This quality standard covers adults (18 years and older) in hospital and the community who are at risk of malnutrition or who have become malnourished, and adults who are receiving oral nutrition support, enteral or parenteral nutrition. For more information see the scope for this quality standard.
Nutrition support in adults has important implications in both health and social care settings. When people are malnourished, their basic health and social care outcomes are significantly affected, making malnutrition an important patient safety issue. It continues to be both under-detected and undertreated, with potentially fatal consequences.
For the purposes of this quality standard, malnutrition is defined as a state in which a deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on body composition, function or clinical outcome. (In this quality standard, malnutrition does not refer to excessive nutrition linked to conditions such as obesity.)
Malnutrition is both a cause and an effect of ill health. Good nutrition support services are crucial in treating a number of other conditions. In many cases nutrition support services are provided as part of a wider care package to treat the underlying cause of malnutrition or manage the increased risk of malnutrition.
This quality standard describes interlinked markers of high-quality, cost-effective care that, when delivered, will improve the effectiveness, safety and experience of care for people who need nutrition support in the following ways:
Preventing people from dying prematurely.
Enhancing quality of life for people with long-term conditions.
Helping people to recover from episodes of ill health or following injury.
Ensuring that people have a positive experience of care.
Treating and caring for people in a safe environment and protecting them from avoidable harm.
These overarching outcomes are from The NHS Outcomes Framework 2012/13.
The quality standard is also expected to contribute to the following overarching outcome(s) from the 2011/12 Adult Social Care Outcomes Framework:
Enhancing the quality of life for people with care and support needs.
Ensuring that people have a positive experience of care and support.
Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm.
Other national guidance, current policy documents and regulatory standards have been referenced during the development of this quality standard. It is important that the quality standard is considered by commissioners, providers, care professionals, patients, service users and carers alongside these documents, including Meeting nutritional needs – essential outcome 5 (Care Quality Commission, 2010) and Guiding principles for improving the systems and process for oral nutritional supplement use (National Prescribing Centre, 2012), listed in evidence sources. These documents describe the basic principles and standards of nutrition support. The quality statements in this quality standard should be seen as markers of high-quality care.
The quality standard for nutrition support in adults requires that all care services take responsibility for the identification of people at risk of malnutrition and provide nutrition support for everyone who needs it. An integrated approach to the provision of services is fundamental to the delivery of high-quality care to adults who need nutrition support. It is particularly important that nutrition support services are multidisciplinary and overseen and led by senior level staff from across settings, for example through nutrition steering groups or committees.
The quality standard should be read in the context of national and local guidelines on training and competencies. Implementation of this quality standard is dependent on all care professionals involved in providing nutrition support to adults being appropriately trained and competent to deliver the actions and interventions described in the quality standard.