When I started in this post just over three years ago, I wanted to review the content of milkshakes in care homes, as I felt many homes used different recipes. Care homes within Greater Glasgow and Clyde (GGC) should offer milkshakes as part of the MUST management plan called ‘MUST Step 5’. Having worked within care homes for several years before the Collaborative post, I was always amazed at how vastly different the recipes on offer had been when asking in the homes I visited. As a new Care Home Dietetic Team of four, we were keen to review this. We started this quality improvement project at the beginning of 2022. We naively thought this would be a quick win but soon realised this was not the case! Working collaboratively with three fantastic care homes really has been an invaluable process for the whole Care Home Dietetic Team and care home staff. We have been so lucky to have the time to learn from the current process, to how we can improve and then how to implement this. We quickly learnt that it is very much not the case of ‘here is a recipe book and off you go’!
Our initial scoping involved talking to 23 care homes from two of the Health and Social Care Partnership (HSCP) areas in the Board. This gave us great insight into what recipes were out there and if homes offered milkshakes to residents daily. We noted that four homes offered milkshakes when it was sunny in Glasgow, which is interesting considering the average amount of rain is 150 days a year! We then reviewed key evidence for energy and protein in older adults, and noted most recipes had energy from fat or sugar only. This gave a sufficient basis to review current practice. We collated over 40 recipes and working with the first pilot nursing home in May 2022, we tested and refined these to 14 recipes, creating an initial draft of a milkshake recipe book. We worked with this first pilot home for a year and noted significant improvements in both weight and MUST scores, as a result of introducing milkshakes (as part of first line intervention). A big learning point was only training two milkshake champions in this home, (as over the year the chef, manager and both champions moved on to other role) s, which did impact the progress of this project.
In our second pilot nursing home, we created a training package for both MUST and MUST Step 5 and providing milkshakes. This training was offered to the whole home. This home was much larger with five units, including a specialist Dementia unit. Following the rollout of training we supported the home to launch milkshakes in May 2023. They decided to do a lovely Hawaiian themed launch event, inviting both residents and their friends and relatives to taste all the recipes. Data was collected to review nutritional risk (MUST) and weight changes. We also created a milkshake tracker tool for staff, to track amounts taken and gather reasons why residents declined the milkshakes. This was to support the catering department to help prevent waste. Again, this showed significant changes to both MUST scores which reduced and weights which increased. The manager also noted falls reducing by 36% over the year since starting milkshakes. The only change in that time was introducing regular milkshakes as part of MUST Step 5. When working with this home, we identified a need to create a 14th recipe ‘mini energy boosting’ to support residents who can only manage small amounts of fluids at a time.
For our third home we identified a residential home with three units, to review how milkshakes would work with a slightly different MUST Step 5 pathway. We had created an information pack alongside the recipe book and again trained the whole home prior to a launch event. Weights and MUST scores were also monitored along with milkshake tracking. This home had some fun with weekly weigh-ins, and made the decision to introduce “weigh in Wednesdays”, which I can only describe as reverse slimming club. The residents became really involved in being a part of this and enjoyed seeing the changes each week.
With significant success in all three pilot homes, it was time to create a package of resources which included three information videos, in addition to the information pack and recipe book. These resources were then promoted and launched to all homes. We held six events during October 2024, where homes could attend and learn how to implement milkshakes in their homes. We also created a ‘Nutrition in Care Homes’ digital app, which hosts all the resources, supporting easier access to homes.
Our next steps will be to support homes with implementing, the use of milkshakes, and to work with nursing and dietetic teams who provide input to the homes. It has been exciting to watch this project grow and flourish! We are aware that other health boards are also adopting our resources which is fantastic to see.
Resources can be found on the following link Food First and Project Milkshake | Right Decisions
Contributor
Gillian Mackay, Advanced Practice Care Home Dietitian
Twitter handle: @gilsiewilsie
Bluesky: @gillianmack25.bsky.social
I currently work as an Advanced Practice Dietitian within the Care Home Collaborative and Community Dietetics for NHS Greater Glasgow and Clyde (NHS GGC). This post allows me to lead on training and quality improvement work, to support development of nutritional care within care homes. Key projects include project milkshake, mealtime champions and developing digital training, including regular webinars and our new ‘Nutrition in Care Homes’ app on GGC – Nutrition in Care Homes | Right Decisions.
