Core Groups updates

BAPEN

New Malnutrition Self-screening Website for Use by the Public

This new website, based on ‘MUST’ and designed for use by adult patients and/or their carers was launched on 1st December 2015. The website includes general information about the effect of illness on appetite, a simple calculator to enable the user to assess their risk of malnutrition and links to the dietary advice sheet from ‘the Malnutrition Pathway’ for those identified as being at risk who are also encouraged to seek professional advice.

The development of the self-screening website by the Malnutrition Action Group of BAPEN is very much in line with a range of professional and government recommendations to help empower patients and involve them in their care. Studies have shown that patients can effectively screen themselves in outpatient clinics using an electronic version of ‘MUST’ similar to the one available on this website and we are delighted that Carers UK and also the BDA have officially welcomed the initiative. The new Malnutrition Self-screening Tool will be available via: www.malnutritionselfscreening.org and we hope that dietitians will support its use.

It is hoped that the website will also help tackle unrecognised and untreated malnutrition, which largely exists in the community. If malnutrition could be prevented or identified and treated at an early stage it could reduce dependency on others and admissions to hospital and other care settings. It could also help family members who are often concerned about weight loss and changes in appetite when a loved one is unwell.

New Care Home Reports

Apart from providing a summary of all the previous NSW surveys (2007-2011) the two new care home reports, one for UK as a whole and the other for England provide a variety of new information This includes establishment of trends over time, comparisons between England and the rest of the UK, and an analysis of the extraordinarily large and variable weight changes that occur in care homes during the six months after admission. Residents who were malnourished on admission to care were more likely to lose further weight during their residency, while ‘non-malnourished’ subjects gained weight. Most residents who were underweight on admission remained underweight at the time of the survey. The reports also compare weight status and its distribution between care home residents and the general public. Underweight (BMI < 20 kg/m²) was distinctly more common among care home residents than the general population and obesity was less common. Underweight among care home residents increased with age, while obesity decreased with age. The overall prevalence of malnutrition among those admitted to care homes in the previous 6 months was found to be 35% and this probably represents probably the most robust figure for England and the UK as a whole.

The two reports which complete the series of reports from the NSW surveys are available for downloading from: www.bapen.org.uk.

BAPEN Nutritional Care Tool Update

BAPEN’s first ever, online Nutritional Care Tool has been put through its paces in the first data collection week. Between 21st-27th September organisations were asked to use the Tool to survey patients on four wards (or more). Questions focussed on the effective screening of patients using ‘MUST’ and, uniquely, also asked patients for their views of the nutritional support they have received.

We are absolutely delighted to report an incredibly encouraging first data collection period, with more than 1,000 patients surveyed across 17 organisations. Although it is early days, the results indicate a high level of quality of nutritional care in participating organisations, but at the same time highlight variation and opportunities for learning and improvement.

It’s becoming clear, even at this early stage, that the use of the Tool differs between organisations; some are surveying ‘little and often’ to build up a long-term view of their data. Others are surveying at scale on a less frequent basis. Either approach is perfectly OK. The whole purpose of the Tool is as an enabler for organisations, so that data can be used to promote the best nutritional care in a way that best suits the organisations using it. We’re focussed on improvement, not performance management. Comparisons between organisations are for learning purposes and we hope that this approach supports you in your ongoing work.

For further details on the National Nutritional Care Data Collection Weeks visit: http://data.bapen.org.uk/.

British Artificial Nutrition Survey (BANS)

Monitoring trends in home artificial nutrition support

What is BANS?

The British Artificial Nutrition Survey (BANS) established in 1996, has been collecting data about patients on home enteral and parenteral feeding for nearly two decades.

BANS reports provide evidence of trends with regards the use of artificial nutrition support (ANS) and continues to evolve in response to the needs of health professionals supporting patients on ANS and to the changes in how NHS services are commissioned.

A multi-disciplinary committee including nursing, dietetic, pharmacy and medical representation oversee BANS initiatives and seek to disseminate meaningful data about current practice. It is the largest register of patients on ANS in the world and is regularly cited in research studies, guidance and other publications focusing on patients receiving ANS. Healthcare professionals across the across the UK contribute to the BANS database, allowing the capture of the following important information:

Date of start and end (with reason) of episode of ANS.
Point and period prevalence.
Indication (diagnosis) and reason for commencing ANS.
The patients demographic including place of residence, age and.
Method of nutrition support.
Feeding route.
Level of activity of patient.
Ability to self-manage ANS.
Date of start and finish (including reason).

The committee publish annual reports with regards regional and national trends in ANS. Many interesting findings were presented in the last report published in 2011 including:

A 5% increase in patients commencing HEF.
The number of patients with an indication of cancer for being on HEF had risen from 25% in 2000, to 39% in 2010.
At the end of 2010, 71% adults and 86% of children registered on BANS continued on HEF.
A trend over the previous decade for the age of children on HEF to be decreasing.
63% of children on HEF being fed via a naso-gastric tube, in contrast to 17% of adults being fed this way.
The falling number of centres registering new HPN patients onto BANS, suggested that fewer centres were managing larger caseloads of HPN patients.

What are the benefits of contributing to BANS data?

BANS reports capture changes in the regional and national prevalence of both the method of ANS and indication for starting ANS. These reports are free to download on the BANS website: (www.bapen.org.uk/professionals/bans/bans-reports) and can be used to strengthen bids for increased staff resources, in conjunction with the growing literature reporting on the effectiveness of multidisciplinary team support for patients on home ANS. In response to user feedback reporters can also obtain reports about their own individual centre ANS caseload to allow a comparison of local practice against national trends. We have a professional responsibility to add to the evidence base with regards the use of ANS and getting involved in collecting BANS data is a great way to contribute to this.

The new intestinal failure registry (HIFNET) will collect information about the nutrition team supporting patients from each reporting centre. This register will collect a range of clinical and nutritional outcomes about patients in both the primary and secondary care setting. Though commissioned to record IF activity of patients in England, the database is available for use from all centres in the UK.

The committee welcome feedback from reporters and are open to collaboration with health professionals to collect information with regards specific patient groups such as the survey of HEF practice in patients receiving radiotherapy for head and neck cancer conducted in 2011.

Future BANS developments

The BANS committee intends to develop e-BANS to be able to collect data that can be used to monitor the clinical outcomes of patients commenced on HEF. A PENG working group is currently developing a nutrition support outcomes toolkit, to enable dietitians to be able to demonstrate the effectiveness of the interventions they recommend. The output of this project will be integrated into the BANS database with an aim to provide a tool that can be used by health professionals across the UK. This will facilitate the benchmarking of services supporting patients on HEF which would allow gaps in services to be identified and may strengthen bids for further resources to be commissioned.

The BANS committee aims to have representation from all 4 corners of the UK to ensure the data reported is relevant to all regions and is interpreted appropriately. There is currently an opportunity for a dietitian from Scotland to join the committee. If you would be interested in applying for this post please e-mail the PENG HEF Clinical Lead for further information at: seanwhite1977@gmail.com.

How do I start registering patients on BANS?

Further information about BANS can be found on the BAPEN website at: www.bapen.org.uk/professionals/bans. If your centre wishes to start registering your patients on BANS, please e-mail the BANS coordinator at: bans@streets-heaver.com to obtain a reporter number.

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