Guidelines for oral nutrition support - East Cheshire NHS Trust

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$Clavicle fracture - children.pdf - East Cheshire NHS Trust$

1.0 INTRODUCTIONAll clinical staff at East Cheshire NHS Trust (ECT) have a crucial role to play in achievingand maintaining good nutritional care.Malnutrition (under-nutrition) can adversely affect every system in the body. Many patientscoming into hospital are able to drink normally and manage a normal diet during theirhospital stay. Patients identified as “at high” risk of malnutrition, with a MUST (MalnutritionUniversal Screening Tool) score of 2 or above, will require nutrition support to help to meettheir nutritional requirements. Randomised controlled studies and meta-analyses suggestthat nutrition support of undernourished individuals can reduce mortality, complications afterillness, length of hospital stay, re-admission rates to hospital and costs of care, and alsoimprove well being. 1,2,3Nutrition support can be provided by the following: Food fortification and use of snacks Use of oral nutritional supplements, some of which are prescribable Enteral tube feeding Parenteral nutritionFood is the simplest form of nutritional intervention and should always be used first.Oral nutrition support (food fortification, snacks, supplements) is the first-line “treatment” forthose at risk of malnutrition and should always be considered before enteral tube feeding orparenteral nutrition.2.0 AIMSThe aim is to provide evidence-based guidance for the use of food fortification and oralnutritional supplements for adult inpatients under the care of health care professionalsworking in ECT.3.0 ORGANISATIONAL RESPONSIBILITIESThe Executive Director of Nursing, who is a member of the Trust Board, has overallresponsibility for the provision of nutrition within ECT. The Clinical Nutrition Steering Group(CNSG) is responsible for the oversight of all aspects of nutrition within ECT and is currentlyaccountable to the Quality Strategy Steering Group, which is in turn accountable to the TrustBoard via the Safety and Quality Standards Committee (SQS). For further informationregarding the role and responsibility of the CNSG in the provision of nutrition, refer to theEast Cheshire NHS Trust Nutrition Policy for in-patients (CNSG001).All clinical service team managers are responsible for ensuring compliance with thisguidance within their unit/team and that staff are competent and attend appropriate training.Certain professional groups and departments have specific responsibilities.CNSG 003 East Cheshire NHS Trust Guidelines for Oral Nutrition Support in Adults Page 4 of 17
3.1 Medical Staff are responsible for: Encouraging an awareness of the benefits of appropriate nutritional managementand treatment before, during and after hospital admission. Considering oral nutritional supplements as part of the appropriate nutritionalmanagement to prevent or treat malnutrition.Ensuring that oral nutritional supplements are correctly prescribed and monitored aspart of the patient’s nutritional care plans during admission and on discharge.3.2 Dietitians are responsible for:Assessing each patient’s nutritional requirements and making any recommendationsfor use of oral nutritional supplements as part of his/her nutritional care plan.Writing any recommended prescribable oral nutrition supplements on inpatient drugcharts, according to the procedure agreed with the Medicines Management Group.Requesting that the patient’s general practitioner prescribes any recommended oralnutritional supplements for patients discharged into the community, as part of theiron-going nutritional care plan, with guidance as to time span and review frequency.Ensuring appropriate nutritional, anthropometric and clinical monitoring of the patientin hospital and in the community if required. Delivering education and training programmes for staff relating to the use of oralnutritional supplements in patient care.3.3 Matrons and Ward Managers are responsible for ensuring that: Patients are screened for the risk of malnutrition using the Malnutrition UniversalScreening Tool (MUST) on admission and weekly thereafter.Nursing staff refer patients identified at risk of malnutrition (MUST score of 2 or more)to the Department of Nutrition and Dietetics.Ordering, stock control and storage of oral nutritional supplements is satisfactory.Ward staff are appropriately trained in the use of oral nutritional supplements.Prescribable oral nutrition supplements are correctly given.3.4 Ward Pharmacists are responsible for:Ensuring that prescribable oral nutritional supplements are correctly prescribed andthat any drug/nutrient interactions are identified.3.5 The Catering and Supplies Departments are responsible forProviding menus with a variety of choices at each mealtime, to include High Energy.Providing appropriate high calorie snacks.Using oral nutritional supplements to fortify meals as directed by the Department ofNutrition and Dietetics.Co-ordinating the ordering and supply of oral nutritional supplements from contractedsuppliers and/or wholesalers in a cost-effective and timely manner.3.6 Speech & Language Therapists are responsible for:Providing guidance to ward staff regarding thickening of oral nutritional supplementsto the recommended consistency for patients who have swallowing problems.CNSG 003 East Cheshire NHS Trust Guidelines for Oral Nutrition Support in Adults Page 5 of 17
Page 1 and 2: Guidelines forOral Nutrition Suppor
Page 3: CONTENTSPAGES1.0 INTRODUCTION 42.0
Page 7 and 8: The range of nutritional supplement
Page 9 and 10: 9.0 APPENDICESAppendix 1Procedure f
Page 12 and 13: Appendix 3How to Store & Use Oral N
Page 14 and 15: Part 2 - CONSIDERATION OF DATA AND
Page 16 and 17: CHILDREN - testing of disproportion

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