Origin of NUTCAP:

AIM-logo-1.png

  • To implement the NUTCAP project, the project required funding. The Project received funding from The Aim Foundation. The AIM Foundation is a registered charity governed by five trustees (Caroline Marks, Sophie Jones, Alison Prout, Joanna Barrett and Pippa Bailey).
  • The Foundation aims to improve the well-being of young people and infants and protects the UK rivers/ coastal waters and oceans. The foundation helps by sponsoring and undertaking research and funds registered charities. The foundation aims to help children and young individuals, charities and voluntary bodies and other defined groups. The Aim Foundation operates throughout both England and wales (The Aim Foundation, 2024)

About NUTCAP:

What is NUTCAP?
  • NUTCAP is an innovative project, created for nursing students to expand their learning and understanding around the topic of nutrition and participate in a quality improvement project  within their local health and social care settings to help improve the nutritional care of adults.
  • Student nurses work alongside registered nurses, health professionals and Doctors  exploring the enablers and barriers to effective planning and management of nutritional care with a range of different health and social care settings, and help to identify and implement solutions to prevent them. 
What does NUTCAP aim to do? 
  • To improve the nutritional care of adult people in health and social care
What are the objectives of this project?
  • Better understanding of the food and nutrition experiences of people during the times they engage with health and social care providers
  • Identify and understand the barriers to planned nutritional care within identified settings.
  • Identify gaps in Nurses’ Nutrition knowledge and management of food and Nutrition to people in their care.
  • Improve professional working between Nurses and Dietitians
  • Identify cost-effective solutions that can be implemented and sustained to improve nutritional care within the constraints of individual health and social care settings.

Background:

What is malnutrition?

(Elsevier, 2024)

“Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization” (WHO, 2024).

 

Malnutrition - Biblioteca de Osmosis

Malnutrition increases the risk of health issues, negative quality of life and mortality. Literature has linked malnutrition with extended hospital stays, placing a larger burden on the health care system (Roberts et al., 2019) The impact of malnutrition on health and health care costs was estimated to cost £7.3 billion per year in 2006 (Hungry to be heard, 2006), with BAPEN indicating this has risen to £20 billion currently

Malnutrition affects around 3 million people in the UK and 33 million around Europe. Adults suffering with malnutrition, account for 30% of hospital admissions, 35% of care home admissions, 15% of outpatient clinic appointments and 10% of GP appointments (BAPEN, 2017).

Malnutrition in health and social care is not new

Hungry in Hospital (Community Health Council 1997) and Hungry to be heard (Age UK 2010) by Age UK identified nutritional inadequacies in hospital patients. These reports were produced to raise awareness for the elderly who were being ‘starved’ in hospitals.

The Hungry to be heard report has introduced 7 steps to reduce malnutrition in hospitals:

  1. Hospital staff must listen to older people, their relatives and carers and act on what they say.
  2. All ward staff must become ‘food aware’.
  3. Hospital staff must follow their own professional codes and guidance from other bodies.
  4. Older people must be assessed for the signs or danger of malnourishment on admission and at regular intervals during their stay.
  5. Introduce ‘protected mealtimes’.
  6. Implement a ‘red tray’ system and ensure that it works in practice.
  7. Use volunteers where appropriate.
  8. However, to overcome malnutrition in hospitals and improve the food consumption of hospital patients, interventions have been implemented in health care settings

Since then the Malnutrition Taskforce in 2017 in their report  ‘State of the Nation‘ identified that as our populations ages so does the risk of malnutrition with as many as 60% of older people and their carers being worried about food availability. Regular surveys in health care by the British Association for Parenteral and Enteral Nutrition (BAPEN) have consistently reported the level of malnutrition in responding NHS trusts. In 2022 45% of patients across all settings were at risk of disease related malnutrition.  More recently, post pandemic issues related to food insecurity influenced by the economic crisis, planetary and climate concerns including extreme weather events, and growing populations has increased the extent of malnutrition in all its forms.  No longer can we think about malnutrition simply as a result of the absence of food as it encompasses people who are overweight or obese, and that have micro nutrient deficiencies (WHO, 2018). There are many factors behind the cause of malnutrition in adults, when unwell.  These include; poor nutrient intake, illness-related loss of appetite, drug-related side effects, poor management of patient nutrition and reduced nutrient bioavailability (Ostrowksa et al., 2021). Literature has found that in‐patients experienced hunger and difficulty accessing food due to the lack of staff noticing and the patients being reluctant to request assistance (Naithani et al., 2008).

NUTCAP Audit:

NUTCAP works as a clinical placement for nursing students undertaking the BSc Hons Nursing degree. Within an identified health or social care setting, nursing students attend a 10-13-week supernumerary placement. Throughout the course of the project, the nursing students attend weekly meetings with their assigned project leaders who acts as practice assessor/supervisor, as they work alongside staff to identify the barriers and supports for  nutritional care, complete audits in their allocated clinical areas to identify the nutritional issues, recognise good practice, and identify cost effective interventions yo address concerns that are raised. 

  • The project uses a participatory action research methodology to understand and explore the nutritional issues within a specific sector or population group.
  • Students undertake training on nutritional screening, and clinical audits.
  • Students complete scoping literature reviews and critically appraise the evidence

The audit tool is based on the The Canadian Malnutrition Task Force More-2-eat validated tool developed for a national survey  to understand  current practices around malnutrition in Canadian hospitals. The tool captures Age, the reason for admission weight, BMI, MUST screening tool completion, food and fluid charts Using the Mealtime Audit Tool (MAT) (CMTF 2015), non-participant observations of the general wards were recorded to monitor meal times. Patient documentation was further reviewed and the data was collected between November 2021 and July 2022.

Please see the attached QR code for the NUTCAP Audit 2023-2024:
The NUTCAP Audit 2023- 2024 is based on Canada’s More-2-Eat implementation project. The more-2-Eat project explores how to improve the nutrition culture in Canadian hospitals.

References:

Age concern (2006) ‘Hungry to be heard’ Available at: https://www.dignityincare.org.uk/_assets/Resources/Dignity/CSIP Comment/Hungry_to_be_Heard.pdf (Accessed: 1 March 2024).

Bapen (2017) ‘Malnutrition’ Available at: https://www.bapen.org.uk/images/pdfs/news/malnutrition-the-facts-july-2017.pdf (Accessed: 1 March 2024).

Canadian malnutrition task force (2022) ‘ National Survey of Current Malnutrition Practices in Canadian Hospitals 2022’ Available at: https://nutritioncareincanada.ca/research/more-2-eat-implementation-project (Accessed: 28 February 2024).

Naithani, S., et al. (2008) ‘Hospital inpatients’ experiences of access to food: a qualitative interview and observational study’, Health Expectations, 11(3), pp.294-303

Osmosis by Elsevier (2024) ‘Malnutrition’ Available at: https://www.osmosis.org/learn/es/Malnutrition (Accessed: 1 March 2024).

Ostrowska, J., et al (2021) ‘Hospital malnutrition, nutritional risk factors, and elements of nutritional care in Europe: comparison of polish results with all European countries participating in the nDay survey’. Nutrients13(1), pp.263.

Roberts, S., et al. (2019) ‘Improving nutrition care, delivery, and intakes among hospitalised patients: a mixed methods, integrated knowledge translation study’, Nutrients11(6), pp.1417.

 

 

Designed by Mia Whittaker