We know it is essential that malnutrition and dehydration problems are recognised and treated. Yet despite many standards and initiatives aiming to improve nutritional care, there are still examples of failure to do so.
Today we look at a case study from nursing homes in Islington, a stone’s throw from BNF headquarters. It will demonstrate what can be achieved with additional staff training.
Education and training for staff across five nursing homes in Islington
An audit of care homes in Islington recognised poor practice around identifying, preventing and monitoring malnutrition.
A project was therefore developed which aimed to address the problem by delivering an education and training programme.. It was a four month project aimed at the staff of five care homes. This aimed to give them greater skill, confidence and competence to identify malnutrition, to provide basic nutritional care – including food fortification, and to make appropriate referrals for dietetic advice.
The Project
There were three phases of the project:
Phase 1 (5 days): Pre-audit
The Malnutrition Universal Screening Tool (MUST), a validated screening tool, was already in use in each of the five nursing homes. As a baseline measurement, a pre-audit was carried out in each home to note how often patient weights and MUST scores had been recorded over the previous four months.
The pre-audit found that on the whole, the nursing homes were generally good at weighing patients every month, but there was room for improvement. In every home there was a degree of error in recording the overall MUST score.
Phase 2 (10 days): Training
Based on the findings, a practical training programme was designed to improve the knowledge and understanding of the MUST tool. Two training session (1½ hours each) were delivered to carers, nursing staff and some catering staff.
A questionnaire was used to determine knowledge and understanding of MUST before and after the training.
Phase 3 (5 days): Re-audit
A post-audit was carried out to determine whether there had been an improvement in recording monthly weights and the overall MUST scores. The post-audit also provided the opportunity to discuss any concerns with the nursing home manager or clinical nurse.
Findings
The results suggested that further to the training programme there had been an increase in awareness of malnutrition.Staff also had a greater knowledge and understanding of the MUST tool.
- Before the training sessions; between 50% and 93% of staff at the different homes were unable to answer one or more of the questions on the MUST tool. After training, knowledge had improved so that 0% to 37% were still unable to answer.
- There was an improvement in the number of patients who were weighed monthly and in the accuracy of MUST screening.
All service users should be screened for malnutrition and those identified as at risk should be offered individualised nutritional care plans appropriate to their needs. To achieve this, all care staff must understand the importance of nutritional care and be trained to identify those at risk. We need to make sure there are structures in place to ensure best nutritional practice, and this should include ensuring all relevant staff receive adequate training to be able to identify those at risk of malnutrition.
