Transcript Document
Malnutrition Prevention Programme
Gateshead
Tracey Dixon Julia Wood
Contents
• The Five Principles • Setting the Scene • Our Approach • Launch Event • Workstream Remits • Challenges and Achievements • Next Steps
The Five Principles
Raising Awareness Working Together Identifying Malnutrition Personalised care, support and treatment Monitoring and evaluation
Setting the scene
Overview of Gateshead
• Total population is 200,000 • Five localities • Gateshead is in the top 20% of those areas with the highest levels of social and economic deprivation • Population of people aged 65 or older is 36,500 • Population of Gateshead is projected to grow by 5% by 2032 with the greatest changes expected in the number of people aged 65 or older • More than one third of people aged 65 or older live alone, 12,138 people in total • Large Orthodox Jewish community • 14% (just over 5100) of people aged 65 and over may be at risk of malnutrition (using BAPEN prevalence tool)
Gateshead Steering Group Membership
Name Job Title
Jim Brown (Chair) Sharon Stuart Sharon Dryden Carol Wood Robert Buckley Madeleine Lee Tracey Dixon Tracey Cowper Daphne Patel Margaret Barrett Public Health Specialty Registrar & GP Chief Executive Healthy Lifestyles Coordinator Director of Public Health Chair Nutrition Nurse Specialist Diabetes and Weight Management Team Leader Clinical Operational Manager, District Nursing Gateshead and Bladder and Bowel Service Team Manager, Social Care and Independent Living Lead Manager/Principal Social Worker, Adult Social Care
Place of work
Gateshead Council Age UK, Gateshead Age UK, Gateshead Gateshead Council Healthwatch, Gateshead Queen Elizabeth Hospital Queen Elizabeth Hospital North Tyneside NHS FT Gateshead Council Gateshead Council
Salford Steering Group Membership
Name
Victoria Holliday Lesley Bainbridge Julia Wood
Job Title
Commissioning Office, Commissioning and Business Development (focus on care homes) Project Lead, Integrated Care and Older People’s Services AQuA Affiliate
Place of work
Gateshead Council Gateshead CCG
Our approach
• Methodology – Short sessions: • PDSAs • Measurement • Behavioural change • Sustainability (date TBC) • Workstream Remits (identified through a matrix) • Action Plan
Launch Event - June
Project Launch Event
Aims
To share the work of the MTF and the effects of malnutrition Identify gaps in current service provision Shape the priorities for taking the work forward
On the day
Over 80 people in attendance Event was a mixture of presentations, interactive breakout sessions, and group work
Outcomes
Good evaluation Learning developed into workstreams Pledges
Photos
Work Stream Remits
Use of volunteers Raising awareness with staff Use of standardised tool Consistency of sharing knowledge and skills Raising awareness with the public
GATESHEAD WORKSTREAM REMIT:
Use of volunteers at mealtimes Context
Provide support to patients at mealtimes to ensure they are receiving the nutrition they need
Objectives
Through the increased use of volunteers everyone within the identified care settings is offered the option of having support/company at meal times by volunteers by March 2015
Links to MTF workstreams: raising awareness and personalised care support and treatment
Deliverables
•Understand current number and use of volunteers who proactively offer support/company within PICs (by end August) •Identify any training gaps (by end August) •Understand current number of people not proactively offered support/company (by September) •Identify number of additional volunteers required (by end September) •Understand barriers e.g. policies around mealtimes in PICs (by end July) •Gain senior level buy-in (by end August) •Develop training package (by end October) •Recruit volunteers (ongoing)
Scope
Promoting Independence Centres (PICs) •Deliver training package to current volunteers (where appropriate) and new volunteers (ongoing)
Success measures
•100% of current (where appropriate) and new volunteers trained •Increased recruitment of volunteers working in PICs at mealtimes to meet demand •Satisfaction survey by users •Satisfaction survey of volunteers •? Less waste and cost of food (? one care setting) to demonstrate impact Risks •Lack of senior level buy in •Lack of demand •Lack of volunteers •Cost of training •Volunteer expenses/overheads for VCS •CRB, clearances, red tape issues •Policy restrictions
Team structure and roles
Lead: Daphne Patel, Social Care and Independent Living Lead
Others to involve
Report to Steering Group
Progress
• • • Four Promoting Independence Centres (PICs) – Testing use of volunteers in Southernwood initially – intermediate care and accommodation for people usually over 65 – Plan to share learning across all PICs and beyond Has been challenging to recruit volunteers but to date X has been recruited and trained (from Gateshead Voluntary Organisations Council) Plan is to incorporate the following questions into the satisfaction survey: – Were you offered the opportunity to have a volunteer to support you at mealtimes?
– If no, would you have liked to have had a volunteer to support you at mealtimes?
– If yes, did you find having a volunteer to help you at mealtimes helpful?
GATESHEAD WORKSTREAM REMIT:
Raising awareness across staff groups Context
Ensure all staff have an awareness of the effects of malnutrition and what to look out for
Objectives
•To raise awareness about malnutrition and its negative impacts on health amongst health and social care professionals working in the community •Link to workstream 3 and 5: increase knowledge and skills amongst these groups to be able to comprehensively assess nutritional status and recognise malnutrition, signpost or refer to other professionals and wider services, and if appropriate initiate appropriate management of malnutrition.
Links to MTF workstreams: raising awareness, working together
Scope
Health, social care and community settings in Gateshead
Deliverables
•Support start-up event to raise awareness among health and social care professionals from across Gateshead [by end June 2014] •Identify key groups/teams and distribute information leaflets and posters. [by end July 2014] •Agree key messages and care pathways for groups/team [by end of November 2014] •Engage with key groups/teams to raise their awareness [by December 2014]
Success measures
•By 30 th June 2014 have supported the start up event •By end of July 2014 have distributed posters and information leaflets to key groups/teams •By end of December 2014 to have arranged awareness raising session with key groups/teams •By end of March 2015 to have undertaken awareness raising sessions with key groups/teams
Team structure and roles
Lesley Bainbridge (CCG; co-Chair) Margaret Barratt (Adult Social Care; co-Chair) Dr Jim Brown (Public Health) Lynne Shaw (Nurse Specialist for Older People STFT)
Others to involve
Report to Steering Group Input from workstreams 3 and 5
Progress
• Chairs acted as facilitators at ‘start up’ event • Established links with nurse specialists for older people aligned with all Gateshead nursing homes • Posters and information distributed to all community health teams • Time taken to understand and determine interface with training work stream • On target to have key group meeting December 2014 so as to have undertaken all awareness raising sessions by end of March 2015
GATESHEAD WORKSTREAM REMIT:
Use of a standardised tool Context
Staff, regardless of which organisation, use the same validated assessment tool
Objectives
Promote the use of a validated assessment tool across all care settings in Gateshead by March 2015 and develop Train the Trainer Programme for delivery
Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care, support and treatment, monitoring and evaluation
Scope
Hospital (21 wards), pilot care homes (5) and promoting independence centres (4)
Deliverables
•Agree on a preferred validated tool (by end July) •Understand through audit the number of care setting where validated assessments tools are being used, and which tools are currently being used, to understand baseline (by end August) •Identify number of care settings where training of proposed validated assessment tool could take place (by end August) •Gain organisational/senior level buy-in (from now until March 15) •Develop questionnaire to understand potential problems (by Nov 14) •Develop training package and train the trainer package (by end dec) •Deliver training package within those organisations who agree to use the suggested tool (January through to March 15 )
Team structure and roles
Tracey Dixon (Diabetes and Weight Management Team Leader, QEH) to Lead Madeleine Lee(Nutrition Nurse Specialist, QEH) Victoria Holliday (Commissioning Officer ,Commissioning and Business Development Gateshead council) Julia Wood (AQuA Affiliate) Aileen Spain (acute team leader dietitian , QEH)
Success measures
Measures: •45% of care settings in Gateshead who agree to use the preferred validated tool have received training in train the trainer (by March 2015) •Stakeholder analysis (before and after) Risks: •Care homes have corporate policies which may restrict implementation (but potentially have commissioning frameworks which could influence this but this could take time due to commissioning cycle) •Level of transition costs (printing, training) •Lack senior-level buy in
Others to involve
Report to Steering Group
GATESHEAD WORKSTREAM REMIT:
Consistency of sharing knowledge and skills Context
To ensure all staff have the same knowledge and skills regardless of where they work
Objectives
Enable consistency of sharing knowledge and skills around approaches to nutrition and hydration across professional groups and settings by March 2015
Links to MTF workstreams: raising awareness, working together, identifying malnutrition, personalised care, support and treatment, monitoring and evaluation
Scope
Hospital (21 wards), pilot care homes (5) and promoting independence centres (4)
Deliverables
• Identify what is currently shared, where and how through a mapping exercise to develop baseline (by nov 14) • Identify best practice in each sector (by dec 14) • Define knowledge and skills to be shared (?against published criteria) (by Dec 14) • Design consistent training skills package (by Nov 14) • Develop strategy to support consistency (by Dec 14) • Within each setting identify training gaps (by Dec 14) • Deliver strategy to those organisations wishing to be involved (by March 2015) • Develop rolling programme to use post March (by March 2015)
Team structure and roles
Tracey Dixon (Diabetes and Weight Management Team Leader, QEH to Lead Julia Wood (AQuA Affiliate) Lynne Shaw Victoria Holliday (Commissioning Officer ,Commissioning and Business Development Gateshead council) Nursing Home Representative (TBC)
Success measures
•45% of care settings in Gateshead have received training in train the trainer (by March 2015). •Stakeholder analysis (before and after) Risks •Unable to access appropriate level of funding •Lack of buy-in by organisations to release staff
Others to involve
Report to Steering Group
Progress
• Considering what level of involvement is required by different staff groups: – Identifier – who will actively screen and take appropriate action – Reporter – they will report their concerns to someone more senior to take action • Event planned for January/Feb 2015 to showcase the new screening tool of choice – MUST (currently use NRS Tool – Nutritional Risk Screening) and increase consistency of knowledge and skill • At this event there will be training on: – How to use the tool – What actions to take after someone has been identified as being malnourished (or at risk of) – Practical tips on how to fortify normal foods to prevent malnutrition developing or progressing • Overarching plan is to develop a rolling training programme which includes an easy to use board game on malnutrition for all involved
Progress
• Training Needs Analysis developed and circulated to support in the understanding of what people are currently doing, what training they have had in the past, and what training they will need in the future around malnutrition and MUST • Although this is still underway, current findings show that 65% are – happy with the proposed change – don’t see any problems with the changeover of tool for those involved – eager to have the levels and personnel clearly defined with their areas (identifiers/reporters)
GATESHEAD WORKSTREAM REMIT:
Raising awareness for the public Context
To raise awareness across the Gateshead community so signs of malnutrition can be identified early
Objectives
To raise awareness about malnutrition in older people living in the community and its negative impacts on health amongst older people and their carers
Links to MTF workstreams: raising awareness, working together
Scope
Gateshead community settings
Deliverables
•Organise a start-up event to provide an opportunity for local organisations that are participating in the Pilot to meet and agree a shared vision and objectives •Run information sessions at appropriate venues aimed at older people and their carers •Engage five local VCS organisations in raising awareness about malnutrition and their beneficiaries including carers organisations •Deliver six eat well events in the community aimed at older people and their carers •Work with Tesco community champions to deliver a number of shopping events at the new Tesco superstore in Trinity Centre Gateshead •Engage with local GP practices to raise awareness about the project •Raise awareness at CEO level within VCS •By 30 th
Success measures
June 2014 have delivered the start up event •By end of December 2014 delivered 15 information events and/or opportunities •By end of December 2014 engaged with five VCS organisations who will be more informed about nutrition and older people •By end of December 2014 delivered three supermarket based shopping events •By end of December 2014 developed closer links with a number of GP practices
Team structure and roles
Lead by AgeUK Gateshead I Sharon Stuart and Sharon Dryden
Others to involve
Report to Steering Group
Progress
• TV appearance – Sharon Stuart from Age UK did a TV appearance in August • Local news – Article in Council News
Progress
• KAP Survey – Number of older people/carers who said they have no information reduced from 29% to 14% – Number of older people/carers who said they have enough information increased from 26% to 32% – Recognition for symptoms such as ‘a lack of food in the cupboard or fridge’ increased from 59% to 71% amongst healthcare professionals • Use of Twitter, website pages, and leaflet drops Statistics have been reported through Twitter and also on a dedicated page on the Age UK website. The ‘Eat Well Live Well Lunches’ have been highlighted on both and leaflets to homes, community centres and VCS organisations have been distrobuted. • CEO Raising awareness at the Older Peoples Partnership Board, Gateshead CCG, Gateshead Health NHS Foundation Trust and target VCS groups
Progress
• Information sessions – Held at numerous venues aimed at older people in the community. Venues include the Queens Elizabeth Hospital, Gateshead Civic Centre, community and other Gateshead VCS groups such as Alzheimer’s Society, Crossroads, Gateshead Older Peoples Assembly, Groundworks and Gateshead Carers – Stands with representative from AgeUK Gateshead – Stands with information, statistics and leaflets – Queen Elizabeth Hospital – afternoon tea with patients and families
Progress
• Eat Well Live Well Lunches – Held in Low Fell (day centre), Gateshead – • 6 to date (23 people in total) – Uptake initially slow but an improvement in numbers over recent months – Voluntary qualified chef prepares appetising dishes that have been copied and produced by way of leaflets
• •
Progress
Shopping trips
– Difficulty building relationships with Tesco and Sainsbury’s – Just going ahead with them now: • Four delivered to date – approximately 30 people • Provide transport (Age UK Gateshead bus) • Meet in the cafe • Discuss the project and its aims • Volunteers on hand to assist with wheelchairs and the less mobile
GP engagement
– Slower than anticipated – Age UK recruited a new Primary Care Navigator role (encourage involvement with Age UK Gateshead including malnutrition work) – Working with three GP practices in Gateshead from January
Challenges and Achievements
Our Challenges and Achievements
• • • • •
Challenges
Developing a cohesive group Working across boundaries Governance/accountability Conflicting priorities Change in leadership
Achievements
• Relationships have now formed which ensures the sharing of knowledge and skills • Great launch
Next Steps
Next Steps
• Sustainability • Scoping document • Local event - ? planning