Multi-professional Care Home Education on Nutrition and Hydration

Problem

With the aging population in the UK, locally a rising number of our patients now live in care homes. A significant proportion of our care home residents have issues achieving adequate nutrition and hydration. This is reflected in rising costs of oral nutritional supplements (ONS) and request for dietician referrals. Education to band 1-4 care home staff on this area has been inconsistent to date and they have reported feeling unsupported through the pandemic.

Our aims were two-fold. Firstly to empower the band 1-4 care home staff to confidently identify and manage residents with issues around poor nutrition and hydration to improve the appropriateness of prescriptions of ONS and reduce costs to Primary Care. Secondly, we sought to nurture multi-professional relationships in Primary Care through having multi-professional facilitators.

Approach

We created a learning event across two pilot care homes in Salisbury facilitated jointly by two prescribing support dieticians from the CCG and a local GP. This was an interactive session with the following objectives:

• how to recognise malnutrition and dehydration

• how to calculate a MUST (Malnutrition Universal Screening Tool) score, including estimating weight and height in bedbound residents

• how to treat malnutrition with a “Food-first” programme and fortifying a diet and improve hydration in a diet

• sharing a recipe for a high calorie milkshake and taste testing this against prescribed ONS

• understanding which are the local formulary-approved lower cost ONS alternatives to traditionally prescribed high-cost brands

• when to involve specialist dietician services

We undertook pre and post session evaluations of the carers including confidence intervals and space for qualitative feeding and a pre and post session audit of the local formulary-approved lower cost ONS in the GP practice attached to the care homes.

Findings

Qualitative and quantitative feedback shows how the carers found the session both informative and enjoyable and increased their confidence managing residents with issues around poor nutrition and hydration and how this will change their practice. (Data demonstrating this will be included in the final presentation). An audit of the ONS prescriptions at the local GP practice prior to the educational sessions showed no requests for the local formulary-approved lower cost ONS. After the sessions, there were 11 new residents commenced on the local formulary-approved lower cost ONS.

Consequences

This demonstrates that this session is pivotal in changing prescribing behaviour for ONS with a significant cost saving to the local Practice. Creating this session has now forged close working relationships with the pilot care homes, GP practice and the BSW Medicines optimisation in care homes team to review all prescriptions from the local care homes. This will improve appropriateness of prescriptions and reduce costs to General Practice.