1. your hospitals, your health, our priority ST05_Mar12 Preventing Malnutrition at WWL Linda Smyth Head of Quality Improvement

2. your hospitals, your health, our priority Wrightington, Wigan & Leigh Population >300,000 16% age>65 Little ethnic diversity (4% BME) Life expectancy < England average Inequalities within the borough Pockets of extreme deprivation Coal Mining legacy “Pie Eaters”

3. your hospitals, your health, our priority NHS Foundation Trust ~ 750 beds 3 hospital sites Specialist orthopaedics 1 town centre outpatient site 4,000 staff

4. your hospitals, your health, our priority Nutrition - where we were… Catering Team Specialist Nutrition Team Professional Competence Artificial Nutrition Steering Group Patient Meals Falls Prevention Pressure Ulcer Prevention Infection Prevention Reducing Mortality

5. your hospitals, your health, our priority Rapid Spread MUST Food4Thought Nutrition Mission Recipe for Success Safety Express Harm Free Care Pressure Ulcers FallsCa UTIVTE Our Nutrition Journey: 2011 - present

6. your hospitals, your health, our priority Action Plan Supporting Patients Positive Dining Experience Staff Awareness & Training Clinical Care Infrastructure

7. your hospitals, your health, our priority Weight Loss As A Harm Event Age Distribution Root cause analysis into weight loss >5kg during in patient stay 6 wards – harm free ward programme Exclusion criteria applied 30 patients included

8. your hospitals, your health, our priority Reasons for Weight Loss

9. your hospitals, your health, our priority Summary of Findings Poor compliance with weighing patients on discharge or transfer → impossible to establish whether weight loss had occurred Majority with weight loss age >70 Issues with accuracy Suitable weighing equipment not always available for acutely ill Clinical condition as a cause of weight loss Dislike of food & refusal

10. your hospitals, your health, our priority Conclusions What worked well Multidisciplinary team working Maintaining momentum ↑Patient satisfaction ↓Harm from falls & hospital acquired infections ↓ Mortality Low rates of hospital acquired pressure ulcers Challenges Inquests & complaints Inconsistency Prioritisation Weights

11. your hospitals, your health, our priority Next Steps A continuous journey Wider health & social care economy Dementia Weight loss as a harm event