1. Improving Nutritional Care in Bristol Sharon Sexton Medicines Management Dietitian NHS Bristol

2. Current Situation Unidentified malnutrition Low use of MUST/screening in community Variable understanding of risks associated with malnutrition Limited dietary advice available/offered Limited dietetic services across Bristol Increasing spend on oral nutritional supplements

3. Initial Findings from training in Bristol Care Homes (delivered by Rachel Cooke) In one care home, just 3.5% of those screened were screened correctly In the home where screening was most accurate, 75% of those screened were screened correctly

4. Initial Findings from Training in Bristol Care Homes (delivered by Rachel Cooke) Average incidence of malnutrition: 45% (17% medium risk, 28% high risk) ‘National average’ taken from results of the BAPEN Nutrition Screening Week survey 2010 (37% of residents at risk of malnutrition)

5. Objectives of Role Promote validated guidance Increased identification of malnutrition Increased screening for risk of malnutrition Pathway for treating malnutrition Appropriate prescribing Support for health professionals Training

6. Key Professionals GPs Community nursing Practice pharmacists Dietetic teams Intermediate Care Care Homes –Nursing staff –Catering staff Public Health

7. Developing Guidance on screening Primary Care Nutrition Working Group –Range of stakeholders NHS Islington guidance adapted with permission –Succinct –draft

8. The Guidance MUST (Malnutrition Universal Screening Tool) Care Pathway Guide to best practice in prescribing oral nutritional supplements –Range of information on starter packs/feeds

9. Distribution of guidance Meetings at all Bristol GP practices Distributed to community nursing teams Care settings Links with practice pharmacists Promoted through training

10. Conference Update Conference held 7 th November 2012 Care homes, community nurses, stakeholders Raise awareness of incidence of malnutrition

11. Key Themes Training provision should be ongoing and available for all teams Housebound without nursing input hard to reach and may be most vulnerable

15. Next Steps Adapt guidance based on feedback Offer further training to: –care homes –community nursing –Intermediate care –Reablement teams –Rapid response teams