PINNT - Patients on Intravenous and Nasogastric Nutrition Therapy) provides a much needed, local improvement assessment tool which easily permits measurement of the quality of nutritional care.
Anne Holdoway, Chair of PENG commented, “This new measurement tool is being launched at a time when dietitians are being increasingly asked to demonstrate their impact and provide assurance to their Trust Boards of the quality of nutritional care being provided. The ability to collectively measure nutrition screening, implementation of nutritional care plans, outcomes and the patient experience in a simple, systematic manner is particularly welcome and will provide extremely useful data at a local and national level. The nutrition dashboard that is a core part of the tool will also support organisations to not only identify areas where improvements are required, but to capture excellent practice that can act as a role model of care for adoption elsewhere.”
Steve Brown, General Secretary at PINNT and a patient on lifelong artificial nutrition was involved in designing the patient experience questions and commented: “I welcome this new Tool – which I see as a real collaboration between healthcare professionals and the patients they care for. I would expect patients to see this as a bonus – providing them with a way in which to have their voice “heard and heeded” by all those involved in the provision of their health care.”
What are the benefits of using the BAPEN Nutritional Care Tool?
- 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 deliver improvements.
- As a point of care measurement tool, improvements in nutritional care can be delivered whilst the patient is still in their care rather than the organisation having an over-reliance on retrospective audits.
- The Tool dashboard provides ward-to-board reporting of nutritional care to enable clinicians and senior leaders to identify areas of best practice and opportunities for shared learning.
- The inclusion of patient experience questions provides the opportunity for Trusts to demonstrate how they are responsive to patients’ needs.
- The Tool could be used to provide assurance of an organisation’s commitment to the delivery of good nutritional care and be used as evidence to provide assurance.
Why is there a need for a new nutritional care measurement tool?
Widespread recognition of the prevalence of malnutrition over a number of years has resulted in the publication of a plethora of standards and guidelines, including:
- NICE Guidance (2006)
- NICE Quality Standards (2012).
Concerns regarding the quality of nutritional care led the Care Quality Commission (CQC) to undertake themed inspections (dignity and nutrition) in 2011-12 that highlighted shortfalls in care. Despite these efforts, there continues to be widespread failure to deliver system wide quality improvements in nutritional care across acute, community and care home settings, with the exception of small pockets of excellent practice.
Even though the UK is one of the leading countries in tackling malnutrition the measurement of nutritional care has lagged behind other areas (such as VTE, cancer and diabetes) in the NHS. Work on a national scale has largely been limited to the measurement of the prevalence of malnutrition (during the National Nutritional Screening Weeks) and although the Hospital Episodes Statistics (HES) dataset contains a primary and secondary diagnosis code for malnutrition, it is rarely used and so cannot be adopted in an intelligent monitoring model. Although many Trusts are now regularly auditing nutritional screening practices, very few are auditing the quality of nutritional care delivered and where such audits have taken place, it has been reported that many individuals who are at nutritional risk do not receive appropriate levels of additional nutritional care.
Liz Evans, NNNG Chair commented: “The NNNG supports the development and launch of BAPEN’s Nutritional Care Tool. We feel it could provide a real opportunity to measure the processes of good nutritional care and more importantly monitor the patient experience. Adopting BAPEN’s Nutritional Care Tool will enable Trusts to showcase areas of good nutritional practice and identify areas requiring improvement. The Tool may also enable nurses to highlight barriers to the provision of good nutritional care, including lack of suitable equipment and the challenges of weighing patients in an acute care setting.”
Commenting on the launch, Dr Mike Stroud, BAPEN President said: “This new Tool will allow organisations to monitor the quality of nutritional care they actually provide and to identify weaknesses. Learning from areas of excellent practice will then help to improve standards in areas falling below required levels and, for the first time, we will have national tool that can document those improvements. By using this tool regularly, organisations will have robust assurance that they are meeting their obligation to provide good nutritional care to every patient, on every ward on every day’
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