‘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 AimReduce 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 OverviewIdentified / invited homes Engaged stakeholders

Visited homes

Piloted Training

Reflected & revised

Assessed training needs

Pre-training data

Delivered training

Developed tailored training

Portsmouth Hospitals NHS Trust

Delivered follow-up training

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

Analysed and evaluated training

Practical recommendations discussed

Produce Recommendations and Publicise Findings

Portsmouth Hospitals NHS Trust

Why was this training

different?

EvaluatedEffectiveness

DualProfessional

Provided tailored

programmes

Engaged NHIn assessment

of training needs

Groupand

IndividualTraining

Used varietyof teaching

methods

Portsmouth Hospitals NHS Trust

Reaction of Students

Learning

Behaviour

Results

Did targeted outcomes improve?

Did the training increase

knowledge?

How did participants react

to training?

Did behaviour change?

Outcome Measurement: Kirkpatrick’s Training Model

Portsmouth Hospitals NHS Trust

Outcome: Reaction of Students

Reaction of Students

Learning

Behaviour

Results

How did participants

react to training?

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 ConfidenceCompleting 'MUST'

0

1

2

3

4

5

6

7

8

9

10

Pre-Training Post-Training

- High confidence ratings for supporting residents at mealtimes both pre & post training

Portsmouth Hospitals NHS Trust

Outcome: Learning

Reaction of Students

Learning

Behaviour

Results

Did the training increase

knowledge, skills, attitudes,

confidence, commitment?

Portsmouth Hospitals NHS Trust

Improved Knowledge

0

10

20

30

40

50

60

70

80

90

Nutrition Dysphagia Overall

Topics

Ave

rag

e S

core

(%

)

Pre-Training Post-Training

Portsmouth Hospitals NHS Trust

Outcome: Behaviour

Reaction of Students

Learning

Behaviour

Results

Did behaviour change?

Did people apply knowledge on

the job?

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

0

2

4

6

8

10

12

14

16

Pre Post

Ave

rage

No.

Litr

es C

ream

Ord

ered

Wee

kly

Portsmouth Hospitals NHS Trust

0

2

4

6

8

10

12

14

16

Condensed Milk Evapourated Milk

Av

era

ge

No

. Tin

s O

rde

red

We

ek

ly

Pre Post

Increased Use of Fortification Ingredients

Portsmouth Hospitals NHS Trust

Improved Mealtime PracticesImproved Positioning

0

0.5

1

1.5

2

Positioning of Resident Positioning of Staff whenAssisting

Ave

rag

e S

core

s A

cro

ss A

ll N

urs

ing

Ho

mes

Pre Training Post TrainingImproved Feeding Practices

0

0.5

1

1.5

2

Spoon Placement Bolus Size Rate of Feeding

Ave

rag

e S

core

Acr

oss

All

Nu

rsin

g H

om

es

Portsmouth Hospitals NHS Trust

Outcome: Results

Reaction of Students

Learning

Behaviour

Results

Did targeted outcomes improve?

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