Enhanced dietetic service in care homes

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A case study from Gateshead Health NHS Foundation Trust describes an initiative to improve nutrition and hydration in care home residents.

What was the problem?

Malnutrition is a major cause and consequence of poor health, with older people particularly vulnerable. As most patients spend less than seven days in hospital, 93% of malnutrition exists in the community, with more than one-third of people recently admitted to care homes having the condition.

What was the solution?

The trust used vanguard funding to appoint a Band 6 dietitian for 10 months to improve nutrition and hydration in care homes. A four-module training programme for care home staff, produced by a dietitian and piloted in five care homes, focused on:

  • malnutrition and screening using MUST (Malnutrition Universal Screening Tool)
  • the 'food first' approach and oral nutritional supplements
  • diet and conditions such as coeliac disease, dementia, diabetes and dysphagia
  • hydration.

All residents under the dietetic service's care were reviewed every six weeks by a dietitian visiting the care home; previously they had been reviewed every six months by phone.

What were the results?

  • 158 care home staff took part in the pilot training project, including managers, deputy managers, nurses, team leaders, carers, care assistants, nursing assistants, support workers, activities facilitators, domestics, housekeepers, laundry assistants, cooks, kitchen assistants and administrators.
  • 83% felt more confident after the training than they did before; 17% felt as confident before as they did after; no-one felt less confident.
  • Correctly completed screening using MUST increased from 72% before training to 94% after.
  • 19% of residents under the dietitian's care had their oral nutritional supplements discontinued, and one-third successfully completed their dietetic treatment and were discharged from the service.
  • The level of malnutrition reduced from 36% to 22% of residents having a body mass index of less than 20 kg/m2.

What were the learning points?

Building relationships and trust, and altering perspectives and attitudes, are vital to changing care home culture. This cannot be achieved by a one-off training initiative. Care homes need dedicated dietetic input to provide a clinical and educational service for residents and staff.

Next steps

Newcastle Gateshead Clinical Commissioning Group has provided 12 months’ funding for the initiative to continue.

Want to know more?

Robyn Collery, Band 6 Dietitian and Clinical Educator in Care Homes, robyn.collery@nhs.net

Emma Emmerson, Service Lead for Nutrition and Dietetics and Occupational Therapy for Acute Services and Older People’s Mental Health, emma.emmerson@nhs.net

Tracy Webb, Service Line Manager for Therapy Services, tracy.webb5@nhs.net

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