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					    ‘Innovative Nutrition & Swallowing Training’




Leah Platt
Community Dietitian




                                    September 2011
                                         Portsmouth Hospitals NHS Trust




                 Background to Project

 Funded by NESC.

 7 Month project to deliver
  bespoke training programmes to
  Nursing Homes in Portsmouth
  City.

 Joint Project between SALT
  (Solent Healthcare) and Dietitian
  (Portsmouth Hospitals NHS
  Trust).
                                                Portsmouth Hospitals NHS Trust




Project Aim
Reduce hospital admissions from nursing homes by
enhancing local skills in identifying and managing risks of
malnutrition and dysphagia.


Objectives
 Implement accurate ‘MUST’ screening and appropriate
  use of care plans

 Improve the identification of dysphagia and use of safer
  swallowing strategies

 Improve mealtime experiences
                                                                Portsmouth Hospitals NHS Trust




                       Project Overview
  Identified / invited homes                           Engaged stakeholders

Pre-training                                                   Assessed training
                                 Visited homes
    data                                                            needs


                         Developed tailored training

                                Piloted Training

                               Reflected & revised

                               Delivered training
                                      Portsmouth Hospitals NHS Trust




Practical recommendations discussed


    Delivered follow-up training


    Collected post-training data
     (4-6 weeks post training)



  Analysed and evaluated training




    Produce Recommendations
       and Publicise Findings
                                       Portsmouth Hospitals NHS Trust




         Evaluated          Dual
        Effectiveness
                        Professional

Used variety    Why was          Engaged NH
of teaching
 methods
               this training    In assessment
                 different?    of training needs

          Group
                          Provided
           and
                          tailored
        Individual
                        programmes
         Training
                                              Portsmouth Hospitals NHS Trust




Outcome Measurement: Kirkpatrick’s Training Model
                           Did targeted
                        outcomes improve?

                                     Did behaviour
                                       change?
            Results
                                       Did the training
           Behaviour                      increase
                                        knowledge?

            Learning                        How did
                                       participants react
                                          to training?
     Reaction of Students
                                  Portsmouth Hospitals NHS Trust




Outcome: Reaction of Students


                             How did
                            participants
           Results            react to
                             training?
          Behaviour


          Learning


     Reaction of Students
                                            Portsmouth Hospitals NHS Trust




               Reaction from Participants

 Good reaction from participants


1               2               3    4                    5
                                                 4.8




    - Clarity, Interest, Relevance
                                               Portsmouth Hospitals NHS Trust




 Increased Confidence
            Completing 'MUST'
10
9
8
7
6
5
4
3
2
1
0


      Pre-Training        Post-Training


- High confidence ratings for supporting residents
at mealtimes both pre & post training
                                        Portsmouth Hospitals NHS Trust




Outcome: Learning

                             Did the training
                                  increase
                                knowledge,
                              skills, attitudes,
            Results             confidence,
                               commitment?
           Behaviour


           Learning


      Reaction of Students
                                                                    Portsmouth Hospitals NHS Trust




 Improved Knowledge
                    90

                    80

                    70
Average Score (%)




                    60

                    50

                    40

                    30

                    20

                    10

                    0
                         Nutrition          Dysphagia               Overall
                                              Topics

                                     Pre-Training   Post-Training
                           Portsmouth Hospitals NHS Trust




Outcome: Behaviour


                     Did behaviour
                         change?

          Results
                       Did people
         Behaviour        apply
                       knowledge
                        on the job?
          Learning
                                    Portsmouth Hospitals NHS Trust




 Continued Completion of ‘MUST’


- Improved frequency of ‘MUST’completition
  post training



- More staff involved with ‘MUST’ and care
  planning
                                  Portsmouth Hospitals NHS Trust




 Increased Provision of Snacks



 Increased Provision of Homemade
  Fortified Milkshakes
                                                                Portsmouth Hospitals NHS Trust




 Increased Use of Food Fortification Ingredients

-   Dried milk powder, condensed milk, evaporated milk, cream, cheese,
     butter/margarine
                                              16
    Average No. Litres Cream Ordered Weekly




                                              14

                                              12

                                              10

                                              8

                                              6

                                              4

                                              2

                                              0
                                                   Pre   Post
                                                                                          Portsmouth Hospitals NHS Trust




 Increased Use of Fortification Ingredients
                                    16
  Average No. Tins Ordered Weekly




                                    14

                                    12

                                    10

                                    8

                                    6

                                    4

                                    2

                                    0
                                         Condensed Milk                Evapourated Milk

                                                          Pre   Post
                                                                                                                                                                            Portsmouth Hospitals NHS Trust




                                     Improved Mealtime Practices
                                                           Improved Positioning
Average Scores Across All Nursing Homes




                                           2



                                          1.5


                                           1



                                          0.5


                                           0

                                                Positioning of Resident        Positioning of Staff when
                                                                                       Assisting
                                                                                                                                                          Improved Feeding Practices
                                                              Pre Training   Post Training

                                                                                                  Average Score Across All Nursing Homes
                                                                                                                                            2




                                                                                                                                           1.5




                                                                                                                                            1




                                                                                                                                           0.5




                                                                                                                                            0

                                                                                                                                                 Spoon Placement     Bolus Size           Rate of Feeding
                             Portsmouth Hospitals NHS Trust




Outcome: Results
                     Did targeted
                      outcomes
                       improve?


          Results

         Behaviour


          Learning
                               Portsmouth Hospitals NHS Trust




In year prior to training:

 924 GP Contacts
 383 admissions to Hospital

Plan to Re-Assess Next Year
                                        Portsmouth Hospitals NHS Trust




               Future Actions…
 Collect GP Contacts & Hospitals Admissions
  Data 1Year Post Training

 Nutrition & Dysphagia Link Training

 1 Day Diet Chef Course
                                               Portsmouth Hospitals NHS Trust




                    Learning Points
• Recognition that changes in practice requires intensive
input. ? Impact on Resources


• Importance of regular training


•Importance of Evaluation Methods
                     Portsmouth Hospitals NHS Trust




Thank you for Listening

				
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