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TACKLING MALNUTRITION IN CARE SETTINGS

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Responding to the National Institute for Health and Clinical Excellence's guidance on tackling malnutrition in the ...
Responding to the National Institute for Health and Clinical Excellence's guidance on tackling malnutrition in the NHS (see below), Commission for Social Care Inspection chief inspector David Behan said:

'The new NICE guidance makes an important contribution to tackling malnutrition in NHS and care settings. The guidance is in line with the Department of Health's national minimum standards (NMS) for care homes for older people. These national standards guide that 'Nutritional screening is undertaken on admission and subsequently on a periodic basis, a record maintained of nutrition, including weight gain or loss, and appropriate action taken.'

The existing assessment of people entering a care home includes dietary requirements and specific nutritional screening. If the risk of malnutrition is detected, residents need to be referred to the appropriate professionals in the health sector. The NICE guidance will help to guide these professionals in responding appropriately to both the resident and in assisting the care home to ensure further risk of malnutrition is reduced.

The commission will be publishing a report into meals and mealtime in care homes in the next few weeks, which will set out performance against the NMS in care homes for older people. The National Minimum Standard relating to the organisation of meals and mealtimes does not relate specifically to nutrition or malnutrition. Care home providers are responsible for providing a wholesome and nutritious diet. CSCI works closely with those who use social care services, including residents of care homes and providers to ensure that meals and mealtimes are given the serious attention it deserves.'

Press release from NICE follows

New NICE guideline will help tackle the problem of malnutrition in the NHS

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Acute Care have today launched a clinical guideline to help the NHS identify patients who are malnourished or at risk of malnutrition.

The guideline sets out the appropriate nutrition support that these people should receive. The guideline recommends that:

-- All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened (weighed, measured and have Body Mass Index (BMI) calculated). Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. People in care homes should be screened on admission and when there is clinical concern.

-- Nutrition support should be considered in people who are malnourished, as defined by a BMI of less than 18.5; unintentional weight loss greater than 10% within the last 3-6 months; or a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months.

-- Nutrition support should be considered in people at risk of malnutrition, as defined by having eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer; who are unable to take in nutrients properly, and/or who have increased nutritional needs.

-- All acute hospital trusts should employ at least one specialist nutrition support nurse and establish a nutrition steering committee.

-- All healthcare professionals who are directly involved in patient care should receive education and training, relevant to their post, on the importance of providing adequate nutrition.

Andrea Sutcliffe, Deputy Chief Executive of NICE and Executive Lead for this guideline says:

'This guideline should help reassure patients and give confidence to their relatives and carers, that all at risk patients, no matter where they live or what their underlying condition, will now be screened and if necessary offered appropriate nutritional support. The recommendations to improve the organisation of care are also important, as they will go a long way to ensuring that good nutrition, both in terms of hospital food and nutrition support is better organised and more effectively delivered. While some recommendations will increase costs for the health service in the short term, in the long run the improvement in the quality of care for patients will mean health service resources are used more effectively and savings will be achieved.'

Mike Stroud of the Institute of Human Nutrition, University of Southampton and Chair of the Guideline Development Group says:

'Ensuring patients receive adequate nutrition is an essential part of basic patient care, yet we know malnutrition is still a big problem for the NHS. The guideline contains one obvious and simple message - Do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest most effective route.' By recommending a widespread programme of screening and nutrition support, this guidance is likely to make a real difference and save lives.'

Joanna Prickett, Chief Dietitian, North Bristol NHS Trust and British Dietetic Association representative on the Guideline Development Group says:

'Malnutrition is very common. Within the population as a whole it affects less than 5% however amongst hospital inpatients and those in care homes, as many as 40% could be suffering from malnutrition. More than 10% of over 65's in the general population are at medium or high risk of malnutrition and this figure rises to as much as 60% amongst those in hospital.'

Paul Little, Professor of Primary Care Research, University of Southampton and Royal College of General Practitioners representative on the guideline development group says: 'GP's and others in primary care see the vast majority of patients who are malnourished, but often do not think of malnutrition during clinical management. Malnutrition is serious problem - the consequences include vulnerability to infection, delayed wound healing, impaired function of heart and lungs, decreased muscle strength and depression. This guideline will raise the profile of malnutrition and its management in primary care, and also highlight the need for more research.'

SCOPE

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