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Issued: 24th June 2010
BAPEN Welcomes the Evidence Contained in the NCEPOD Artificial Nutrition Enquiry Report Published Today
(A Mixed Bag, 24th June 2010)
Dr Mike Stroud, Chair of BAPEN states:
“The NCEPOD Report ‘A Mixed Bag’ (1) provides solid evidence that many hospitals are currently delivering unsafe artificial nutrition to the most vulnerable adults and babies.
The irrefutable data confirm what BAPEN and other organisations such as NICE have been saying for some time – that standards in nutritional care must be improved to ensure all patients receive quality, safe and equal treatment from staff who are appropriately trained and supervised.
Artificial or parenteral nutrition (PN) is tube feeding delivered intravenously and is used where the gut is inaccessible or unable to absorb sufficient nutrition. It is an invasive and complex procedure which requires input from a multi-disciplinary team to deliver the specialist training, supervision and monitoring needed to avoid the inappropriate use and avoidable complications identified in the NCEPOD Report.
Previous evidence (2) has already established that improved nutritional care is delivered when a hospital has a multi-disciplinary Nutrition Support Team (NST), a practice that BAPEN and its members have long championed. Although we have not had the opportunity to examine the data from each hospital site, we are confident that examples of better practice were observed where such teams were in place.”
BAPEN ‘s recently published Malnutrition Matters Toolkit (3) provides a framework for both Commissioners and Providers to establish quality and safe standards in nutritional care from food and supplements at one end of the spectrum to the highly specialised PN investigated by NCEPOD at the other. The Toolkit guidance is based on four key tenets:
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Screening to identify nutritional care needs followed by detailed assessment
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Care pathways in place with appropriate monitoring
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Training for all staff to appropriate levels
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Management structures in place to support the delivery of safe nutritional care of the highest quality
Dr Mike Stroud continues:
“BAPEN supports the recommendations set out in the NCEPOD Report, particularly those concerned with training of staff in decision-making and monitoring. However, in response BAPEN makes two further recommendations:
- All acute hospitals should have multi-disciplinary NSTs in place to oversee PN prescription and management in line with previous recommendations from NICE and BAPEN.
- A rolling system of registration and audit of all patients on PN should be established to monitor practice and hence secure improved standards in PN usage and on-going care. This registration and audit system could be delivered by extending BAPEN’s existing BANS database (4) which currently covers patients on long-term home PN, to cover all PN patients, both in and out of hospital. BAPEN would welcome support to develop this idea in partnership with the DH. The system would also support the work of the newly established commissioning and management framework that deals with intestinal failure and longer-term PN known as HIFNET. (5)”
“BAPEN issues a challenge to the Coalition Government to implement fully the recommendations from the Delivery Board of the Nutrition Action Plan (6), which included the establishment of clear political leadership for this topic, together with a public and professional awareness campaign on the impact of poor nutritional status on health outcomes.
BAPEN itself is intent on promoting such leadership by establishing an All Party Parliamentary Group on Nutritional Care including Hydration in partnership with parliamentary and professional colleagues. This group will help ensure that safe nutritional care of all types continues to make its way up the political, professional and practical agendas for the benefit of patients, residents and people of all ages across primary, secondary and community settings.”
Footnotes:
[1] NCEPOD is an independent charitable organisation that reviews medical and surgical clinical practice and makes recommendations to improve the quality of the delivery of care by undertaking confidential surveys covering many different aspects of care and making recommendations for clinicians and management to implement. ‘A Mixed Bag’ reports the findings of a study that reviewed the care of patients who received parenteral nutrition in hospital. Data was collected from 1211 sets of case notes and 1646 questionnaires across 150 NHS Hospital Trusts.
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The majority of members of the Expert Group who advised NCEPOD on the study are members of BAPEN and more than half the Advisors who reviewed the cases are also members.
[2] NICE, 2006: Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition http://guidance.nice.org.uk/CG32
Lennard-Jones J 1992, A positive approach to nutrition as treatment, Kings Fund, London
[3] The BAPEN Nutritional Care Commissioning Toolkit ‘Malnutrition Matters’ is free to download here until the end of 2010 (www.bapen.org.uk) Printed copies are available to order from the BAPEN website. The Commissioning Toolkit is endorsed and supported by BAPEN Council and the charity’s core groups (PENG, NNNG, BPNG, BAPEN Medical, Nutrition Society and PINNT the patient organisation) and the following organisations – RCP, Age UK, RCN, BDA, NPSA, BSPGHAN, NHS County Durham & Darlington, and the Patient Safety Federation.
[4] BANS British Artificial Nutrition Survey the unique national audit of clinical nutrition practice, managed and currently funded solely by BAPEN, has made vital contributions to the planning and delivery of high quality nutritional care in the UK.
[5] HIFNET, the Home Intestinal Failure Network, brings the multidisciplinary team including medical and surgical clinicians together to improve standards, share good practice and highlight challenges in the long term management of intestinal failure and PN. A commissioning framework has recently been established endorsed by NHS specialised commissioning, the Royal College of Physicians and Royal College of Surgeons of England with BAPEN members.
[6] Access the Nutrition Action Plan developed by the DH with stakeholders at the Nutrition Summit, the Final Report of the Delivery Board and the previous Government’s response (Feb 2010) at http://www.dh.gov.uk
Notes to Editors:
1. Dr Mike Stroud, Chair of BAPEN is available for interview and comment and will be speaking at the launch of ‘A Mixed Bag’ organised by NCEPOD on 24 June 2010 at the Wellcome Collection, 183 Euston Road, London NW1 2BE. To arrange interviews please contact Rhonda Smith as below.
2. BAPEN, the British Association for Parenteral and Enteral Nutrition, is the multi-professional association and registered charity, committed to addressing malnutrition & to improving nutritional care and treatment in hospital, care & community. BAPEN is Registered Charity No. 1023927 www.bapen.org.uk
3. A Symposium addressing the specific training needs of all working with PN is being held as part of BAPEN’s ‘Malnutrition Matters’ annual conference in Harrogate (2-3 November 2010 full details on line at www.bapen.org.uk). Abstract submission deadline 2 July 2010. Early Bird delegate rates close 30 July 2010.
Further Media Information:
Rhonda Smith / Marc Catchpole @ Minerva on 01264-710428
07887-714957 / 07753-821525 info@minervaprc.com