Annual Report and Accounts - The Great Western Hospital

Priority 12: To undertake nutritional assessments on patients on admission to
hospital to ensure we meet their nutritional and hydration needs
Good nutrition and hydration are fundamental to well being and recovery from illness or trauma. A
high proportion of individuals admitted to hospital or requiring support via the neighbourhood teams
are vulnerable to malnutrition
Targets, compliance and audit methodology & frequency for the 3 key locations vary:
• GWH site: Target 95%; compliance 86.9% Jan 2012
• Community Hospitals: Target 100%; Compliance 77.5%
• NHT: Target 100%; compliance 44.4%
Despite not yet meeting the target significant improvements in other aspects of nutritional care have
been achieved. At GWH site “MUST” (Malnutrition Universal Screening Tool) completion is assessed
via Crescendo (electronic system) on a daily basis to provide weekly and monthly compliance rates.
Wiltshire Community conducts a qualitative audit 6 monthly. For the purposes of this report an
average of all wards is used for the key parameters of the audit.
GWH site:
• Prior to MUST implementation there was no consistent or validated screening tool in place
and compliance was measured at 33%.
• In 2010 MUST was implemented with a training programme carried out by the dietetic team.
Compliance was improved to 75% by February 2011.
• The improved MUST compliance resulted in a >100% increase in referrals to the dietetic
team resulting in a lack of time available for on-going training.
• During 2011 refinements were made to compliance audits, including improving the
identification of exclusions and supporting wards with lower levels of compliance.
• Compliance has further improved to 87% with 3 areas achieving 95%; 6 areas 85 – 94% and
5 areas at or below 84% (range 78 – 84%).
• An on-going training programme is in place for NAs and volunteers including MUST and
nutrition care.
Additional and existing activities to improve MUST accuracy and compliance are being
introduced and strengthened.
• To support accurate MUST completion a new E- learning package and workbook for MUST
are being introduced via the academy. The Nursing Auxiliary and volunteer training
programme is to be updated to incorporate the needs of Wiltshire Community staff and
changes to meals service such as the menu-less meals project.
• An additional dietician has now been funded by industry (commenced in post 20 th Feb 2012
until March 2013) to support the MUST and nutrition care plan programme and to identify
ways of managing the resultant referral demand. The post holder will be required to identify
and pilot alternative ways of working to achieve this once the funding ceases.
• Ward dieticians will be targeting their lower compliance wards with additional training and
support Regular comfort rounds (intentional rounding) instituted to provide more proactive
and timely care.
• Matron’s weekly inspections have recently started with a more specific and consistent
approach to monitoring and improving compliance issues with MUST, nutrition care pans
and documentation of fluid balance.
Page 124 of 211