Prescribing of ONS | Practiguide
The Unique Skills of Dietitians can Contribute to Cost Effective Prescribing of Oral Nutritional Supplements (ONS)
Carole Noble, Dietetic Prescribing Advisor, Community Dietetic Department, Woodend Hospital, Aberdeen
Introduction It has been over 10 years since the inappropriate use of oral nutritional supplements (ONS) and the problems associated with this was highlighted.1
A number of other projects and audits, including our own project in NHS
Grampian, have highlighted that a significant proportion of prescriptions are inappropriate resulting in cost inefficiencies. ONS are often initiated by healthcare professionals other than dietitians, without any appropriate advice or monitoring.2
Data suggests General Practitioners (GPs) often lack knowledge around ONS and are less
likely to give appropriate first line dietary advice. Dietitians are more effective than GPs at offering support to patients and helping to reduce inappropriate prescription.2 In today’s climate there is an increased emphasis on healthcare professionals to demonstrate core skills which are unique to them and to demonstrate how application of these skills can contribute to cost effectiveness in the NHS. This report outlines two initiatives, with measurable outcomes, where the unique skills of dietitians have contributed to a reduction in inappropriate prescribing and an improvement in quality of care for patients.
1. Education and awareness sessions for GPs on appropriate ONS prescribing
Background A two-year project in NHS Grampian (NHSG) to address inappropriate prescribing highlighted that 45 per cent of ONS prescribed without dietetic intervention were not necessary. An audit of patients referred to the dietetic service revealed that only 37 per cent of patients prescribed ONS were known to dietetics across NHSG. GPs reported a lack of knowledge about ONS and requested guidelines to help inform their practice. An algorithm was developed outlining first line treatment for patients at
risk of malnutrition (food first), when to prescribe ONS, monitoring patients and when to refer to dietetics. ONS were included in the NHS Grampian Joint Formulary, with further guidance on how and when to prescribe ONS. An audit in the second year of the project revealed that these guidelines were not routinely followed and the use of ONS continued to increase.
A
decision was taken to recommend that any patient requiring ONS should be referred to the Community Dietetic Department (CDD) and permanent
funding was secured to enhance the dietetic staffing levels. A Dietetic Prescribing Advisor was appointed to oversee and monitor prescribing of all dietary products. Existing guidelines for GPs were re-drafted with information and resources
for first line treatment for patients at risk of malnutrition (food first) and how to refer to CDD if ONS were deemed necessary.
Initiative A planned programme of awareness sessions with each GP practice to highlight the revised guidelines was implemented. The session included information on: • The food first approach and the contribution food fortification can make to the diet
• The cost to the NHS associated with inappropriate prescribing • ONS use in their own practice and a comparison with other practices in their Community Health Partnership (CHP)
• The role of the dietitian in assessing and supporting patients requiring ONS The audit of patients referred to the dietetic service was repeated after implementation of the programme.
Complete Nutrition Vol.10 No.6 December/January 2010/11 | 29
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