What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Although the SHSCT community nutrition and dietetic service has strong links with care home (CH) staff there are service improvements that can be made. Due to long waiting lists, there is limited capacity for delivery of timely and regular nutrition training.

The SHSCT care home support team (CHST) has a physiotherapist, occupational therapist and speech and language therapist (SLT) but it does not have a dedicated dietitian to provide support and training to the CHs.

In this absence this project aims to use a dietetic support worker (DSW) to partly bridge this gap and to provide regular training to enhance CH staff’s understanding of good nutrition. This will not only improve the interface between care homes and the nutrition and dietetic service. But also ensure ongoing good nutritional care of our clients.

What does your project aim to achieve?

Increasing productivity and reducing waste.

• Improved nutrition awareness and training for CH staff
• Improved food fortification practices reducing need for oral nutrition supplements
• Joint training with CHST SLT reducing time-out for CH staff for training

Boosting the culture, capabilities and structures needed for learning and improvement.

• Improved understanding of the Malnutrition Universal Screening Tool (MUST) and nutrition action plans
• Improved understanding and use of remote monitoring system – healthcall
• Provide additional support to CHs with particular nutritional needs

Embedding improvement into management systems and processes.

• Improved levels of appropriate and timely referrals
• Reduce frequency of complaints to CHs regarding food provision
• Dedicated point of contact between CHs and community nutrition and dietetic service
• Hoped that results of this project show the benefit and need for a DSW working between CHs and the community nutrition and dietetic service and we will be able to use this information to impact funding availability.

How will the project be delivered?

Existing DSWs manage a busy care home caseload remotely but are only able to provide limited nutrition training.

Project will be led by the community nutrition and dietetic service, whilst existing strong links with the SHSCT’s CHST will be utilised to co-work on this project.

Funding will be utilised to employ 0.6wte Band 3 DSW for two years.

DSW will:

• Carry out training needs assessment with each care home
• Co-develop training with CHST SLT

Training will include:

• MUST
• Food Fortification
• Care home nutrition standards
• Use of healthcall
• Dietetic access criteria and considerations for appropriate referrals.
• With SLT, deliver significant proportion of training remotely enabling training of multiple CHs simultaneously
• Link with CHs individually to ensure training applied to practice
• Aim where possible to identify link nutrition champions in each CH
• Provide continuous feedback to locality DSWs and dietitians, which will be key in measuring and defining the impact of the project

How is your project going to share learning?

We will actively seek training and support needs assessment from care homes

We will use pre & post training questionnaires assessing knowledge gained

We will monitor feedback forms from training delivered and act on these as required

CHST will monitor complaints regarding food choices in care homes

We will monitor referrals from care homes regarding accuracy of MUST and appropriateness of referrals

By gathering this info we can share our learning through a variety of forums:

• ·the Q-exchange Community via updates on the online platform
• SHSCT QI team
• Community dietetic and dietetic support worker meetings
• SHSCT’s Promoting Good Nutrition community group
• The CHST
• The CH managers meetings
• Trust social media
• Updates via trust e-magazines and newsletters
• Learning shared with regional colleagues which may influence scaling across the region
• With senior management teams with hope of influencing funding