The recent publication Commissioning Excellent Nutrition and Hydration 2015-2018 has brought to light the importance of undernutrition and dehydration care. 35% of those admitted to care homes are affected by undernutrition and 1 in 3 admitted to acute care will be malnourished or at risk of being so. Given the scale of malnutrition and dehydration, this release is encouraging for both patients living in the community and residents in care homes.
So what’s the vision?
The vision is that “all people will receive safe and high quality nutrition and hydration support when required, through the commissioning of person-centred and clinically effective integrated services in the community and in health care commissioned settings.”
The guidance urges commissioners to view nutrition and hydration as a top priority as well as outlining steps on how to tackle the problem. As a Product Manager in undernutrition, I see first-hand the struggles dietitians and care home managers face. So what are they?
Lack of resources
I hear often about the lack of dietetic resources within the NHS. Be it, how there aren’t enough staff to complete patient monitoring as regularly as they would like, or how dietitians can’t spend enough quality time with their patients. At a time where resources are limited, I see duplications in information gathering, and highly qualified clinicians carrying out tasks better suited for a carer or even the patient themselves. Could improvements be made to the efficiency and productivity of available NHS time, ensuring that it is better spent? I think so.
Pharmaceutical regulation
Without real integrated care, pharmaceutical allocation can often lead to unnecessary NHS costs. Take for example a care home resident who is being prescribed oral nutritional supplements. If they don’t like them, they may have stopped taking them meaning ONS are being wasted. Another common example is patients who have gained weight and no longer need the supplements. If the dietetics team haven’t been able to see the patients for six months, this information may not have been picked up meaning supplements are arriving by the case load, leaving them either unused or used unnecessarily.
Integrated care
The guidance states, “if patients can all be connected via one master system this reduces the need for so many visits”. Often, there is lack of communication between the care homes, dietetic departments and primary care because there is no central system. If patient readings could be visible to the entire care team, weight fluctuations could be seen by all meaning better decisions can be made around each patient. As a result, this will improve ONS compliance and reduce unnecessary visits.
Undernutrition and the role of digital health
A digital health approach to undernutrition could overcome these challenges. In a recent care home user group I attended, I heard from one care home how digital health has made a huge difference to their way of working so much so they were throwing parties to celebrate their patient’s weight gain.
Digital health provides the means of improving communication, whether that’s between a GP and the care home or the dietitian and the care home or a patient and their nurse. Using one central system that enables a dietitian, a GP and a community nurse to see a patient’s progress over time can make all the difference. Alerts can be set up to warn of those patients that are losing weight so intervention can happen before more weight is lost. Why also stop at nutrition and hydration? Why not also monitor blood pressure, heart rate, INR and their risk of falls also?
The NHS is experiencing difficult times through lack of resource and funds. By adopting a digital health approach, issues can be addressed safely and efficiently. Dietitians are able to prioritise their patients, gather regular and appropriate patient readings, make savings in prescribing areas and even reduce referrals to the local GP or secondary care.