your hospitals, your health, our priorityST05_Mar12

Preventing Malnutrition at

WWL

Linda SmythHead of Quality Improvement

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”

your hospitals, your health, our priority

NHS Foundation Trust

• ~ 750 beds• 3 hospital sites• Specialist

orthopaedics• 1 town centre

outpatient site• 4,000 staff

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

your hospitals, your health, our priority

Rapid SpreadMUST

Food4ThoughtNutrition Mission

Recipe for Success

Safety Express

Harm Free Care

Pressure Ulcers Falls Ca UTI VTE

Our Nutrition Journey: 2011 - present

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Action Plan

Supporting Patients

Positive Dining

Experience

Staff Awareness & Training

Clinical Care

Infrastructure

Catering Team

Nurses

Volunteers

Dieticians

Therapists

Lead Doctor

Executive

Porters

QI Team

Communications Team

Business Intelligence

Housekeepers

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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

0

2

4

6

8

10

Num

ber o

f pati

ents

Under50

50-60 60-70 70-80 80-90 >90

Patients Age (years)

your hospitals, your health, our priority

Reasons for Weight Loss

0

2

4

6

8

10

12

Num

ber

of P

atien

ts

Reasons for weight loss

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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

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ConclusionsWhat 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

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Next Steps

• A continuous journey• Wider health & social

care economy• Dementia• Weight loss as a

harm event

THANK YOU