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New Guidance for Community Healthcare Professionals to Help Fight Adult Malnutrition in
the Community A new practical guide has been launched to assist GPs and other community healthcare professionals in identifying and managing the three million people in the UK at risk of disease-related malnutrition.
While poverty is often considered a major factor in malnutrition, disease is actually the primary cause.1
in the UK are at risk of disease-related malnutrition at any one time,2
More than three million people the vast majority
(93%) live in the community. At risk groups include those with chronic disease such as cancer, individuals suffering from dementia, patients with an acute illness and those recently discharged from hospital.1 Public health expenditure on disease-
related malnutrition costs in excess of £13 billion per year.3
the NHS more than twice as much to treat as non-malnourished individuals.4
Malnourished individuals cost NICE
recommend that malnutrition can be identified using the ‘Malnutrition Universal Screening Tool’ (‘MUST’), and this new guide also clearly explains its use. Where malnutrition risk is identified, action should be taken to address using oral nutrition support.5, 6 Dietitians are key in the implementation of
robust malnutrition screening and management policies in their local area. Training should be provided for other healthcare professionals to aid them in identifying and initiating first line oral nutrition support actions.7 The guide ‘Managing Adult Malnutrition in
the Community’ has been developed by a multi- professional team and is supported or endorsed by key organisations including the British Dietetic Association (BDA), Royal College of General Practitioners (RCGP) and the British Association for Parenteral and Enteral Nutrition (BAPEN).8
The document is based on clinical
experience and evidence alongside accepted best practice. It also includes a pathway to assist in the appropriate use of oral nutritional supplements (sip feeds). “This guide aims to give professionals practical
guidance on tackling the growing issue of malnutrition in the community to improve overall patient care,” says Anne Holdoway, Specialist Dietitian, Chair of the Parenteral Nutrition (PEN) Group of the BDA and Chair of the Consensus
Panel which developed the guide. “We know that many hospitals now screen routinely for malnutrition and quite rightly many patients will be commenced on ONS to support their nutritional intake during their hospital stay. Community Healthcare Professionals will often inherit these patients discharged from hospital on ONS with little information to assist decision making regarding on-going use. Equally in the community we know malnutrition is overlooked and if identified health professionals are unsure of optimal management. The pathway for the appropriate use of ONS aims to assist decision- making and provides two routes; the first gives guidance on managing individuals who have recently been discharged from hospital with ONS, or who require short term ONS until oral intake is adequate, the second gives guidance on managing people with chronic conditions or those with longer term ONS requirements to enable appropriate monitoring, escalation or cessation of the intervention. Throughout the pathway, reference is made to concurrent dietary advice, the importance of monitoring and when to involve other members of the healthcare team, including dietitians.” Dr Rachel Pryke, RCGP Clinical Champion for
Nutrition for Health and GP member of the consensus panel which developed the document, says: ‘‘With an ageing population many of the risks associated with malnutrition are also going to increase. We can help reduce these risks by ensuring that GPs and their teams are well-versed in spotting the signs of malnutrition and managing appropriately to improve clinical and health economic outcomes in what can be an avoidable issue.” “Malnutrition matters in primary care and
evidence highlights the need for improved nutritional care,” says Dr Ailsa Brotherton, BAPEN’s Honorary Secretary. “Yet malnutrition has, to date, been largely neglected in primary care for multiple reasons including a lack of nutrition steering committees in Strategic Health Authorities and Primary Care Trusts and a lack of
Managing Adult Malnutrition in the Community
Including a pathway for the appropriate use of oral nutritional supplements (ONS) Produced by a multi-professional consensus panel
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awareness amongst GPs. Research findings and recent articles have highlighted the dangers of malnutrition and the importance of shifting the focus to prevention, early detection, and early treatment; all of which can only be achieved in primary care. This pathway will help to remove fragmentation and support the development of integrated systems that are needed to ensure that vulnerable individuals who are at risk of malnutrition are screened early and receive appropriate nutritional care in the community.” ‘Managing Adult Malnutrition in the
Community’ includes: • An overview of malnutrition including its clinical consequences, cost implications, details on the prevalence across healthcare settings and information on key patient groups at risk
• Information on the identification and management of malnutrition according to risk category
• Guidance on optimising oral intake including dietary advice and the appropriate use of oral nutritional supplements
• A practical pathway on the appropriate use of oral nutritional supplements in the management of malnutrition. ‘Managing Adult Malnutrition in the
Community’ is available as an interactive website or download for free via:
www.malnutritionpathway.co.uk.
References: 1. Stratton RJ et al. Disease-related malnutrition: an evidence-based approach to treatment. Oxford: CABI publishing; 2003. 2. Elia M and Russell CA. Combating Malnutrition: Recommendations for Action. Report from the advisory group on malnutrition, led by BAPEN. 2009. 3. Elia M and Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007 (public expenditure only) in: Combating Malnutrition: Recommendations for Action. Report from the advisory group on malnutrition, led by BAPEN. 2009. 4. Guest JF et al. Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clin Nutr 2011; 30(4):422-429. 5. NHS National Institute for Health and Clinical Excellence (NICE). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition (Clinical Guideline 32). 2006. 6. National Prescribing Centre. Prescribing of adult oral nutritional supplements (ONS). Guiding principles on improving the systems and processes for ONS use. 7. British Dietetic Association. A framework for screening for malnutrition. 2009.
www.bda.uk.com (members section). 8. The document has been supported by ten key professional associations: British Association for Parenteral and Enteral Nutrition; The British Dietetic Association; The British Pharmaceutical Nutrition Group; The National Nurses Nutrition Group; The Pharmaceutical Service Negotiating Committee; The Primary Care Pharmacists Association; The Primary Care Society For Gastroenterology; The Royal College Of General Practitioners; The Royal College Of Nursing; The Royal Pharmaceutical Society.
BAPEN In Touch No.66 August 2012 2
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