1. COMMITMENTS & NEXT STEPS TURKISH SOCIETY OF CLINICAL NUTRITION TURKISH SOCIETY OF CLINICAL NUTRITION Meltem HALIL General Secretary of KEPAN Geriatrics Society of Turkey

2. Learnings from yesterday Compose national prevalence data of DRM – Per health care setting if possible Show the economic burden of DRM on health care system, develop national pharmacoeconomy data

3. Learnings from yesterday Use media – Become popular – Public service announcement – press Convince politicians that DRM is also one of their problem, they have to pay for screening and treatment of DRM, to make them face with public

4. Learnings from yesterday Use patients and patient societies to reinforce health care professionals to screen MN To ensure multi-stakeholder invovement

5. Optimal nutritional care for all Education Public health Implementation Undergrad Postgrad Nutrition Day Hospital ICU Oncology Care home Public awareness National nutrition plan Hospital Care home Community Trained Staff Screening Care plan Medical nutrition Stakeholder groups Multi-stakeholder PEN Ger Medicine Paediatricians Patients Dietitians Nurses Pharmacists General practice Hospital Health insurance Industry Politicians Media Policy and standards Screening policy Standards/q uality indicators Audit Hospital Care home Community Guidelines Screening Hospital Care home Community Intervention Dietitians Medics Nurses Pharmacists Economic data Cost DRM Value of intervention Presence Engagement Prevalence DRM Hospital Care home Community Reimbursement Hospital Care home Community Malnutrition Services ONS Tube PN TURKEY Malnutrition risk for Inpatients > 65 yrs Malnutrition risk: 33.5 % Malnutrition :13.5% Malnutrition for Pediatric population: 2-6 years children: malnutrition risk: 31.8% Age <5 years: malnutrition: 24 %

6. Priority actions Short and mid term targets Create and implement a screening policy for inpatient in clinics with collaboration of authority (Public Hospital Alliance) Making screening and nutritional treatment as a part of Quality Indicators of Public Hospitals

7. Priority actions Short and mid term targets Show the burden of malnutrition to healthcare system and increase awareness of benefit of medical nutrition Nutritional screening results has to be involved in patient records for reimbursement Keep on going current reimbursement status

8. Priority actions-Long term Create and implement a screening policy for outpatients with collaboration of authority (Public Hospital Alliance) Implement regular screening for care home residents Establish a care home policy for nutritional support Involve GP’s

9. KPI’s; Number of hospitals that have screening policy – For the first year 29 hospital To compare the number of patients that have DRM between hospitals that have policy or not Provide nutrition as a quality indicator of a hospital – Provide audit by the authority Increase the number of hospitals having nutrition teams

10. KPI’s; Number of relevant societies involved in the project (1 year) – Family practitioners’ society – Oncologic society – Neurology – Home care – Nursing society – Pediatric gastroenterology – Society of celiac disease Number of stakeholders from government (1 year) – Ministry of family and social policy – Department of public health

11. KPI’s; prevention of malnutrition/public awareness Involve GP’s Involve patient organizations To maintain the continuity of nutrition in media to aware public – Public service announcement

12. KPI; training Number of LLL courses (12 live modules/year) Specific training programs for each professional groups (GP, nurse, neurology) Specific training programs for Pharmacist in hospitals