1. Meeting the Challenge of Malnutrition in the Community Sue Hawkins Care Catering Services Manager Dorset's Nutritional Care Strategy for Adults supported by:

2. 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

3. Dorset's Nutritional Care Strategy for Adults supported by: MUST Score 0 Low Risk If revisiting, review annually or reassess if circumstances change No additional action or if overweight/obese provide appropriate lifestyle advice eg Change 4 Life for Adults MUST Score 1 Medium Risk Encourage & observe Recommend appropriate actions from “Build Yourself Up” and implement own nutritional care action plan ALERT For a MUST Score 4 or more - Report to Safeguarding Triage Team or follow the Interagency Risk Management Protocol. Send amended letter to GP practice. MUST Score 2 or more High Risk Encourage & take action Recommend appropriate actions from “Build Yourself Up” and implement own nutritional care action plan Not revisiting Revisiting in 4 weeks Inform GP (Standard letter/form) See GP pathway (5.10) If further weight loss or no improvement inform GP (standard letter/form). See GP pathway (5.10) Repeat MUST monthly If weight has improved follow the appropriate actions for their new MUST score Not revisiting Revisiting in 4 weeks Inform GP (Standard letter/form) See GP pathway (5.10) Repeat MUST monthly If weight has improved follow the appropriate actions for their new MUST score If further weight loss or no improvement inform GP (standard letter/form). See GP pathway (5.10) 5.4 The Home and Community

4. Dorset's Nutritional Care Strategy for Adults supported by: 5.10 GP Practice MUST Score 0 Low Risk No action No additional action or if overweight/obese provide appropriate lifestyle advice eg Change 4 Life for Adults Repeat annually for those over 75 ALERT For a MUST Score 4 or more – Report to Safeguarding Triage Team or follow the Interagency Risk Management Protocol. MUST Score 2 or more High Risk Encourage & take action Recommend appropriate actions as per “Build Yourself Up” Consider Medication review. If Dysphagia consider referral to SLT* Arrange follow up appointment in one month. Repeat MUST If weight has improved follow the appropriate actions for their new MUST score If further weight loss or no improvement Consider prescribing **ONS Arrange follow up appointment in one month If further weight loss or no improvement Refer to Dietitian If weight has improved follow the appropriate actions for their new MUST score MUST Score 1 Medium Risk Encourage & observe Consider Medication review. If Dysphagia consider referral to SLT* Arrange follow up appointment in one month. Repeat MUST and follow appropriate actions for their new MUST score Recommend appropriate actions as per “Build Yourself Up”

5. Dorset's Nutritional Care Strategy for Adults supported by: Joint working – 60 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. Dorset's Nutritional Care Strategy for Adults supported by: It is possible! Passion and enthusiasm Highlighted otherwise unreported malnutrition Different technology complicates issues Highlighted interesting practices! GP’s don’t always see it as their role Next Stage Full locality Pilot – Can we make a difference to health and well being.

7. Dorset's Nutritional Care Strategy for Adults supported by: 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

8. Dorset's Nutritional Care Strategy for Adults supported by: Losing Weight is Not Always Great (Nutritional Care Strategy for Adults) www.dorsetforyou.com/adult-nutrition

9. Dorset's Nutritional Care Strategy for Adults supported by: Thank you – any questions Sue Hawkins s.hawkins@dorsetcc.gov.uk 01305 225930 Strategy - http://www.dorsetforyou.com/nutritional-care-strategy Care Pathways- http://www.dorsetforyou.com/nutritional-care-strategy Build Yourself Up - http://www.dorsetforyou.com/407934 Eating Opportunities - http://www.dorsetforyou.com/eatingopportunities