Early nutritional screening, appropriate first line advice and prescribed oral nutrition support across organisational boundaries. New oral nutrition support pathway striving for seamless delivery of care from Hospital into Community Care

ABSTRACT

In the UK, approximately 3 million people are malnourished or at risk of malnutrition. Malnutrition is a major public health issue with costs the NHS over £19 billion per year in England alone. We know 93% of malnutrition happens in peoples own homes, 5% in care homes and 2% in hospital. It is also understood that 30% of inpatients are at higher risk of becoming malnourished in hospital. 1 As many departments, demand for dietetic services has outweighed capacity, in part due to improved rates of nutritional risk screening across the organisation. The Trust uses an internal validated nutritional screening tool but community partners largely use MUST (Malnutrition Universal Screening Tool). Within our Dietetic team, we identified a number of treatment strategies needed to ensure timely care, patient empowerment and patient safety with a focus on improved nutrition to help recovery across organisational boundaries from the acute admission and into primary care. Patients who are identified as malnourished or at very high risk of malnutrition, have specialist requirements should have immediate referral to a dietitian. Oral nutritional supplements are now prescribed appropriately whilst in hospital and post discharge in line with national and local guidelines. 4 Communication between different healthcare professionals and settings is essential for the seamless delivery of care2 and hospital teams discharging patients with an identified risk of malnutrition should communicate this in writing to primary care teams3. As a team, we decided to encompass nutrition and dysphagia scores as an inpatient on discharge letters. This was be achieved by working closely with the pharmacy, Speech and Language, catering, nursing and medical teams to develop and implement a clear process for all adult inpatients to improve ward based nutritional care and appropriate prescribing, based on their individual risk of malnutrition. We have developed and implemented a discharge process that provides patients with a nutrition pack (malnutrition pathway leaflets, cover letter +/- Care Homes information) +/- nutritional supplements on discharge. The process was developed with local CCGs, GPs, PCN Pharmacists and community dietetic services. Outcomes measured include;appropriate prescribing, access to snacks and supplements, clinical outcomes including length of stay (LOS), readmission rates and timely access to first line advice. Baseline audit information revealed only 8% of inpatients received the a first line nutrition leaflet, this has increased to 13% just 6 weeks post implementation, patient first line snacks has increased to 5 different categories as choice available has increased. Oral nutritional support (ONS) is now solely prescribed using the agreed ONS pathway. Early indications suggest a direct improvement in patient care and choice. References 1. Brothern A, Simmonds N, Stroud M.2010. Malnutrition Matters Meeting Quality Standards in Nutritional Care. A report on behalf BAPEN Quality Group 2. ‘A Guide to Managing Adult Malnutrition in the Community’ Last accessed from on 02.07.2021 3. ‘Pathway for using ONS in the Management of Malnutrition’ Last accessed fromhttps//www.malnutritionpathway.co.uk/library/ons_pathway.pdf on 29.06.2021 4. ‘Nutritional considerations for primary care teams managing patients with or recovering from COVID-19’ BDA and optimising nutritional prescribing last accessed. 02.07.21