Undernutrition Service Helping nutrition and dietetic services meet the changing needs of the NHS Catherine McShane Project Manager Dietitian Sarah Gooch Dietetic Assistant

Why Undernutrition? Patients nutritional needs identified and addressed quickly. Identifies safety concerns quickly. Promotes self-management. You asked for 3 reasons why Health Call Undernutrition should win this category. Essentially identifying, treating and monitoring the effectiveness of the treatment is a matter of quality and safety. Undernutrition is a major problem within the UK and left untreated can have serious consequences for individuals. For example if you are undernourished you are more likely to have a fall and potentially break your hip, be in hospital longer recovering, take longer to return to ‘normal’ for you, have a greater chance of being readmitted because of complications. Worse case scenario is that someone dies as a result of the fall. So identifying, treating and monitoring undernutrition is a matter of safety. Despite their being a raft of guidelines and standards we are still very poor at identifying and treating undernutrition and as dietitians our traditional service delivery model does not have the capacity to provide a proactive service to meet the changing needs of our patients. So in answer to the original question as to why Health Call Undernutrition should win: Firstly the remote monitoring quickly highlights any changes in the nutritional needs of our patients that can be addressed at that time, for instance if someone is losing weight or not managing with their recommended treatment. Secondly it has identified patient safety issues quickly – such as incorrect prescriptions or patients not being weighed regularly in care homes. Finally Health Call has been shown to promote self management which to me is key – if we can increase awareness of the importance of nutrition and support people to manage their own nutrition we can start working towards a more preventative model, reducing the risk of undernutrition, improving their safety and quality of life.

How Undernutrition works

Traditional Initial assessment within 3 months No monitoring Reviewed when the service dictates Average intervention 40 weeks Initial assessment within 2 weeks Remote monitoring weekly Reviewed when a need is identified Average intervention 14 weeks

Traditional Assessed within 2 weeks Prescription error highlighted in a week Now low risk of undernutrition Still waiting to be assessed Prescription error not highlighted Continues to lose weight Patient A

Traditional Assessed within 2 weeks Weight loss highlighted within 3 weeks Treatment increased Still waiting to be assessed Weight loss continues Secondary complications Patient B

benefits Reduced delayed treatment Improved case load management Links with electronic records Improved accuracy of ‘MUST’ Improved joined up working Reduced complications Releases clinician capacity Drives nutritional care

Care home feedback Simple and easy to use. It only takes 2 minutes but is invaluable. Extra support network, knowing someone else is looking at the information. Increased shared responsibility. Staff know that if there are any problems a dietitian will call. Driven improved nutritional care. More person centred. Reassuring that someone is responding within hours. Want it to be used proactively. Is there a possibility for other functions?

Clinician feedback Simple and easy to use. Able to be more proactive. Increased confidence in stopping ONS. Supports caseload management. Quickly identifies ineffective treatments. Quickly identifies any errors in prescribing. “The automated system offers great support to the dietitians and empowers the care home staff to take a more proactive approach to monitoring their increasing number of vulnerable residents. The residents and their families feel more supported too because the frequency of monitoring has been increased along with more timely reviews. To stop the service would be a backward step. We couldn’t go back to what we did before.”

Outcomes Demonstrated that Health Call Undernutrition can improve dietetic care in other organisations. Driven the use of technology in care homes. Identified other areas that Health Call can be implemented. Data provided is raising questions to research and improve patient safety further. Commissioners and providers see evidence that excellent nutritional care is being delivered.

Conclusions Simple solution to improve dietetic care to patients. Reduces delays in dietetic treatment. Can be scaled up and easily implemented in other organisations. You asked for 3 reasons why Health Call Undernutrition should win this category. Essentially identifying, treating and monitoring the effectiveness of the treatment is a matter of quality and safety. Undernutrition is a major problem within the UK and left untreated can have serious consequences for individuals. For example if you are undernourished you are more likely to have a fall and potentially break your hip, be in hospital longer recovering, take longer to return to ‘normal’ for you, have a greater chance of being readmitted because of complications. Worse case scenario is that someone dies as a result of the fall. So identifying, treating and monitoring undernutrition is a matter of safety. Despite their being a raft of guidelines and standards we are still very poor at identifying and treating undernutrition and as dietitians our traditional service delivery model does not have the capacity to provide a proactive service to meet the changing needs of our patients. So in answer to the original question as to why Health Call Undernutrition should win: Firstly the remote monitoring quickly highlights any changes in the nutritional needs of our patients that can be addressed at that time, for instance if someone is losing weight or not managing with their recommended treatment. Secondly it has identified patient safety issues quickly – such as incorrect prescriptions or patients not being weighed regularly in care homes. Finally Health Call has been shown to promote self management which to me is key – if we can increase awareness of the importance of nutrition and support people to manage their own nutrition we can start working towards a more preventative model, reducing the risk of undernutrition, improving their safety and quality of life.

www.nhshealthcall.co.uk cdda-tr.businessdevelopment@nhs.net Thank You www.nhshealthcall.co.uk cdda-tr.businessdevelopment@nhs.net