Transcript Nutrition screening: why bother

Nutrition screening:
why bother
Adapted presentation originally prepared by:
Christine Russell RD
Hon Treasurer
BAPEN
British Association for Parenteral and Enteral Nutrition
www.bapen.org.uk
Registered Charity No: 1023927
BAPEN
• Multi-disciplinary charity dedicated to raising
awareness and standards of nutritional care
• Founded in 1992 – “A Positive Approach to
Nutrition as Treatment” Kings Fund Centre Report
• Increasing focus on nutritional care and
status of all consumers of health & social care
• ‘Malnutrition Universal Screening Tool’
(‘MUST’) 2003
• Health Economic Report 2005
www.bapen.org.uk
Registered Charity No: 1023927
King’s Fund Centre Report
(1992)
“ only when the assessment of every
patient’s nutritional status has become
routine will the full benefits of nutrition
treatment be realised”
www.bapen.org.uk
Registered Charity No: 1023927
Defining malnutrition
No universally accepted definition but the following has
been suggested:
“ A state of nutrition in which a deficiency or
excess (or imbalance) of energy, protein and
other nutrients causes measurable adverse
effects on tissue/body structure and function
and on clinical outcome”
www.bapen.org.uk
Registered Charity No: 1023927
Causes of malnutrition
Multifactorial!
• Clinical – associated with disease leading to problems
such as nausea and vomiting, pain, malabsoprtion,
infections, difficulty eating and swallowing, confusion,
medication…
• Important changes to the body with ageing
• Lifestyle – accessibility shops, finances, cultural, living
conditions, bereavement, depression, cooking ability and
knowledge
www.bapen.org.uk
Registered Charity No: 1023927
Prevalence of malnutrition
% underweight adults (BMI<20kg/m2 ) living freely in the
community, hospital & residential accommodation Elia/MAG 2003
General population:
England
Scotland
Wales
Patients in the community:
Major surgery previous 6 wks
Chronic diseases
Residential accommodation:
In UK >65 yrs
In Scotland >65yrs
Hospital:
5.2%
5.5%
5.0%
>10.6%
12.2%
16.0%
29.0%
13-40%
www.bapen.org.uk
Registered Charity No: 1023927
Prevalence of malnutrition on
admission (BAPEN NSW07)
Hospitals
• Overall
28% ( 22% high risk, 6% medium risk)
• Acute hospitals
27%
• Community hospitals 29%
Care Homes
• Overall
• Nursing homes
• Residential homes
30% (20% high risk, 10% medium risk)
35%
22%
Mental Health Units
• Overall
• Acute units
• Long stay/rehab.
19% (12% high risk, 7% medium risk)
31%
21%
www.bapen.org.uk
Registered Charity No: 1023927
Consequences of malnutrition
• Increased morbidity
• Increased length of stay
• Increased dependency
• Increased mortality
• Increased costs of care
www.bapen.org.uk
Registered Charity No: 1023927
The Malnutrition Carousel
28% of patients
admitted to hospital are
malnourished
Hospital
Home
More GP visits
Longer stay
More hospital
admissions
More support postdischarge
More likely to be
discharged to Care Homes
Up to 70% of patients
discharged from hospital
weigh less than on admission
Why screen for malnutrition?
• Malnutrition is frequently unrecognised and
untreated
• Malnutrition costs health and social care
≥£7.3b/year
• Effective management of malnutrition improves
clinical outcome and reduces costs
• Regular screening is the only way that
malnourished individuals can be identified and
appropriate action taken
• Recommended / required by various bodies e.g
NICE, NHSQIS, Council of Europe, Care
Commissions
www.bapen.org.uk
Registered Charity No: 1023927
Who to screen & when?
Hospital – on
admission
• In
• In Care – on admission
& monitor as appropriate
• In the Community – on
registering with a GP & at
Annual Check for 75
years +
Definitions
Nutritional screening
Rapid, simple general procedure done at first
contact with subject to detect risk of
malnutrition, done by nurses, doctors or other
HCWs
Nutritional assessment
Detailed, more specific in depth evaluation of
subject’s nutritional status, done by those with
nutritional expertise
www.bapen.org.uk
Registered Charity No: 1023927
How to screen?
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Establish screening policy
Use a validated tool
One that is quick and easy to use
Establish care plans
Identify resources
Educate and train staff
Audit practice
NICE Guidance and Scottish Standards
based on ‘MUST’
www.bapen.org.uk
Registered Charity No: 1023927
The ‘Malnutrition Universal
Screening Tool’
(‘MUST’)
www.bapen.org.uk
Registered Charity No: 1023927
Malnutrition Universal Screening Tool
Screening as part of the patients
journey
Where is he/she now?
• BMI an indication of current nutritional status
Where has he/she come from? i.e past
history
• Recent weight loss
Where is he /she going? i.e likely clinical
course
• Acute disease effect
www.bapen.org.uk
Registered Charity No: 1023927
Step 1: BMI
• Obtain weight and height
• Calculate BMI or use BMI chart provided to
get score
• Use recalled height and weight or
recommended alternative methods of
measurement if actual values cannot be
obtained
www.bapen.org.uk
Registered Charity No: 1023927
BMI Score
BMI
>20 kg/m2
18.5-20 kg/m2
<18.5 kg/m2
>30 kg/m2 ( obese )
Score
0
1
2
0
www.bapen.org.uk
Registered Charity No: 1023927
Unintentional weight loss over 3-6
months
•
<5% body weight: normal intra-individual variation
• 5-10% body weight: of concern
– decrease in voluntary physical activity
– increase in fatigue
– less energetic
• >10% body weight: of significance
– changes in muscle function
– disturbances in thermoregulation
– poor response or outcome to surgery and chemotherapy
www.bapen.org.uk
Registered Charity No: 1023927
Step 2: Weight loss score
• Indicates acute or recent-onset malnutrition
Score
<5% body weight: 0
5-10% body weight: 1
>10% body weight: 2
www.bapen.org.uk
Registered Charity No: 1023927
Step 3: Acute disease effect
• Patients who are acutely ill AND have had or
are likely to have no nutritional intake for
more than 5 days
• Most likely to apply to patients in hospital
• Add 2 to score
www.bapen.org.uk
Registered Charity No: 1023927
Step 4: Overall risk of
malnutrition
• Total of scores from Steps 1, 2 and 3
• Document score
0 = Low risk
1 = Medium risk
2 or more = High risk
www.bapen.org.uk
Registered Charity No: 1023927
The old ones are the best
“It is not for the sake of
piling up miscellaneous
information or curious
facts but for the sake of
saving life and
increasing health and
comfort”
F Nightingale 1859
www.bapen.org.uk
Registered Charity No: 1023927
Care plan
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Set aims and objectives
Agree management of those at risk
Treat underlying conditions
Improve nutritional intake
Monitor and review
Reassess subjects at nutritional risk as
they move through care settings
www.bapen.org.uk
Registered Charity No: 1023927
It’s not…
In summary
We should bother to screen because:
• Malnutrition in UK is common and costs
≥£7.3billion
• Screening identifies those at risk, enabling
early intervention.
• Screening is simple and quick to do and
recommended / required by various bodies
• Working together helps overcome barriers
www.bapen.org.uk
Registered Charity No: 1023927