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Jack Bell & Donna Hickling of The Prince Charles Hospital talk malnutrition and falls.

9 Aug 2016, by Informa Insights


Hosting ‘The Role of Nutrition across Fractures, Falls and Pressure Injuries’ stream at the Falls, Fractures & Pressure Injuries Management Conference later this month, are Jack Bell & Donna Hickling of The Prince Charles Hospital. They were nice enough to talk to us in the lead up to the event about their presentation and how nutrition affects prevention.

Informa: What have been some of the highlights of your elderly-1461424_1920work so far with using nutrition to assist with falls, fractures and pressure injuries prevention? Is there a particular accomplishment you’re particularly proud of?

We have identified malnutrition as a strong independent predictor of mortality in patients with acute hip fracture. We have also highlighted key barriers to nutrition care in this group of patients, and identified strategies to improve multidisciplinary nutrition care. These improved care processes have been shown to reduced barriers and more than double protein and energy intakes. Most importantly, this has led to less patients becoming malnourished in hospital, and more patients getting back home. A combination of commitment to nutrition screening, auditing, and multidisciplinary nutrition care, combined with broader pressure injury prevention and management strategies means our healthcare facility is consistently reporting some of the lowest pressure injury prevalence rates nationally. Some interesting current work we will be discussing at the conference demonstrates how individuals who are both obese and malnourished are much more likely to develop pressure injuries than their well-nourished, albeit obese, counterparts.

Informa: What are some ways in which you think it’s possible to establish / maintain true multidisciplinary care of those sustaining or at risk of falls, fractures, and pressure injuries? 

For change to happen, a business case for change is required. Once patients and those who treat them realise that something is important, and is going to impact something they care about, then they will identify and prioritise what change needs to happen, and will make sure that it is sustained.

The first thing we did in our hip fracture unit was to engage with the patients and members of the treating team to identify barriers and potential facilitators to nutrition care. One of the biggest barriers we found was that patients and staff said nutrition was important, however they did not prioritise nutrition care. Lack of resources was not the primary problem; it was rather lack of knowledge about the importance of nutrition care. So we engaged the team and consequently published a few papers that demonstrated just how important nutrition was. After that it was pretty easy to sell the message of nutrition as a medicine. The team then identified what things could best be done locally to improve nutrition care. The best thing is, because the patients and team were engaged throughout this process, the change has been sustained with the odd tweak here and there…

Informa: Your extended workshop session will address the role of nutrition across fractures, falls and pressure injuries – without giving too much away, what are some of the important takeaways attendees can expect from the session?

Not all ‘stick thin’ people are malnourished, and those with obesity can also have protein-energy malnutrition.  Malnutrition screening and diagnosis tools are useful but still require clinical judgement. While protein and energy malnutrition are key diagnoses, there are a broad variety of other nutrition diagnoses that need to be considered when planning interventions. Systematic and individualised interventions both have a place. The best nutrition care model needs to be refined and owned by the local patients and treating team. For a hospital-wide approach you need to engage people at all levels AND keep them engaged and informed. Once you work out your “key people”, you’ll have networks and opportunities to impact on change in more areas than you knew existed. Patients and those who care for them all have bias; qualitative and quantitative audit data can be very useful to drive and sustain improvements to nutrition care.

Informa: As a past speakers/attendees of the event, what are you most looking forward to this year?

  • Discussing common difficulties and difficult issues
  • Learning about new problems and ways to tackle them
  • Exploring new ways to tackle old problems
  • Getting a better understanding of how to translate research into practice
  • Networking with colleagues around how barriers and facilitators to care
  • Putting faces to names.

Join Jack and Donna at our Annual Falls, Fractures & Pressure Injuries Conference as it heads to Brisbane this year featuring over 22 expert speakers providing presentations, streams, case studies and research into fall prevention and management.


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