YOUR LOGO
The Cost of Doing Nothing
Dr Ailsa Brotherton, Honorary Secretary, BAPEN
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YOUR LOGO
British Association for Parenteral and
Enteral Nutrition
A multi-disciplinary c...
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YOUR LOGO
Poor breathing and
cough from loss of
muscle strength
Psychology –
depression &...
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YOUR LOGO
Who is affected by malnutrition?
Chronic disease COPD, cancer, inflammatory bow...
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Change in screening practice on
admission in hospitals
0
10
20
30
40
50
60
70
8...
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We have measured the prevalence of malnutrition
Page  6
Hospitals Care Homes M...
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Nutrition support in
adults 2006
February 2006
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Page  8
So what is the cost of not tackling malnutrition effectively?
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MORTALITY
Page  9
Significantly lower mortality rates found in supplemented ho...
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COMPLICATIONS:
 Significantly lower complication rates in supplemented surgica...
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Page  11
READMISIONS: High protein ONS have been shown to
reduce hospital read...
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NICE ONS and length of stay
Standardised Mean diff.
-3.45185 0 3.45185
Study % ...
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The Malnutrition Carousel
HOSPITAL
NURSING
HOME CARE
HOME
HOME
Malnourished
PRI...
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So what does all this cost?
Financial costs
Over 3 million individuals malnouri...
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Prevention
We know where malnutrition exists is but we do little to prevent it
...
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Our Challenge
Page  16
We know
what excellent
nutritional care
looks like
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YOUR LOGO
We need highly reliable systems to deliver
Design
systems to
screen all
patient...
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YOUR LOGO
How should we measure good
nutritional care?
Has the patient
been screened
for ...
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Page  19
A vision for success
1
2
3
4
5
Prevention of malnutrition and dehydra...
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We have started to work
differently
Page  20
What
How
Convince
people there
is...
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Page  21
Working together across the UK towards an
integrated national nutriti...
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YOUR LOGO
Page  22
Building a blue print for an integrated strategy
and sharing best pra...
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Page  23
Thank You
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The cost of doing nothing

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Presentation given at the Department of Health Improving Hospital Food event by Dr Ailsa Brotherton, Honorary Secretary of British Association for Parenteral and Enteral Nutrition

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The cost of doing nothing

  1. 1. YOUR LOGO The Cost of Doing Nothing Dr Ailsa Brotherton, Honorary Secretary, BAPEN
  2. 2. Geben Sie hier Ihre Fußzeile ein YOUR LOGO British Association for Parenteral and Enteral Nutrition A multi-disciplinary charity committed to raising awareness of malnutrition and options for nutritional treatment, along with consequent impacts on health outcomes, resource utilization, and health & social care budgets.
  3. 3. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Poor breathing and cough from loss of muscle strength Psychology – depression & apathy Poor Immunity and infections Decreased Cardiac output Hypothermia – decline in all functions Renal function – limited ability to excrete salt and water Loss of muscle and bone strength – Immobility, falls, fractures and VTE Impaired gut integrity and immunity Impaired wound healing and susceptibility to pressure ulcers Liver fatty change, functional decline necrosis, fibrosis Consequences of Malnutrition (occurring within days) Malnutrition is both a cause and a consequence of disease
  4. 4. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Who is affected by malnutrition? Chronic disease COPD, cancer, inflammatory bowel disease, gastrointestinal disease, renal or liver disease. Chronic progressive disease Dementia, neurological conditions (Parkinson’s disease, MND). Acute illness Where food is not being consumed for more than 5 days (this is often seen in the acute setting and is rare in the community). Debility Frailty, immobility, old age, depression, recent discharge from hospital. Social issues Poor support, housebound, inability to cook and shop, poverty. Page  4
  5. 5. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Change in screening practice on admission in hospitals 0 10 20 30 40 50 60 70 80 2007 (N=175) 2008 (N=90) 2010 (N=141) 2011 (N= 147 ) % C e n t r e s 0-25% patients 26-50% patients 51-75% patients 76-100% patients Key finding: Majority subjects at risk admitted to hospital are from home and could be identified earlier Data kindly supplied by Christine Russell, Chair of NSW
  6. 6. Geben Sie hier Ihre Fußzeile ein YOUR LOGO We have measured the prevalence of malnutrition Page  6 Hospitals Care Homes Mental Health Units Centres (n=) Patients (n=) Centres (n=) Residents (n=) Centres (n=) Patients (n=) 2007 Autumn 175 9336 173 1610 22 332 2008 Summer 130 5089 75 614 17 185 2010 Winter 185 9668 148 857 20 146 2011 Spring 171 7541 78 523 67 543 Prevalence 25-34% 30-42% 18-20% Data kindly supplied by Christine Russell, Chair of NSW
  7. 7. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Nutrition support in adults 2006 February 2006
  8. 8. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  8 So what is the cost of not tackling malnutrition effectively?
  9. 9. Geben Sie hier Ihre Fußzeile ein YOUR LOGO MORTALITY Page  9 Significantly lower mortality rates found in supplemented hospitalised liver disease, orthopaedic, and surgical patients, and hospitalised older people1. Represents a 24% reduction in mortality p < 0.001; odds ratio 0.61 (95% CI, 0.48 to 0.78), meta-analysis of 11 trials, n = 1965; no significant heterogeneity between individual studies
  10. 10. Geben Sie hier Ihre Fußzeile ein YOUR LOGO COMPLICATIONS:  Significantly lower complication rates in supplemented surgical, orthopaedic, elderly and neurology hospital patients1 Represents a 56% reduction in complication rates Page  10 p < 0.001; odds ratio 0.31 (95% CI, 0.17 to 0.56), meta-analysis of 7 trials, n = 384; no significant heterogeneity between studies
  11. 11. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  11 READMISIONS: High protein ONS have been shown to reduce hospital readmissions by 30%1 Readmissions
  12. 12. Geben Sie hier Ihre Fußzeile ein YOUR LOGO NICE ONS and length of stay Standardised Mean diff. -3.45185 0 3.45185 Study % Weight Standardised Mean diff. (95% CI) -0.32 (-0.83,0.20){HARTSELL1997} 12.3 -0.49 (-0.78,-0.21){PEARL1998} 12.7 -3.00 (-3.45,-2.55){REISSMAN1995} 12.4 -0.03 (-0.39,0.33)Gist 2002 12.6 -2.54 (-2.93,-2.15)Gocmen 2002 12.5 -0.38 (-0.78,0.01)Burrows1995 12.5 -2.08 (-2.53,-1.63)Patolia2001 12.4 0.11 (-0.25,0.47)Weinstein1993 12.6 -1.09 (-1.91,-0.27)Overall (95% CI)
  13. 13. Geben Sie hier Ihre Fußzeile ein YOUR LOGO The Malnutrition Carousel HOSPITAL NURSING HOME CARE HOME HOME Malnourished PRIMARY CARE  ↑ dependency  ↑ GP visits  ↑ prescription costs ↑ hospital admissions SECONDARY CARE  ↑ complications  ↑ length of stay  ↑ readmissions ↑ mortality
  14. 14. Geben Sie hier Ihre Fußzeile ein YOUR LOGO So what does all this cost? Financial costs Over 3 million individuals malnourished or at risk of malnutrition in the UK Public expenditure associated with disease related malnutrition 2003 - >£7.3 billion p.a 2007 - >£13 billion p.a. NICE Cost Saving Guidance placed malnutrition as the 3rd potential biggest cost saving to the NHS 2013 - ?? >£15 billion p.a.
  15. 15. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Prevention We know where malnutrition exists is but we do little to prevent it SECONDARY CARE  ↑ complications  ↑ length of stay  ↑ readmissions  ↑ mortality CARE HOMES 30-42% of recently admitted residents HOSPITAL 28% of admissions PRIMARY CARE  ↑ hospital  ↑ dependency  ↑ GP visits  ↑ prescription costs SHELTERED HOUSING 10-14% of tenants HOME General population (adults) BMI <20kg/m2 : 5% BMI <18.5kg/m2 : 1.8% Elderly: 14% Prevalence of malnutrition in the UK
  16. 16. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Our Challenge Page  16 We know what excellent nutritional care looks like
  17. 17. Geben Sie hier Ihre Fußzeile ein YOUR LOGO We need highly reliable systems to deliver Design systems to screen all patients using a validated screening tool Develop a personal nutritional care plan Design reliable systems to deliver high quality nutritional care Monitor ongoing nutritional intake / status
  18. 18. Geben Sie hier Ihre Fußzeile ein YOUR LOGO How should we measure good nutritional care? Has the patient been screened for malnutrition risk? Does the patient have a nutritional care plan? Is the care plan followed with the provision of high quality food and drink (with ONS and assistance to eat where required?) Is ongoing monitoring in place? Good Nutritional Care Patient 1 √ x x √ x Patient 2 x √ x x x Patient 3 √ √ √ √ √ Patient 4 √ x x x x Total 75% 50% 25% 50% 25% Which patient would you want to be?
  19. 19. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  19 A vision for success 1 2 3 4 5 Prevention of malnutrition and dehydration Screening Identify malnutrition/ risk of malnutrition early through screening and assessment e.g. the ‘MUST’ Tool Treatment – high quality food and drink, assistance with feeding, nutritional support where required & ‘individualised’ care pathways Education and training for all care staff appropriate to setting, profession and responsibilities Management systems and structures to facilitate multidisciplinary nutritional care 5 principles of good nutritional care in all settings
  20. 20. Geben Sie hier Ihre Fußzeile ein YOUR LOGO We have started to work differently Page  20 What How Convince people there is a problem Working together to develop solutions Invest in data collection and feedback systems Have the right kind of leadership Overcoming challenges to improving quality
  21. 21. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  21 Working together across the UK towards an integrated national nutrition strategy •BAPEN •NACC •BDA •RCN •NHS Trusts – acute, community, mental health •Care Homes •Sheltered Housing PINNT: Supporting people on artificial nutrition Patient Association: CARE Campaign Carers UK: Care about Nutrition AGE UK •Food Industry •Clinical Nutrition •Catering Integrated Nutrition Strategy
  22. 22. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  22 Building a blue print for an integrated strategy and sharing best practice at a local level Outline the Problem  Develop shared ownership for the vision  Focus on Prevention  Focus on self management including self screening  Accessibility of information  Accessibility of food and drink  Early diagnosis and treatment  Developing person centred pathways of care Putting patients and the public first  Excellent use of patient stories  Increased public awareness  Describe how this can be delivered  The case for change  The campaign Raising awareness  Define the challenge  Outline the purpose of the Strategy  Outline the scope and structure
  23. 23. Geben Sie hier Ihre Fußzeile ein YOUR LOGO Page  23 Thank You

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