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Exclusions

The following groups are excluded from the BAPEN Nutritional Care Tool data collection:

  • Patients being cared for in their own homes
  • Patients being cared for in an outpatient (clinic) only setting
  • Patients under the age of 18 or under the care of paediatric team

Demographics, organisational and clinical details

Organisation

Description

The overarching organisation in which the survey is being undertaken (e.g. NHS Trust)

Construction (if applicable)

 

Rationale

Recording organisation name allows data to be analysed to a level at which variations can be identified and ensures appropriate questions appear in the tool (for example, if the organisation is an acute hospital, questions regarding the specialty are included but these are excluded for care homes 

Instructions for data entry

You do not need to enter your organisation name, this is automatically generated based on your log-in

 

Current ward/team/area

Description

The name of the ward, team or area in which or under whose care the survey is being undertaken

Construction (if applicable)

 

Rationale

Improvement and change is most effective when it starts at the front-line of care and goes from the bottom up rather than imposed from the top down.  The inclusion of a ward/team/area name allows data collected via the BAPEN Nutritional Care Tool to be analysed at a level that is meaningful to staff working within these groupings, and can potentially be discussed or displayed in patient areas with the same degree of import.

Instructions for data entry

Ward/team/area names are set up and linked to your log-in.  You may have multiple wards/teams/areas linked to your log-in and will need to ensure that you enter data under the correct ward/team/area.

 

Specialty

Description

The main specialty of the ward/team/area that is undertaking the survey

Construction (if applicable)

 

Rationale

Understanding of nutritional care at the specialty level allows identification both of variation between different specialties as well as the ability to identify specific areas within which to target improvement.

Instructions for data entry

Select the appropriate specialty from the drop down menu.  If the ward or team has more than one specialty area select the specialty where the volume of activity is greatest, or select the ‘mixed specialty option’.

 

Date of collection

Description

The date on which the survey has been carried out

Construction (if applicable)

 

Rationale

The BAPEN Nutritional Care Tool is designed to help track change over time.  The date of collection allows this time series analysis to be undertaken.

Instructions for data entry

The current date is shown automatically, but can be overwritten if a different date is required.  The format should be dd/mm/yyyy; the web tool will not accept dates entered which are not in this format.

 

Admitting ward/team/area

 

Description

The name of the ward, team or area in which or under whose care the patient was first admitted to the care setting.

Construction (if applicable)

 

Rationale

Nutritional screening is primarily initially undertaken on admission (or within 24 hours of admission).  In order to track the provision of effective re-screening at appropriate intervals and effective nutritional care throughout the patient’s journey within the organisation it is useful to understand where the initial care was provided and to track how many times patients are screened during their admission

Instructions for data entry

As for ward/team/area above.

 

 

 

Age group

Description

The patient’s age group

Construction (if applicable)

Age grouped into 3 groups; 18-64, 65-74 and 75+

Rationale

Understanding nutritional processes and outcomes by age can provide important intelligence in deciding where to focus improvement efforts

Instructions for data entry

Select appropriate option from drop down menu.

 

Feeding route

Description

The route through which the patient receives nutrition

Construction (if applicable)

Options presented: Oral food & drink, altered textures, food & oral supplements, enteral, parenteral

Rationale

Understanding the route through which patients receive nutrition is critical to assessing whether or not they have received adequate nutritional care and assessment

Instructions for data entry

Select all options that apply to the patient from the options presented

 

Date of admission to care setting

Description

The date on which the patient was admitted to the care setting in which the survey is being carried out

Construction (if applicable)

 

Rationale

The date of admission is used to calculate length of stay (LoS) by subtracting it from the date of collection.  The LoS is an important variable in breaking down the data from the BAPEN Nutritional Care Tool to be more meaningful.

Instructions for data entry

Select the date from the calendar pop up or type the date into the tool directly.  The format should be dd/mm/yyyy; the web tool will not accept dates entered which are not in this format.

 

Setting

Description

The type of care setting in which the survey is being undertaken

Construction (if applicable)

 

Rationale

Data from national screening weeks suggests that there are differences in malnutrition rates between different settings.

The BAPEN Nutritional Care Tool has been designed, as far as possible, to be applicable across multiple care settings, with exceptions noted above.  Recording the setting provides the ability to assess variation between different settings in order to better understand the scope for change in and improvement and identify the differing challenges in each setting.

Instructions for data entry

Select the most appropriate setting from a drop down menu

 

Patient diagnosis

Description

The primary diagnosis for the patient being surveyed

Construction (if applicable)

 

Rationale

Understanding of nutritional care at the diagnosis level allows identification both of variation between different diagnoses as well as the ability to identify specific areas within which to target improvement.  Recording diagnosis and its attendant detail (see below) also allows us to exclude specific cohorts of patients if required.

Instructions for data entry

Select the appropriate high level diagnosis from the drop down menu. You will be prompted to enter more detail dependent on your selection.

You will only be prompted to enter data for this variable if you have selected  'Acute Hospital' under the setting options.

 

Diagnosis detail

Description

Diagnosis detail for the patient being surveyed

Construction (if applicable)

 

Rationale

Understanding of nutritional care at the diagnosis level allows identification both of variation between different diagnoses as well as the ability to identify specific areas within which to target improvement.  Recording diagnosis and its attendant detail also allows us to exclude specific cohorts of patients if required.

Instructions for data entry

Select the appropriate diagnosis detail from the drop down menu.  You will be prompted to select detail from a specific list of diagnostic details based on your selections under 'patient diagnosis'.

 

Process details

Screening on entry to the care setting

Description

The individual was screened with a validated screening tool (‘MUST’) on entry to care setting

Construction (if applicable)

 

Rationale

The NICE Guidance (CG32); Nutrition Support in Adults (2006) makes clear recommendations regarding the screening of patients in care settings (e.g. hospital, care homes) and in primary care. By recording the completion of screening on admission to the care setting it is possible to assess compliance to this element of the NICE Guidance / Quality standard.

Instructions for data entry

Select ‘yes’ or ‘no’ or ‘not applicable’ from the drop down list

 

Re-screening at an interval appropriate to the care setting

Description

The individual was re-screened with a validated screening tool (‘MUST’) at the time interval (e.g. weekly, monthly) appropriate to the to care setting

Construction (if applicable)

 

Rationale

The NICE Guidance (CG32); Nutrition Support in Adults (2006) and the ‘MUST’ screening tool make clear recommendations regarding the re-screening of patients in care settings. By recording the completion of re-screening at intervals appropriate to the care setting it is possible to assess compliance to this element of the NICE Guidance / ‘MUST’ protocol.

Instructions for data entry

Select ‘yes’, ‘no’ or ‘not applicable’ from the drop down list.  If a patient has been in the surveying care setting for less than one week (not the ward/team/area), the 'not applicable' option should be selected.

 

Documented nutritional care plan

Description

Individuals found to be at risk on last nutritional screening have a documented nutrition care plan appropriate to the organisation and setting

Construction (if applicable)

 

Rationale

The ‘MUST’ screening tool makes clear recommendations regarding the development and implementation of an individualised nutritional care plan for patients found to be at risk of malnutrition. By recording the documented nutritional care plan it is possible to begin to assess implementation of improved nutritional care. However, we are very aware of the ease of ‘ticking a box’ and we ask that on completing this question, the care plan is appropriately reviewed.

Instructions for data entry

Select ‘yes’ or ‘no’ or ‘not applicable’ from the drop down list

 

Nutritional care plan being followed

Description

An appropriate nutrition care plan is being followed or has been offered to the individual

Construction (if applicable)

 

Rationale

We know from audits of nutritional care that screening and care planning is often completed/ documented but not then implemented. We fully appreciate the complexities of this question but it is an attempt to determine to what extent the nutritional care plans are implemented.  By recording the implementation of the nutritional care plan it is possible to begin to assess improvements in the nutritional care delivered. As above, we are very aware of the ease of ‘ticking a box’ to indicate that the care is being delivered (when it may be variable) and we ask that on completing this question, the care plan and food and fluid record charts are  appropriately reviewed.

Instructions for data entry

Select ‘no’, ‘some elements, ‘most elements’ , ‘yes’ or ‘not applicable’

 

Outcome details

Current weight

Description

Patient’s weight in kilograms recorded at time of survey

Construction (if applicable)

 

Rationale

Weight is considered a reasonable and easily measured outcome measure when considering the quality of nutritional care, though has significant limitations which must be noted.  Combined with current height this allows calculation of Body Mass Index (BMI) which is a critical element in calculating the 'MUST' score for the patient.  For more detail see:  'MUST' Explanatory Booklet

Instructions for data entry

Record patient’s weight as a whole number.  If no weight is available enter “N/A”.

 

Estimation of current weight

Description

Indication of how current weight (at time of survey) has been recorded

Construction (if applicable)

 

Rationale

Weight is a critical factor in assessing for risk of malnutrition and it is important to understand the accuracy and quality of the measurements taken.  For more detail see:  'MUST' Explanatory Booklet

Instructions for data entry

 Select 'Recalled,', 'Estimated', 'Calculated from subjective criteria', 'Actual weight', 'Patient weighed at time of survey'

 

Unplanned weight loss in past 3-6 months

Description

Unplanned patient weight loss recorded in the most recent 3-6 months in kilograms

Construction (if applicable)

 

Rationale

Weight loss is considered a reasonable and easily measured outcome measure when considering the quality of nutritional care, though has significant limitations which must be noted.  Unplanned weight loss is a critical element in calculating the 'MUST' score for the patient.  For more detail see:  MUST Explanatory Booklet

Instructions for data entry

Record patient’s weight in kilograms.  If no weight is available enter “N/A”.

 

Estimation of weight loss in past 3-6 months

Description

Indication of how unplanned weight loss in past 3-6 months has been recorded

Construction (if applicable)

 

Rationale

Weight is a critical factor in assessing for risk of malnutrition and it is important to understand the accuracy and quality of the measurements taken.  Using this measure alongside the current weight enables calculation and categorisation of weight loss to help take into account fluctuations of weight due to causes other than poor nutrition or poor nutritional care.  For more detail see:  'MUST' Explanatory Booklet

Instructions for data entry

 Select 'Recalled', 'Estimated', 'Calculated from subjective criteria', 'Actual weight', 'Patient weighed at time of survey'

 

Patient's height

Description

Patient's current height in metres

Construction (if applicable)

 

Rationale

Combined with current weight this allows calculation of Body Mass Index (BMI) which is a critical element in calculating the 'MUST' score for the patient. For more detail see:  'MUST' Explanatory Booklet

Instructions for data entry

Record patient’s height in metres.  If no height is available enter “N/A”.

 

Estimation of current height

Description

Indication of how current height (at time of survey) has been recorded

Construction (if applicable)

 

Rationale

Height is a critical factor in calculating BMI and thus assessing for risk of malnutrition and it is important to understand the accuracy and quality of the measurements taken.  For more detail see:  'MUST' Explanatory Booklet

Instructions for data entry

 Select 'Recalled,', 'Estimated', 'Calculated from subjective criteria', 'Actual height', 'Patient measured at time of survey'

Impact of acute illness

 

Description

Has the patient been acutely ill AND has there been, or likely to be, no nutritional intake for more than 5 days

Construction (if applicable)

 

Rationale

If the subject is currently affected by an acute patho-physiological  or psychological condition, and there has been no nutritional intake or likelihood of no intake for more than 5 days, they are likely to be at nutritional risk. Such patients include those who are critically ill, those who have swallowing difficulties (e.g. after stroke), or head injuries or are undergoing gastrointestinal surgery.  This consideration of the impact of acute disease is a critical element in calculating the 'MUST' score for the patient.  For more detail see: 'MUST' Explanatory Booklet

Instructions for data entry

Select ‘Yes’ or ‘No’

 

 MUST score on admission

Description

The ‘MUST’ score that has been recorded on admission to the care setting

Construction (if applicable)

Score as per the ‘MUST’ screening tool.  For more details see: MUST toolkit

Rationale

'MUST' is the dominant screening tool for adults in care, with some specialty exclusions which have specialist screening tool (e.g. renal, liver and paediatric specialties).  The risk of malnutrition is, in this context, considered the most effective and reliable measure indicating the need for nutritional care.  The initial risk assessment on entry to the care setting provides a baseline from which to assess change in nutritional status, which is assumed to be directly linked to the quality of nutritional care, although it is appreciated that this is multifactorial.

Instructions for data entry

Select the appropriate option from the drop down menu; if the patient has not been screened before due to recent admission, select 'This is patient's first screen'.  If the patient has not been screened or the score is not documented or known select 'Not known/done'.  Otherwise select the relevant score for the patient on the scale of 0 to 6.

The score entered should be that which was first recorded on entry to the care setting, as opposed to the specific ward or team undertaking the survey (i.e. the admitting ward).

 

Patient experience: receiving food drink or nutritional care needed

Description

Has the patient received all the food and drink and/or nutritional care they have needed

Construction (if applicable)

 

Rationale

The experience of the patient is crucial in ensuring that all services are delivered effectively and in a truly patient centered way.  Whilst the measurement of patient experience of nutritional care is a relatively untested area, and fraught with complexity, the inclusion of experiential questions will help to ensure that the patient plays a crucial part in the assessment and improvement of nutritional care.

Instructions for data entry

Select the appropriate option from the drop down menu, 'Yes', 'Yes to some extent' or 'No'.  Is is very important that this question is asked of the patient and their views recorded.

If the patient is unable to answer for any reason, or it is not felt clinically appropriate to ask the question at that time, a carer or relative may be asked if present.  If this is not possible select the option 'Patient unable to answer'.

 

Patient experience: receiving help to eat and drink

Description

Has the patient received assistance to eat and drink if required

Construction (if applicable)

 

Rationale

The experience of the patient is crucial in ensuring that all services are delivered effectively and in a truly patient centered way.  Whilst the measurement of patient experience of nutritional care is a relatively untested area, and fraught with complexity, the inclusion of experiential questions will help to ensure that the patient plays a crucial part in the assessment and improvement of nutritional care.

Instructions for data entry

Select the appropriate option from the drop down menu, 'Yes', 'Yes to some extent', 'No' or 'Not applicable (I haven't needed any help)'.  It is very important that this question is asked of the patient and their views recorded.

If the patient is unable to answer for any reason, or it is not felt clinically appropriate to ask the question at that time, a carer or relative may be asked if present.  If this is not possible select the option 'Patient unable to answer'.

 

Patient experience: receiving help to eat and drink, additional information

Description

If the patient did not feel they received the assistance to eat and drink they required, record the reasons for this

Construction (if applicable)

 

Rationale

The experience of the patient is crucial in ensuring that all services are delivered effectively and in a truly patient centered way.  Whilst the measurement of patient experience of nutritional care is a relatively untested area, and fraught with complexity, the inclusion of experiential questions will help to ensure that the patient plays a crucial part in the assessment and improvement of nutritional care.

This additional information will provide insight into issues that may affect the ability of services to assist patients in accessing nutrition.

Instructions for data entry

Free text question; enter details up to 100 characters describing the reason why the patient was not able to received assistance to eat and/or drink.