Tackling Malnutrition BAPEN Actions to Combat Malnutrition
- Last Updated on 16 June 2012
BAPEN’s approach to fighting malnutrition in the UK has been wide ranging and comprehensive. BAPEN has recognised the need to engage with ALL stakeholders, including the public, patients, health and social care professionals, charities, Industry, government and regulators to maximise awareness of the problem and to embed good nutritional care in all settings.
The success of this approach is evident in many areas. The following are just a few of the more notable examples:
"I welcome the leadership shown by BAPEN and many other respected organisations that collaborated in developing this resource and I hope that care providers and commissioners will use it locally to make sure older people receive the nutritional care they are entitled to."
- Nutrition is included in the Chief Nurses “High Impact Actions”
- Nutrition and Hydration have been included as fundamental issues in the provision of harmfree care
- The National Patient Safety Agency (NPSA) have produced a series of Nutrition Fact Sheets to support the delivery of the 10 key characteristics of good nutritional care
- The Care Quality Commission has introduced basic enforceable nutritional care standards. It has now carried out detailed inspections and issued reports on the implementation of these standards.
- NICE has identified nutrition as one of the most cost effective investments with an estimated saving of £28,472 per £100,000 invested
- NICE is now developing a quality standard for nutrition support in adults, with the group being chaired by Professor Marinos Elia (a past Chairman of BAPEN)
- Nutrition is now included in two of the five domains of the Department of Health outcomes framework
- NICE is developing an IV fluid guideline, chaired by Dr Mike Stroud, (a past chairman of BAPEN)
- BAPEN, working with the Department of Health, has been instrumental in developing and delivering a national quality improvement strategy and implementation programme to ensure safe nutritional care is delivered for patients in England
BAPEN has achieved this by addressing the problem on many fronts. Some of these are explained in more detail below.
Data collection and analysis
The British Artificial Nutrition Survey (BANS) has been collecting data on patients on artificial nutrition in hospital and in the community since 1996. These data are then analysed and reported, both by region and nationally. A report is published annually to ensure the findings are widely disseminated.
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BAPEN’S Nutrition Screening Weeks were established in 2007 to establish the prevalence of malnutrition in adults on admission to care across the UK. Four screening weeks have now taken place across all four seasons and detailed reports have been written on each. The results are based on a total of 31634 patients who were screened on admission to hospital, 3604 who were admitted to care homes and 1206 admitted to mental health institutions. The final report comparing the 4 surveys is still awaited, but the results of the most recent survey still make shocking reading.
Key points from BAPEN’s fourth Nutrition Screening Week survey in the UK ‘Malnutrition’ in Spring 2011 ‘Malnutrition’ was found to affect:
- 1 in 4 adults on admission to hospitals
- More than 1 in 3 adults admitted to care homes in the previous 6 months
- Up to 1 in 5 adults on admission to mental health units in the UK
Most of those affected were in the high risk category.
- BAPEN’s Health Economic Report in 2005 was a wake-up call for all involved in nutritional care – the estimated cost of malnutrition of £7.3 billion being far greater than the costs associated with obesity Click here to read more
- BAPEN’s “Combating Malnutrition” report, published in 2008, estimated that public expenditure on disease-related malnutrition in the UK in 2007 was more than £13 billion a year Click here to read more
Development of tools
BAPEN launched the ‘Malnutrition Universal Screening Tool’ (‘MUST’) in 2003 to help identify adults who are underweight and at risk of malnutrition, as well as those who are obese. The tool underwent rigorous evaluation in hospital and community settings and was found to be easy to perform and reliable. ‘MUST’ has been widely adopted and is now the most widely used nutritional screening tool in the UK. It is also commonly used in other countries worldwide.
‘MUST’ continues to be developed to meet the needs of patients and health professionals – there is now a ‘MUST’ calculator available on the website and a ‘MUST’ app for the iPhone.
E-learning modules have been developed to support the use of ‘MUST in both the community and in hospitals. Click here to read more
Publications
BAPEN has produced many reports, setting standards and advising on best practice, on all aspects relating to the identification and management of patients who are either malnourished or at risk of malnutrition. Topics covered include:
- The detection and management of malnutrition
- Hospital food as treatment
- Enteral tube feeding
- Parenteral feeding (directly into the bloodstream) in adults and children
- The ethics of nutrition support
- The health economics of malnutrition, its consequences and its treatment
- The organisation of nutritional support in hospitals
- Improving nutritional care from the patients’ and carers’ perspective
- Policy and action recommendations
National Conferences
- BAPEN holds an annual conference that covers all aspects of nutritional care. This allows networking and the dissemination of best practice in nutritional care and encourages participation in education and research.
- BAPEN members are often invited to speak at meetings of other professional societies at home and abroad
- BAPEN members are also invited to speak at conferences on the delivery of all aspects of care – Dr Mike Stroud spoke at the Department of Health QIPP safe care conference in London in October 2011, leading to in depth dialogue with the Department of Health and the embedding of nutrition into Department of Health Policy, operating frameworks and contracting
- Teaching days are also held at the annual conference, bringing together all professions with an interest in nutrition and updating them with the latest thinking on topics of interest in nutritional care
- Each of BAPEN’s Core groups also hold their own annual conference, maximising the opportunity for education and networking
Regional meetings
- Most regions also hold an annual meeting or teaching day, to enable access to those who can’t get to the annual conference and allow networking locally
Briefings
BAPEN issues regular press releases and briefings on topics that are relevant to nutritional care – either relating to BAPEN activities, or responding to events
BAPEN actively seeks to engage with MPs and ministers – responding eagerly to the call from Downing Street in 2000 and more recently working towards setting up an All-party Parliamentary Group in Nutrition – shortly to become the Nutrition and Hydration action Alliance and calling for Andrew Lansley to work collaboratively to eliminate avoidable malnutrition through the development of a malnutrition strategy and the appointment of a national clinical director to lead this work.
Partnership working
BAPEN works with all professional groups that have an interest in nutritional care and BAPEN members will often represent BAPEN on the working parties of other professional societies or organisations (for example the Royal College of Physicians, the British Society of Gastroenterology, NICE and recently in the production of the consensus guidelines on peri-operative fluid management (GIFTASUP) , the Association for Clinical Biochemistry, the Association of Surgeons of Great Britain and Ireland, the Society of Academic and Research Surgery, the Renal Association and the Intensive Care Society).
- BAPEN works with numerous governmental and non-governmental organisations to produce reports. For example the report on “Screening for malnutrition in sheltered housing” was produce in association with Accent Group, City of Westminster Housing and Care, Essential Role of Sheltered Housing (ERoSH), Harrogate Neighbours, National Association of Care Catering (NACC), Nutricia UK and Richmond Housing Partnership. The “Nutrition Action Plan” included partners such as age Concern, British Medical Association, Caroline Walker Trust, Commission for Social Care Inspection, Council of Europe Alliance, English Community Care association (ECCA) and many others.
- BAPEN responds actively to any consultation documents relating to nutritional care – for example that on the Department of Health outcomes framework recently
- BAPEN actively promotes the involvement of its members in working parties – for example Professor Marino Elia is chairing the development of a NICE quality standard on nutritional care and Dr Mike Stroud chaired the guideline development group for the NICE guideline “Nutrition Support in Adults” and is now chairing the NICE guideline development group for IV Fluids
Education initiatives
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National and regional meetings and teaching days provide good opportunities for learning and education
- BAPEN ran an annual 3 day residential course for newly formed nutrition support teams for many years and continues to provide support and advice on setting up nutrition support teams
- BAPEN has developed e-learning for ‘MUST’ e-learning for ‘MUST’ in both hospital and community settings
- BAPEN has developed e-learning modules for junior doctors and made these freely available via its website
- BAPEN members are actively involved in setting the curriculum and exam questions for the training of junior doctors in nutrition
- BAPEN is actively engaging with the ESPEN (European Society of Parenteral and Enteral Nutrition) lifelong learning programme to make its diploma programme more accessible to trainees (both medical and non-medical) in the UK
Networking
One of the key benefits for BAPEN members is the opportunity to network with colleagues who are also working in the field of nutritional support. Networking opportunities lead to many benefits including opportunities to get involved in the work of BAPEN committees, development of new resources, planning the conference and regional events, collaborative research and perhaps most importantly sharing of best practice.
