Elderly care home nutrition
The North Bedfordshire ‘PUFFINS’ Project PUFFINS - aren’t they small black and white birds, often pictured with their brightly coloured beaks packed with sand eels? Well, North Bedfordshire is a long way from the coast, but we do have PUFFINS!
Bernice Chiswell Bsc Hons RD Bedford Hospital NHS Trust and North Beds Food First Project
Carol Ferdinandez Msc RN South Essex Partnership Trust, Lead Tissue Viability Nurse
Bernice is a Community Dietitian with over 30 years’ experience. As well as leading part of the North Bedfordshire Food First Project, she has interests in behaviour change, obesity and MS.
Carol has been a Registered Nurse for 22 years, laterally specialising in Tissue Viability with a keen interest in Pressure Ulcer Prevention work.
Our PUFFINS are Pressure Ulcer Food First INitiative Champions, and their ‘habitat’ is the elderly care homes in Bedford and surrounding areas. The impetus for this project was generated by a desire to see an improvement in the detection and management of malnutrition in care homes for the elderly. At the same time, there are national and local initiatives to stop avoidable pressure ulcers (1). This is seen as a key objective for healthcare providers and commissioners in an effort to ensure provision of high quality, patient-centred care in line with the Department of Health’s ‘Operations Framework for the NHS in England’ 2012/13. Pressure ulcers are seen as an indicator of quality of care and, given that they are largely avoidable, Tissue Viability Nurses (TVNs) have long expressed concern (2). Some are questioning whether pressure ulcers could be construed as an act of nursing negligence (3). NHS Midlands and East (previously the regional SHA cluster, compromising NHS East Midlands, NHS West Midlands and NHS East of England) set the goal to eliminate avoidable grade 2, 3 and 4 pressure ulcers by December 2012. BAPEN are involved in this ongoing work, looking at disseminating good practice and sharing the resources produced to support this goal (4). Managing nutrition and hydration is a key aspect of pressure ulcer prevention (5). In view of this, we teamed up with the lead tissue viability nurse in Bedfordshire (South Essex Partnership Trust) who was also considering a champions programme in order to recruit, train and support champions who would be skilled
to focus on both agendas. Studies indicate that provision of champions in addition to effective prevention practices leads to an improvement in patient outcomes with respect to pressure ulcers (6). This multidisciplinary approach of sharing knowledge and expertise enhanced engagement with the care homes. Together I believe we have achieved far more than we could have as separate teams, to promote evidence-based practice in the care homes. The name PUFFINS came from the champions themselves, as did the title ‘Puffin Flyer’. (I wish we possessed such creative thinking!) To qualify as a champion, the member of staff needs to be in a position to influence practices in their care home. It was necessary to have the care home management buy in to ensure commitment to change within their care homes, as it is known that practice is linked not only to knowledge, but to inherent beliefs and values (3) 3. We have chefs, senior carers, nurses and home managers who are PUFFINS. In all, 96 have been trained, with a further training course planned in March where a further 22 are booked (with a waiting list). Once recruited, budding champions attend a one-day training course. This is presented in an interactive way to keep staff engaged and includes topics such as: the aetiology of pressure damage; the cost in terms of morbidity and mortality as well as financial; how to screen using Waterlow and action plans to prevent and managed pressure ulcers. The Food First approach is explained, together with MUST screening and nutrition NHDmag.com April 2015 - Issue 103
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