It has been found that many organisations still fail to meet the basic rights of those in their care, in terms of access to food, drink and support when they need it. In acknowledgment that food service in hospitals must be given a higher priority, and be recognised as an integral part of the patient's treatment and care, Irish hospitals must now have a system to evaluate the nutritional and hydrational care for patients admitted to hospital. The purpose of this audit was to examine the level of mealtime support available to patients during the main mealtime service in our hospital. As the audit highlighted the need to alter ward processes around the mealtime service, quality improvement initiatives were introduced. These initiatives had a positive impact, enabling ward staff to improve adequacy of mealtime support to patients, leading to better patient quality care at this time.
Study aims were to validate agreement between the weighed intake method and the EWFRC record and to assess the effectiveness of the tool for identification of nutritional risk. Data was collected from 35 patients (male n¼16, female n¼19) over a consecutive three day period on two acute medical wards. 393 meals were weighed pre and post-delivery to patients over three meal occasions (breakfast, lunch and evening meal) and compared with intake recorded on the EWFRC. Comparison of means was conducted using ANOVA. Agreement between the weighed intake and EWFRC methods was tested using Bland-Altman plots (CI¼95%) with linear regression analysis used to determine significance (p¼0.05). Overall limits of agreement between the EWFRC and the weighed intake method were wide (À75.1 e +100%), therefore, do not accurately represent oral intake. Non-contemporaneous completion of the EWFRC based on patient recall may have influenced this result. Narrow limits of agreement were demonstrated (À17-19.5, p¼0.944) for 49 meals, which suggests that the EWFRC has potential to accurately represent oral intake when completed contemporaneously after direct observation of the meal. 18 patients remained on the ward for the duration of the three day period and their data was analysed to validate the accuracy of the EWFRC for prediction of nutritional risk. Comparison of nutritional risk between the two methods did not reach statistical significance. The EWFRC identified patients at low (n¼9 vs n¼10 from weighed intake), moderate (n¼1 vs n¼2 from weighed intake) and high nutritional risk (n¼5 vs n¼6 from weighed intake). The EWFRC is, therefore, a valid tool for prediction of nutritional risk over a three day period and may accurately record oral intake if completed contemporaneously and when meals have been observed. References [1] Palmer M, Miller K, Noble S. The accuracy of food intake charts completed by nursing staff as part of usual care when no additional training in completing intake tools is provided. Clin Nutr.
Background Ambulatory services provide specialist outpatient care, reducing costs associated with inpatient admissions and enabling the person to remain at home for longer (Report of the National Acute Medicine Programme, 2010). An Older Person’s Ambulatory Care Hub was established in a large teaching hospital. Prior service evaluation demonstrated that approximately one third of patients attending had a diagnosis of Parkinson’s Disease (PD). People with PD should have a collaborative approach between patient, family and healthcare providers to optimally manage their condition (NICE, 2017), therefore, the need was identified to evolve the traditional medical model to an interdisciplinary approach. The aim of this project was to complete a service evaluation and breakdown of Interdisciplinary Team (IDT) referrals. Methods An IDT working group including Clinical Nutrition (CN), Medical, Nursing, Occupational Therapy (OT), Physiotherapy (PT), and Speech and Language Therapy (SLT) was established. A comprehensive assessment form was developed and outcome measures were chosen. A short pilot was conducted and necessary amendments were made. A weekly clinic was established which included an IDT assessment, followed by a huddle with the medical team where referrals were generated. Data pertaining to the number of attendees and referrals generated were collected over a 3-month period. Results Over the data collection period, 31 patients attended the clinic. Referrals were as follows; Medical: 19, PT: 13, SLT: 10, OT: 7, CN: 6, Medical Social Work: 2. Patients requiring urgent medical review were seen immediately after the IDT huddle. Conclusion This project demonstrates a service evaluation of a novel IDT PD Clinic. This clinic highlights the need for an IDT approach to management of people with PD. Future service developments include obtaining patient feedback, pre-clinic calls to patients by a Healthcare Assistant to explain the purpose of the clinic, and adapting the clinic as appropriate.
Background Malnutrition, frailty and functional impairment adversely impact individuals and should be considered simultaneously in rehabilitation. Individuals in a Day Hospital (DH) setting require a multidisciplinary approach to rehabilitate and nutrition plays a fundamental role in improving patient outcomes. The aim of this study was to establish the nutritional profile of the patients attending the DH and to measure this against current dietetic referral criteria. Methods A prospective quality improvement analysis of older adults attending the DH was conducted. Nutritional status, using the mini nutritional assessment short-form, demographic and biochemical information was collected from nursing notes and the software Key. Frailty scores were assigned using Rockwood Clinical Frailty Scale. Nutrition service provision was evaluated in relation to the priority rating system for DH Patients. Results Nearly two-thirds of the 57 patients were malnourished (17.5%) or at risk (45.6%), 1 in 4 (26.3%) was obese. Most patients were frail (77.2%). 45.6% of patients were referred to clinical nutrition services. 90% of malnourished patients and 53.8% of those at risk were referred to dietetic services. Patients were seen at 4 ± 2.45 weeks after referral, 19.2% of patients were seen on time. Patients with underweight or obese BMI classifications were at greater risk of malnutrition and frailty. Those referred to the DH for falls review were nutritionally poorer and physically frailer. Conclusion This study highlights the need for a focused nutritional service in this environment. Revision of dietetic referral criteria and streamlining strategies are required to provide quality, timely intervention to those who need it most.
Background Sarcopenia, characterised by progressive loss of muscle mass and strength, is associated with increased morbidity, mortality and poorer quality of life. International and European clinical practice guidelines on diagnosis and management of sarcopenia suggest the algorithm: Find Cases through screening, Assess Strength with validated outcome measures, Confirm Diagnosis with muscle quantity analysis and Determine Severity with validated physical performance measures (PPMs). Treatment recommendations include progressive resistance training (PRT) and a protein-rich diet. This audit aimed to investigate our specialist gerontological services’ adherence to these guidelines. Methods Using a custom-designed audit tool, patient medical records (PMRs) were reviewed in two inpatient rehabilitation wards and one Day Hospital (DH). Patients were included if under the care of a geriatrician and reviewed two or more times by a physiotherapist. Results Thirty PMRs were reviewed (18 DH, 12 inpatient). 0% of patients were screened for sarcopenia using a validated screening tool. 83.3% (n=15) of DH patients and 33.3% (n=4) of inpatients underwent a validated strength assessment. 0% of patients underwent muscle quantity analysis. 66.6% (n=12) of DH patients and 33.3% (n=4) of inpatients had validated PPMs performed. Probable sarcopenia was identified in 75% of DH and 100% of inpatients who had PPMs conducted. PRT was prescribed in 94% (n=17) and 50% (n=6) of DH patients and inpatients respectively. 16.6% (n=3) of DH patients and 75% (n=9) of inpatients were referred for nutritional assessment. 100% (n=9) of patients assessed by clinical nutrition were prescribed a high-protein/high-calorie diet. Conclusion This audit demonstrates limitations in identifying and managing sarcopenia as per the most recent international and European clinical practice guidelines. It is recognised that a multi-disciplinary approach is required to improve adherence to these guidelines. A multi-disciplinary sarcopenia management pathway is being implemented to facilitate this. Re-audit is planned to ensure the effectiveness of this pathway.
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