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Benchmarking and nutrition

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Nutrition for hospitalised patients can be compromised by a number of common factors. These have been identified as a failure to detect or recognise poor nutrition, lack of patient nutritional data, for example weight and weight loss, lack of relevant referrals, fragmented working practices, and failures in education and training (British Association of Parenteral and Enteral Nutrition, 1999).

Abstract

VOL: 99, ISSUE: 03, PAGE NO: 49

Isobel Mason, RGN, is clinical nurse specialist gastroenterolgy, Royal Free Hampstead NHS Trust, London; Claire Brady, RGN, is clinical nurse specialist nutrition support, Royal Free Hampstead NHS Trust.

Nutrition for hospitalised patients can be compromised by a number of common factors. These have been identified as a failure to detect or recognise poor nutrition, lack of patient nutritional data, for example weight and weight loss, lack of relevant referrals, fragmented working practices, and failures in education and training (British Association of Parenteral and Enteral Nutrition, 1999).

Clinical practice benchmarking offers an opportunity to address these problems through a process that identifies best practice. This process leads to continuous improvement through comparing and sharing ideas.

The benchmarking process has enabled nurses at the Royal Free Hampstead NHS Trust to take a step-by-step approach to sharing good practice and developing action plans to remedy poor practice.

Benchmarking The Essence of Care resource pack is designed as a tool to assist health care professionals to improve the quality of care (Department of Health, 2001). In order to use it effectively at the Royal Free Hampstead NHS Trust, several stages of benchmarking implementation were developed:

- Identifying a benchmarking group;

- Addressing the requirements of The Essence of Care;

- Examining current practice and attitudes;

- Evaluating results and action planning;

- Publication and advertisement of results;

- Ward scoring.

 

Identification of a benchmarking group The nursing directorate in the trust identified a multiprofessional group that could work together to improve the quality of nutritional care. The group included pharmacists, dietitians, medical staff, domestic staff, the chaplaincy, the clinical governance department and support service managers.

The group also involved nurses from a variety of clinical areas, for example, clinical nurse specialists in nutrition, tissue viability, gastroenterology and infection control as well as ward managers. Senior nurses were recruited to help negotiate changes in practice.

Addressing The Essence of Care Led by one of the nurses, the group reviewed each factor of The Essence of Care and areas that needed to be addressed were identified (see Table 1).

Examining current practice and attitudes Using questions from The Essence of Care, a data collection pack was produced. This contained:

- Instructions on how to collect information from wards;

- A list of questions to ask two nurses on each ward using a semi-structured technique;

- A list of observations to be made during lunchtime on a ward with instructions to observe one patient in a bay and one patient in a side room;

- A list of questions to ask six patients on the ward using a specific interview technique, with instructions to interview one patient with ethnic or cultural nutritional needs and one who requires assistance when eating.

The data collection was piloted by a clinical nurse specialist in nutrition and a member of the clinical governance department. The working party was then divided into pairs and the pairs each collected data from two wards. A total of 12 wards were examined.

Although the questionnaires gave helpful data about staff skills and knowledge, the working party felt it did not capture attitudes. As a result, two of the clinical nurse specialists ran small focus groups with nurses and domestic and catering staff.

Members from the working party also consulted the trust’s user’s panel in order to gauge opinion about the quality of food provision. All the data collected was analysed by the clinical governance department.

Evaluating results and action planning Fifty-three patients from 12 wards were interviewed. A total of 55 nurses from 22 wards were asked to complete a questionnaire. Many positive comments about the service were received. A number of issues were identified as important and the working party made recommendations to the trust about how to address these (Table 2).

Publication and advertisement of results Several methods were used to advertise the findings and disseminate information about the project. These included trust-wide nursing strategy days, the trust newspaper, presentation to the trust board, discussion with ward staff and review of the clinical practice manual.

Ward scoring Once the issues surrounding nutritional services had been identified and addressed, wards were asked to address their own specific issues. This is ongoing and each area will be asked to score themselves and develop services based on the results.

Conclusion Our experience has highlighted several key areas that are essential to implement the benchmarking process successfully:

- Involve all levels and disciplines of staff in the process;

- Involve users;

- Identify issues across the trust that need to be solved first, then ask local areas to identify individual problems;

- Value the positive. Share and applaud good practice locally, regionally and nationally;

- Advertise the work. Communication and information can provide solutions to many of the issues raised.

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