The Health Services Safety Investigation Body (HSSIB) has published a report (following a legal investigation) which it is hoped will support improvements in the identification of malnutrition and management of nutritional needs for patients within acute medical units (AMUs).
The investigation used a real patient safety incident in which the nutritional needs of a 61-year-old man were not met during a 19-day stay in hospital, (13 days in AMU), resulting in him losing upto 26% of his body weight within a six-week period. In spite of a nutritional screening using MUST (Malnutrition Universal Screening Tool) having been carried out, the scoring did not reflect his actual risk of malnutrition. Attempts to feed the patient via a feeding tube were unsuccessful and he did not receive sufficient nutritional support.
Although this event took place during the pandemic, the HSSIB investigation identified that the findings are still relevant to the healthcare system today.
Findings
The HSSIB report identified that with increased lengths of stay the role of AMUs has changed and additional tasks – including but not limited to nutritional screening – are required to meet the ongoing needs of patients. Units that are short-staffed or rely on agency workers present a risk that nutritional screening may not happen in a timely manner, and recruitment challenges create conditions where national staffing guidance could not be followed. Although digital systems with functionality to support staff in managing initial and ongoing nutrition assessment are available, they may not be widely available or consistently used.
Learning
Following the investigation, HSSIB has made a number of suggestions that Trusts should consider to improve the identification of malnutrition and management of nutritional needs in AMUs.
• Support staff in AMUs to complete and review MUST screening, identify where a subjective assessment has been completed and when further MUST screenings should take place.
• Identify and plan for increased need for routine periodic and ongoing screening and monitoring to account for increased length of patient stays.
• Ensure permanent and temporary staff in the AMU are supported in accessing training, achieving competence and seeking support in completing MUST screenings.
• Implementing, and/or appropriately using, digital systems to monitor and highlight nutritional screening requirements.
• Review policies, processes and procedures in AMUs to ensure they provide clear and easily accessible pathways to refer patients to dietetics or speech and language services.
