1. Variables Results from initial dietary clinical
review
Malnutrition Universal
Screening Tool (MUST) from
admission and weekly and
dietetic referral due to ONS
prescriptions1,2
100% compliance
Dietetic referrals and reason
for referral
72% of patients referred. Of these referrals:
• 46% low and medium risk of Malnutrition (MN) –
inappropriate referrals)
• 32% at high risk of MN
• 31% other needs (wt management, diabetes etc.)
Updated nutrition care plan
after each MUST screening1,2
0% compliance – Clinical Support Workers (CSWs) role
without Registered Nurses involvement
First line dietary advice 1
27% of food charts showed consistency (three days of intake)
5.5% of food charts were fully completed
11% of food charts showed evidence of food first and Dietitian
(DT) recommendations
Meal time observations (5
days lunches – March 2012)
Food wastage
• 33 portions of mains
• 24 portions of vegetables
• 28 portions of puddings
• 9 portions of cooked snacks
*estimated cost £11,291 per year
Maria Ureta
Community Rehabilitation In-Patients Dietitian
Reducing Food Wastage & Promotion of
MUST within Athlone Rehabilitation Unit
Methods
Resources development:
1. Eating and drinking pathway including identification of not only malnutrition but
also other dietary needs; simple and accurate indication for implementing food first
advice from admission; and appropriate Dietetic referrals indications - From February
2012
2. New MUST forms with 5 steps of MUST tool, dates and times, care plan updates
and Registered Nurses signature – From February 2012
3. Food chart developed with portion sizes to guide CSWs and Nurses through
menus and food ordering – From February 2012
4. Communication book to improve catering – Clinical staff working relationship
5. New menu format without cooked snacks and new snack list which includes type
of diet and textured and it is based on cold snacks already available.
6. SLT and DT recommendations folder for easy access - From May 2012
Trainings: MUST training including new online MUST calculation and Portion size
training including food first advice, healthy eating and nutrition support diets - From
April 2012 and twice yearly
Forums: Food wastage and snack time with catering involvement and CSWs forums
to communicate results - April and May 2012
Audits: Monthly MUST and care plans and Meal times observations and food
wastage from April to June 2012 and every three months - From June 2012
Results
Figures 1, 2 and 3 show the positive impact that the use of new resources and
training have had in compliance with standards of care and the use of current food
resources from March’12 to June’12 to address dietetic treatment, reduce food
wastage and optimize local resources.
It is important to highlight
The food wastage reduction (from 33 portions of mains to 0 portions during two
consecutive months) of food observation and audit,
Cost reduction estimated after training from £11,291 (initial observation) to £ 0
(June’s observation)
100% compliance with the 3 standards of care (1.MUST from admission and weekly 2.
Updated nutrition care plan after each MUST screening 3. First line dietary advice)
Conclusion
At Ahtlone Rehabilitation Unit, best dietetic practice is being applied by optimizing
current food resources, updating local pathways, developing skills and increasing
knowledge and awareness about nutrition and dietetics among members of staff and
liaising with other services
Future work
1. To continue auditing food wastage and standards of care
2. To continue developing nutrition competences among members of staff by
training and support
3. To continue improving working relationships and communication with catering
Acknowledgment: Thank you to all members of staff at Athlone Rehabilitation
Unit, members of Catering staff, Peleta Hamilton – In Patients Estates and
Facilities Support Officer and Lee Thorogood- Service Manager for their
support
References:
1. National Institute for Clinical Excellence, Nutrition Support, 2006
2. Care Quality Commission, Standards of care.
Figure 2: Estimated annual cost in £ and average
number of potions of food wastage based on montlhy
meal times observations
0
5
10
15
20
25
30
35
M
arch'12
A
pril'12
M
ay'12
June'12
Monthly meal times
observations
Potionsoffood
0
2,000
4,000
6,000
8,000
10,000
12,000
Pounds(£)
Number of food
portions wastage
Annual estimated
cost in £
Background
From July to October 2011 a Dietary clinical review took place at Athlone
Rehabilitation Unit. The clinical review aimed to assess whether best dietetic practice
was applied to patient at the unit from admission (See table below for clinical review
results) The results showed a need to improve competences among all clinical staff
regarding first line dietary advice, an appropriate referral system and better use of
current dietetic and food resources in order to meet patients’ nutritional needs. In Feb
2012 it was also identified by the Service Manager, and Estates and Facilities Officer
that there was a significant amount of food wasted at meal times and both parties
were keen to understand why this was occurring.