High Impact Action: Keeping nourished - getting better
Stop inappropriate weight loss and dehydration in NHS provided care.
Extent of the problem
Three million people are at risk of malnutrition in the UK; of these, 3% are in hospitals or other NHS settings (BAPEN; 2009). In 2006, it was found that around 10–40% of patients in the community (at home and in care homes) and in hospital have malnutrition (NICE 2006).Currently, 40% of patients admitted to hospital are undernourished. (British Nutrition Foundation, 2009).
Malnutrition is associated with poor recovery from illness and surgery (Stratton et al 2003). Yet NICE (2006) found that only about 1/3 of patients were screened for malnutrition on admission to hospital. Subsequently, patients at risk of malnutrition are not recognised and referred for treatment (Elia et al 2005).
Lack of adequate hydration has been noted by the NPSA, the RCN and Water UK (2007) as a common problem in hospitals. Dehydration increases length of hospital stay and is linked to a number of serious conditions, such as coronary heart disease (CHD) and stroke. In one study adequate hydration has been shown to reduce the risk of CHD by 46% in men and 59% in women. Conversely, dehydration increases the mortality of patients admitted to hospital with a stroke two-fold.
Benefits for patients and benefits for NHS
A study by the British Association for Parenteral and Enteral Nutrition (BAPEN) (2009) found that malnourished patients stay in hospital longer, succumb to infection more often, visit their GP more and require longer-term care and more intensive nursing care. They also identified additional consequences of malnourishment, such as muscle wasting, increased risk of infection, predisposition to falls and pressure ulcers, delayed recovery and reduced quality of life.
BAPEN estimated in 2005 that malnutrition costs the NHS £7.3 billion annually. Of this, 52% (£3.8 billion) relates to malnourished patients in hospital, and a further 36% (2.6 billion) to patients in long-term care facilities. Proper hydration alone could lead to savings of £0.95 billion (NPSA, RCN & Water UK).
High Impact Action front-line submission
Enhancing Care for Vulnerable Patients is a new scheme to prevent dehydration at Milton Keynes Hospital NHS Foundation Trust. The red water jug scheme helps staff identify patients who require help with their fluid intake. Any patient who is vulnerable or at risk of dehydration is given a red jug and mug to highlight their specific hydration requirements. Devised and implemented by nursing staff, the scheme is helping ensure that patients are adequately hydrated. Results include: reductions in length of stay, earlier discharge for those patients involved in the scheme and reduction or elimination of the need for IV fluids. As patients are adequately hydrated the risk of contracting an infection, e.g. UTI, or as a result of intravenous access, is also reduced.
British Association for Parenteral and Enteral Nutrition (2009) Combating Malnutrition: Recommendations for Action Worcester: BAPEN. British Nutrition Foundation (2009) Undernutrition in the UK. Available at: http://www.nutrition.org.uk/home.asp?siteId=43& sectionId=463&subSectionId=341&parentSection=303&which=6#1163 (Accessed on 3rd November 2009). Elia, M., Zellipour, L., Stratton, R.J. (2005) ‘To screen or not to screen for adult malnutrition’, Clinical Nutrition, 24, 867-84. NICE and the National Collaborating Centre for Acute Care (2006) Nutritional Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (Clinical Guideline 32). Available at: http://www.nice.org.uk/ nicemedia/pdf/cg032fullguideline.pdf (Accessed 5th November 2009). NPSA, RCN and Water UK, Hospital Hydration Best Practice Toolkit. Available at: http://www.rcn.org.uk/newsevents/campaigns/ nutritionnow/tools_and_resources/hydration (Accessed on 3rd November 2009). Stratton, R.J., Green, C.J., Elia, M. (2003) Disease related malnutrition, UK: CABI Publishing.
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