The patient

Mrs. Smith is an 85-year-old lady living in her own home. She has a grown up daughter near by.

Patient’s situation

Mrs Smith was active and living independently at home, cooking for herself with occasional help from her daughter with everyday activities of living such as shopping, when she caught COVID-19 and pneumonia. This led to a reduced dietary intake due to a poor appetite. During this time, Mrs Smith spilled a boiling hot cup of tea on her thigh and buttock, causing a 40 cm x 20 cm, extremely painful combination of superficial and full thickness burn.

The local Burns Unit assessed Mrs. Smith and made a routine appointment for her with the plastic surgery team, as they felt the wound may not heal on its own. She was then discharged into community care, to be seen by both community and tissue viability nurses for wound management, including daily dressing changes.

When Hayley, TVN, first met Mrs. Smith, she was very concerned about her nutritional status. Mrs Smith already had a poor dietary intake due to COVID-19, then the pain caused by the burn impacted her appetite further, as well as her ability to mobilise and cook. The burn affected Mrs Smith’s mental health, and she reported she felt very depressed. Dressing changes very difficult to the point that the patient was in tears due to the pain. Hayley was also concerned with the high amount of wound exudate, as it was likely Mrs Smith would be losing nutrients, particularly protein, through the exudate too.

Nutritional Intervention

2 bottles Ensure Plus Advance daily.

Nutritional Intervention Goals

• Support wound healing
• Maintain body mass index (22kg/m²)
• Improve quality of life and ability to do activities of daily living

Patient Outcomes

After 11 days of taking Ensure Plus Advance, the wound was starting to retract and show signs of healing, so the dressing changes were reduced to 3 times a week rather than daily, much to Mrs. Smith's relief, as she found them very painful. Hayley reports she herself was ‘amazed at how quickly the wound started to heal and so pleased the patient was no longer in so much pain’. Within 3 weeks, the wound had halved in size and Mrs. Smith was starting to get back to activities of daily living, mobilising and cooking again. In 7 weeks the wound had healed completely, leaving no scarring. The referral to plastic surgery was cancelled as no longer required.

Mrs. Smith is ‘so happy to be back to her normal self’. Her food intake started to improve after a month of taking Ensure Plus Advance and she was eating so well after 9 weeks, that her ONS prescription was stopped accordingly. Mrs. Smith is back to being as independent as she was previously.

Economic impact outcomes

Hayley feels certain that nutritional intervention with Ensure Plus Advance led to fewer nursing visits and fewer dressings which would have a positive impact on NHS economic outcomes.

In addition:

• Cost of Ensure Plus Advance for 9 weeks: £291^*
• Potential reduction in nursing visits: ~20 (at a total cost of £1,260)^ϯ
• Potential cost saving of plastic surgeon consultation: £143^ϯ
• Potential cost savings of £1,112 (excluding dressing costs)

*Costings based on 2 servings Ensure Plus Advance a day for 9 weeks. Price as of October 2023. MIMs October 2023. Accessed October 2023:| MIMS online .

Ϯ Based on Unit Costs of Health and Social Care 2022 Manual. Accessed October 2023: Unit Costs of Health and Social Care programme (2022 – 2027) | The new home for the Unit Costs of Health and Social Care report (pssru.ac.uk)