New tool to help nurses improve nutritional care

Contains measures for quality of care as well as barriers and patient experience

The NMC Code is clear that nutrition and hydration are among the fundamentals of nursing care, yet to date, there has been no nationally available tool to support nurses to measure the quality of nutritional care.

Traditionally, measurement of patients’ nutritional care has been limited to a retrospective audit approach, measuring the percentage who have had nutritional screening completed on admission.

It has, in clinical practice, tended to be a tick-box exercise with many organisations achieving a good result. However, when nutritional care is observed during, for example, Care Quality Commission (CQC) inspections, or when patients are asked about their experiences, the results are much more variable.

During its inspection programme, the CQC has found a number of trusts falling below the minimum standard required. However, lack of a tool to measure and monitor quality has been one of the main barriers for senior and front line nurses to be able to demonstrate that good nutritional care has been provided.

The British Association for Parenteral and Enteral Nutrition (BAPEN) has therefore designed, tested and launched a tool that measures the quality of nutritional care delivered.

It takes around five minutes to complete per patient and collects information on the care setting and specialty; the patient’s age and diagnosis; the accuracy of nutritional screening undertaken; care planning and implementation of the nutritional care plan, and outcomes in terms of changes in weight and patient experience.

It is the first nutritional 'point of care' measurement tool that is available nationally to enable nurses to not only measure the quality of nutritional care they deliver, but to also make improvements where required. If deficiencies in nutritional care are identified - for example, if a patient is malnourished but has a care plan that is not being implemented - then improvements in nutritional care can be delivered in ‘real’ time.

Nurses lead on ensuring that nutritional screening has been undertaken.  When difficulties exist that prevent screening from being implemented accurately, for example if there are not any calibrated scales or hoist scales at ward level, the tool is designed to log and measure any barriers to accurate screening.

Patient experience

The tool contains two patient experience questions that have been designed by patients and tested by nurses. Given the importance of nutrition and hydration in the NMC Code, we believe it is important to measure patients’ experiences of the nutritional care provided more regularly than in an annual survey.

The 2013 inpatient survey highlighted the number of patients who were not receiving all the help they needed with eating and drinking, and the 2014 results found no significant improvements in the support provided.  

This tool has been designed and tested by BAPEN's multidisciplinary quality and safety committee, many of whom are front line staff and have therefore designed a tool with a high level of clinical utility.

For further information or to sign up to use the free tool click here.

About the author

Wendy-Ling Relph is matron for nutrition and quality improvement, East Kent Hospitals University NHS Foundation Trust, and BAPEN communications officer.

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