There is currently considerable interest in seeing an improvement in the detection and management of malnutrition in care homes for the older person. At the same time there are national and local initiatives to stop pressure ulcers. Pressure ulcers, like nutritional status, can be seen as an indicator of the quality of care, as they are both potentially avoidable.
Working to eliminate avoidable malnutrition and pressure ulcers
Managing nutrition and hydration is a key aspect of pressure ulcer prevention. In view of this, a champions programme to recruit, train and support champions skilled in both health areas has been set up in North Bedfordshire as reported in this month’s NHD magazine.
Studies indicate that provision of champions, in addition to effective prevention practices, leads to an improvement in patient outcomes with respect to pressure ulcers, and a multidisciplinary approach of sharing knowledge and expertise can encourage evidence-based practice in care homes.
PUFFINs, Pressure Ulcer Food First INitiative champions, have been recruited. To qualify, staff had to be in a position of influence in their care home. This is important as it is necessary to have management buy-in to ensure commitment to change within care homes. After all, practice is linked not only to knowledge but to the beliefs and value system of organisations. So far, the North Bedfordshire scheme has trained around 100 PUFFINs, including care home managers, nurses, chefs and senior carers.
Training a PUFFIN
The training included actions and plans to prevent and manage pressure ulcers including the SSKIN five step model:
- Surface: make sure your patients have the right support
- Skin inspection: early inspection means early detection. Show service users and carers what to look for
- Keep your service users moving
- Incontinence/moisture: your service users need to be clean and dry
- Nutrition/hydration: help service users have the right diet and plenty of fluids
Nutrition training included a focus on screening for risk of malnutrition and food fortification, for example, using fortified recipes for foods and drinks to encourage higher energy and protein intake.
In terms of results, it has been reported that in the last six months of 2014, care homes reporting 0-1 pressure ulcer alerts had 83 per cent PUFFIN involvement, whilst those reporting two or more only had 59 per cent involvement.
If you think you might like think about PUFFINs in your area, tips from the North Bedfordshire for champion projects include:
- Team up with colleagues for a multidisciplinary approach. Care home staff are busy so will not be able to allocate separate champions for different facets of their work
- Make allies of community dietitians, district nurses/tissue viability nurses
- Recruit champions who will be proactive and have a role in their care home which will enable them to influence practice
- Demonstrate that such initiatives are good evidence of good practice for the CQC
- Regular contact including with ongoing information on relevant topics and examples of good practice
- Audit of results is essential to measure success and can help secure funding
