The Challenge of Hospital Nutrition Support Richard C. Wilson BSc RD FBDA MTF Day 25 March 2014.
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Transcript of The Challenge of Hospital Nutrition Support Richard C. Wilson BSc RD FBDA MTF Day 25 March 2014.
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The Challenge of Hospital Nutrition Support
Richard C. Wilson BSc RD FBDA MTF Day 25 March 2014
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Structure of this presentation
• The challenge and recent initiatives
• The current situation and how we try to rise to the challenge
• Future direction
www.malnutritiontaskforce.org.uk
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King’s College Hospital NHS Foundation Trust
• Nature of King’s (pre – Oct 2013)
– Foundation trust– 1200 beds– 6,000 live births– ~70,000 admissions– 55% unplanned
• England 150,000 beds• England 10 million admissions
• 38 Dietitians– ~36,000 patient contacts per year
• Food service - PFI– Cook chill (Steamplicity)
• Plated cook chill• Microwave & steam regen.
• Initiatives in place– Protected Mealtimes– Red Trays– Ward housekeepers
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Hospitality is key to care
• Hospitality is the foundation of all care
• The first hospitals were in monastery's
• Sanctuary for the sick, poor and destitute
• Providing shelter, security, nursing, nurture and nutrition
• 10,000 + staff need to be aware of this
• Hippocrates 400BC– “In all maladies those who are
well nourished do best. It is bad to be very thin and wasted.
• Approximately 1200 patients at King’s– ~120 on artificial nutrition
support– 1080 (90%) dependent on a
‘knife and fork’
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Nutrition and human physiology
AWARENESS RAISING
• Entropy – 2nd Law of thermodynamics
• Matter has a tendency to become chaotic
• Human body made of very organised molecules
• Keeping them organised requires energy
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Our collection of molecules
• Constantly being broken down and replaced
• Every seven years it is all replaced
• Replacement molecules are swallowed!
• All this requires energy• We measure energy in calories• 1kg of human = 7000kcal• 1 missed meal = -400kcal• = 60g (2oz) of tissue lost!!
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Obese people can be undernourished too!
• These days Michelangelo would have needed considerably more marble!!
• Unintentional weight loss still has detrimental effects
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Every performance review / feedback opportunity taken…
• What do the patients think of the food?
• ‘How Are We Doing?’ survey• Continuous performance
management• Virtuous circle of improvement
Monthly survey – response of 1236 patients following discharge
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Sobering tales…
Nutrition can kill• We recently had a serious incident related to refeeding• Patient arrested and died
NICE ‘Nutrition Support in Adults’ CG032, 2006• High risk of developing refeeding problems if:
One or more of the following: Two or more of the following:
• BMI less than 16 kg/m2
• Unintentional weight loss >15% in last 3-6 months
• Little or no nutritional intake for more than 10 days
• Low levels of potassium, phosphate or magnesium prior to feeding
• BMI less thank 18.5 kg/m2
• Unintentional weight loss greater than 10% in last 3-6 months
• Little or no nutritional intake for more than 5 days
• A history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics
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Strategic direction?
• Malnutrition is still a significant problem in hospitals including ours
• ICT systems offer ways to:– Raise awareness– Advise on need– Monitor progress against nutrition targets– Communicate plans between settings
• Based on research conducted by:– www.hospitalfoodie.com
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The proposal
• Assessment on Wardware (MUST)
• Lookup target in DRV table
• Target provided by dietitian
• Data on nutritional inputs collected
• Intake visually mapped against targets
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Benefits of this approach
• Includes all patients• Includes all feeding modalities• Visual analogue target engages all staff and
patients in meeting target• Holistic approach will improve communication
Between staff on site
Between care settings
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Bringing the Hospitality back into Hospital!
• Delivering nurture, nourishment and sustenance is what care is all about
• The raw materials for recovery