Screening for malnutrition

I know, it's been ages. Working 9 to 5 with an hour's commute each way removes a lot of the time I used to employ for blogging, and there's nothing I can do about it. Evenings are precious time now.

The good news is that the placement is going very well, and incomparably better than my A placement two years ago, thank goodness. The department's staff are extremely supportive and generally nice to be with, and we two students are being given just the right amount of work to do - not so much that we are daunted but enough to keep us occupied, despite having few of the skills required to do anything very useful. It's still very hot indeed in the office, which makes it quite an effort to concentrate towards the end of a long day.

I've mentioned before that many people are malnourished on admission to hospital, and one of the ways to deal with this is to enable many healthcare workers to make an objective assessment of the level of malnutrition. I attended a nutrition screening training session led by the hospital's Nutrition Sister (a senior nurse responsible for nutritional matters). Only two out of the seven potential attendees actually turned up, plus me and a student nurse. The training was intended to cover the importance of food and nutrition in the hospital setting, the different ways that food can be delivered to patients, and how to use a scoring tool to measure the level of malnutrition.

Many places use a tool known as MUST - Malnutrition Universal Screening Tool - which scores on just three criteria: current BMI, degree of recent weight loss, and low oral intake or risk of reduced intake into the future. MUST is often used in community settings like nursing and residential care homes, but within this hospital there is a different scoring system, with about ten assessment measures producing a score that can trigger a referral to a Dietitian if it reaches 15 or above.

That was last week. This week my fellow student J and I attended a training session delivered by a senior dietitian on nutritional screening and identifying and dealing with risk of malnutrition, but intended for staff of nursing homes: nurses, care workers and catering staff. Again, only two of the eight attendees who had signed up for the half day actually turned up. It's possibly an indication of the pressure that staff are under, since last minute difficulties at work probably prevented them from attending, rather than lack of interest, but who knows? Perhaps they just couldn't be bothered.

I have been introduced to some more of the administrative requirements of the dietitian's job, including the medical notes, and spent quite a lot of time shadowing dietitians on their visits to patients on the hospital wards. We have also been given a few projects to do, including three talks between the two of us. My individual one is to residents of sheltered housing, and I'm doing one together with J to staff supporting adults with learning disabilities living in the community. Both will be about healthy eating in general.

J and I also have a Health Promotion assignment to do together, which is a display for a noticeboard in the Children's Waiting Area. We are hoping to do something about lunchboxes. We've also collaborated on entering a mountain of menus into the nutritional analysis software used in the department, which is a whole lot easier than the one used in the university, but still pretty tedious.

The last thing I did on Friday, and the focus of the coming week, is paediatric dietetics. But you'll have to wait to hear about that.