Prescribing of ONS | Practiguide
Results Sixty nine per cent of care homes across Grampian have now received training on the use of MUST and food fortification. The community dietitians are all fully aware of the requirements of care homes to provide food fortification. This has ensured consistent messages are given to care homes across Grampian.
Outcomes The number of residents on the CDD caseload has reduced by 20 per cent from 358 in June 2009 to 285 in June 2010 (see Table Two) ONS use has reduced by 22 per cent. The
percentage of residents on ONS is relatively unchanged (approximately 66%). However, this may be an acceptable outcome as it could be argued that the majority of residents known to the CDD post training should be those on ONS. The majority of those no longer requiring ONS
should be managed by the care home. However, some of these patients will be those referred to CDD after initial food fortification, but where continued fortification alone is still felt appropriate. Some will be residents whose ONS have been discontinued but where monitoring is required for a period after discontinuation. Preliminary results indicate that the majority
of care homes are now more aware of the correct use of ‘MUST’ and are implementing the correct food fortification measures. A full audit of this is underway.
Comment A structured, practical training programme, aimed at the cooks, care staff and managers has resulted in real changes which have benefited the residents and led to more cost effective ONS prescribing. In addition it has released dietetic time to focus on sustaining the changes.
Conclusion The London Procurement Programme highlighted the need for a robust training and monitoring strategy to facilitate long-term change.2
‘ The
unique skills of dietitians, core to their role, are in assessing, choosing appropriate treatment pathways and monitoring patients requiring nutritional support. Research has shown that assessment and monitoring by dietitians results in more appropriate prescribing of ONS, ultimately resulting in cost savings in the prescribing budget.2 The skills in developing training and auditing the impact of such programmes are possibly not unique but the knowledge and skills which underpin our ability to devise training and interpret data which is clinically relevant is particular to our role and should not be undermined. Improvements occur not only from
appropriate prescribing practices but also from the prevention and treatment of malnutrition, including reducing hospital admissions, improving patient outcomes and reducing GP visits. As dietitians we must now begin to address how we can measure these more complex outcomes and sustain change.
Figure 1: Predicted versus Actual Spend on ONS 2008/9
£1,400,000 £1,200,000
£1,000,000 £800,000
£400,000 £600,000
£200,000 £- 2007/8 Predicted cost 2008/9 Actual cost
Improvements occur not only from appropriate prescribing
practices but also from the prevention and treatment of malnutrition...
’
Table Two: Impact on Dietetic Input and Dietetic Recommendations for Residents
June 2009 June 2010
Patients on caseload (n) 358 285
Number on ONS (%) 236 (66%) 181 (63.5%)
Number on diet only (%) 122 (34%) 104 (36.5%)
References: 1. McCombie L (1999). Sip feed prescribing in primary care: an audit of current practice in greater Glasgow Health Board. JHND.;12(3): 201-212. 2. Appropriate community oral nutritional supplementation. London Procurement Clinical Oral Nutrition Support Project Document (November 2009). 3. Department of Health (1992). Dietary Reference Values for food energy and nutrients for the United Kingdom. Report on the panel on dietary reference values of the Committee on Medical Aspects of Food Policy HMSO London.
Complete Nutrition Vol.10 No.6 December/January 2010/11 | 31
Cost (GIC) £
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