1. An Appetite For Change Purbeck Sue Hawkins Care Catering Services Manager Michelle Smith Health Programme Advisor Dorset's Nutritional Care Strategy for Adults supported by:

2. Dorset’s Reaction Nutritional Care Strategy For Adults Care Pathways: Raising awareness The Home and The Community Care and Nursing Homes Community Hospitals Community Hospital Discharge Planning Acute Hospitals Acute Hospital Discharge Planning GP Practice Dorset's Nutritional Care Strategy for Adults supported by:

3. Malnutrition Universal Screening Tool MUST 3 Steps: Step 1 = BMI score 0,1 or 2 Step 2 = Weight loss Score 0,1 or 2 Step 3 = Acute Disease Effect 2 TOTAL = MUST scoreMaximum 6! Step 3 – not generally used in the Community Dorset's Nutritional Care Strategy for Adults supported by:

4. Screening Questions Is the Person Very Underweight? Prominence of bones, ribs, muscle wasting Has the person lost weight unintentionally? Fit/size of clothes Watch straps/wedding rings 10% of body weight – 10 stone now 9 stone Dorset's Nutritional Care Strategy for Adults supported by:

5. Wellbridge Practice Locality Pilot Joint working – 68 staff involved GP Practice Nurses Purbeck Locality Team Purbeck Integrated Team OT’s/Physio’s Social Workers Community Matron and Staff Nurses Falls Assistant Re-ablement Team Carers Caseworker Adults Safeguarding Triage Team Community Stroke Practitioner

6. If starting to be concerned Build Yourself Up Introduction on Malnutrition and Dehydration How to increase calories and proteins What if I’ve lost my appetite or am too tired Sample Menu Plan Nourishing Drinks Foods to keep in the cupboards Assisting someone to eat Hydration Eating Opportunities Dorset's Nutritional Care Strategy for Adults supported by:

7. Or not?

8. Evaluation Process only Training, Care Pathways, Administration, General operational issues Individual questionnaires and focus groups with each participating team through existing team meetings Dorset's Nutritional Care Strategy for Adults supported by:

9. Training 100% of respondents felt the session met it’s objectives 78% stated that their knowledge of malnutrition had increased 100% of delegates had a better understanding for their role in delivering nutritional screening and everyone felt confident to return to their day jobs and start screening Dorset's Nutritional Care Strategy for Adults supported by:

10. Focus Groups  Several staff stated they could see the need and value in nutritional screening and that they understood their role in it; and the need for the prevention of malnutrition in the community.  The paperwork was generally manageable within their existing roles and the pathways were easy to follow  Time needed for paperwork was too much so would benefit from being reduced  Sharing data across teams was problematic.  The scales that were provided were not appropriate for use. Dorset's Nutritional Care Strategy for Adults supported by:

11. Room for Improvement  Forms need to be amended to make them shorter  Effort needs to be made to engage the Mental Health Team  The pathway needs to include a signposting option for staff if they identify a service user who they are concerned is overweight.  An IT system that will allow the sharing of data across and within organisations and that allows staff to complete the forms electronically on site needs to be explored to avoid duplication reduce admin time.  Alternative scales need to be sourced  An option for wheel chair users to be weighed needs to be explored All of the above have done been addressed Dorset's Nutritional Care Strategy for Adults supported by:

12. Next Steps - Purbeck and Beyond…..  Purbeck GP Locality engaged ( further 5 GP practices)  Electronic forms and mobile IT options needs to be set up  Launch to tell the Purbeck locality about the programme - TODAY  Wider Purbeck staff need to trained – Oct / Nov 2013  Evaluation framework for the wider pilot needs to be established with Solent University so we can also begin to evaluate whether we are actually making a difference to the health and well being of people in Purbeck and to measure any potential cost savings made as a result of the screening programme  Build a case for a roll out to the whole of Dorset - need your help to do this! More evaluation! Dorset's Nutritional Care Strategy for Adults supported by:

13. Any Questions? Contacts: Sue Hawkins Michelle Smith s.hawkins@dorsetcc.gov.uks.hawkins@dorsetcc.gov.uk michelle.smith@dorsetcc.gov.ukmichelle.smith@dorsetcc.gov.uk 01305 225930 Strategy - www.dorsetforyou.com/nutritional-care-strategy Care Pathways- www.dorsetforyou.com/nutritional-care-strategy Build Yourself Up - www.dorsetforyou.com/407934 Eating Opportunities - www.dorsetforyou.com/eatingopportunities Dorset's Nutritional Care Strategy for Adults supported by: