Guidelines for oral nutrition support - East Cheshire NHS Trust
Guidelines for oral nutrition support - East Cheshire NHS Trust Guidelines for oral nutrition support - East Cheshire NHS Trust
4.0 SNACKS AND “OUT OF HOURS” MEAL PROVISIONThe NHS Plan (DoH, 2000) was devised to improve patients’ access to good quality foodand to improve its provision and presentation at ward level.The Catering Department is open from 0700 to 1800 daily. However, outside these hours,a snack box is available (accessible via the porters) for patients who have missed meals.Snacks are available at ward level and include milky drinks, biscuits, toast and Build-Up(non-prescribable supplement). Other snacks are at the discretion of the ward manager.Patients at high risk of malnutrition who are under the care of the Nutrition and DieteticsDepartment will receive snacks between meals, including appropriate snacks for patients ontherapeutic diets (e.g. gluten-free, texture-modified).5.0 FOOD FORTIFICATIONFood fortification is a key part of oral nutrition support and is done by enriching existingmenu items acceptable to patients to improve the nutritional profile. Fortification can bedone using food products such as butter, cream, milk powder and with prescribableborderline substances (see section 5.0). Items suitable for fortification include orange juice,porridge, soup, milk puddings, yoghurt, texture-modified meals and mashed potato.Patients requiring food fortification are identified by ward dietitians during nutritionalassessment and the requirement for a fortified “supplemented” diet is recorded at ward leveland in the Catering Department.The menus of patients requiring a supplemented diet are identified and amended by thedietetic assistant or designated person checking the menus, who highlights the items chosenfor fortification and collates the figures for the Catering Department.The diet chef fortifies the number of items required using standard recipes calculated by theDietetics Department.The highlighted menus are visible on the service belt and the supplemented items preparedare placed on the tray for the named patient for transport to the wards.6.0 PRESCRIBABLE ORAL NUTRITIONAL SUPPLEMENTSIn certain conditions some foods have characteristics of drugs and the Advisory Committeeon Borderline Substances (ACBS) advises as to the circumstances in which suchsubstances may be regarded as drugs. More details are given in section A7 of the BritishNational Formulary. Prescribable products used at ECT to fortify food are on the ACBS list.Prescribable oral nutritional supplements are ordered, stored and managed by wards atMacclesfield, Congleton & Knutsford hospitals. Each ward should have a designatedindividual responsible for this task, who should liaise with the Supplies and DieteticsDepartments. The procedure for ordering feed and supplements is outlined in Appendix 1.Certain borderline substances are also ordered by the Catering Department from theSupplies Department and from the collated figures wards can be recharged for the productsused at the end of each month.CNSG 003 East Cheshire NHS Trust Guidelines for Oral Nutrition Support in Adults Page 6 of 17
The range of nutritional supplements that are stocked at ECT is listed in Appendix 2. Someare nutritionally complete and can be used as a sole source of nutrition, while others areused to supplement an inadequate oral intake. It is essential that the patient’s total intake isa balance of protein, energy, fibre, electrolytes and vitamins and minerals (NICE guidanceCG032) 4 and this should always be considered when supplements are prescribed.The use of oral nutritional supplements should be restricted to those patients who are unableto meet their nutritional requirements despite the use of high calorie & protein foods and foodfortification. 4 Supplements can be used inappropriately leading to clinical risk and also highlevels of wastage with cost implications,Nutritional supplements should be given under the direction and supervision of a doctor ordietitian, who will write the appropriate product and dosage on the drug chart.If a patient is admitted on supplements not stocked by ECT, the Dietetics Department shouldbe contacted for advice about appropriate alternatives or obtaining the supplement.Supplements should not be given unless accurately written on the drug chart and signed forby a trained member of staff.Oral nutritional supplements should be thickened to the recommended consistency asadvised by the Speech & Language Therapy Department for those patients that areidentified as having swallowing problems.Unopened supplements should be stored in a cool dry place between 5 ºC and 25ºC. Onceopened, supplements should be stored according to the guidance outlined in Appendix 3.7.0 PROCEDURE FOR PATIENTS REQUIRING PRESCRIBABLE ORALNUTRITIONAL SUPPLEMENTS ON DISCHARGE FROM HOSPITALOn discharge, patients should be given 7 days supply of the oral nutritional supplements thatthey require, from ward stock. Oral nutritional supplements should not be listed specificallyas medications for discharge on the Electronic Discharge Notification Form (EDNF), butshould be included as “ward supplies”. If the patient is assessed as not requiring oralnutritional supplements on discharge, the dietitian will write “Not for TTO’s” in the instructionbox on the drug chart.While inpatients will be started on oral nutritional supplements supplied by the company thatholds the ECT contract for them, these supplements should be reviewed before discharge toensure that nutrition support in the community is provided in the most cost-effective way.Where appropriate, the ward dietitian should give samples of oral nutritional supplementsthat are more cost-effective for use in the community to the patient, who will be able to trialthese samples on discharge. If well tolerated, further supplies of these supplements canthen be requested from his/her general practitioner on prescription after discharge.For all patients who require prescribable oral nutritional supplements as part of their ongoingnutritional care plan after discharge, the dietitian will request a prescription from his/hergeneral practitioner using a standard prescription request letter. This will provide informationregarding the supplement(s) required and patient follow up plan.CNSG 003 East Cheshire NHS Trust Guidelines for Oral Nutrition Support in Adults Page 7 of 17
- Page 1 and 2: Guidelines forOral Nutrition Suppor
- Page 3 and 4: CONTENTSPAGES1.0 INTRODUCTION 42.0
- Page 5: 3.1 Medical Staff are responsible f
- 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
4.0 SNACKS AND “OUT OF HOURS” MEAL PROVISIONThe <strong>NHS</strong> Plan (DoH, 2000) was devised to improve patients’ access to good quality foodand to improve its provision and presentation at ward level.The Catering Department is open from 0700 to 1800 daily. However, outside these hours,a snack box is available (accessible via the porters) <strong>for</strong> patients who have missed meals.Snacks are available at ward level and include milky drinks, biscuits, toast and Build-Up(non-prescribable supplement). Other snacks are at the discretion of the ward manager.Patients at high risk of mal<strong>nutrition</strong> who are under the care of the Nutrition and DieteticsDepartment will receive snacks between meals, including appropriate snacks <strong>for</strong> patients ontherapeutic diets (e.g. gluten-free, texture-modified).5.0 FOOD FORTIFICATIONFood <strong>for</strong>tification is a key part of <strong>oral</strong> <strong>nutrition</strong> <strong>support</strong> and is done by enriching existingmenu items acceptable to patients to improve the <strong>nutrition</strong>al profile. Fortification can bedone using food products such as butter, cream, milk powder and with prescribableborderline substances (see section 5.0). Items suitable <strong>for</strong> <strong>for</strong>tification include orange juice,porridge, soup, milk puddings, yoghurt, texture-modified meals and mashed potato.Patients requiring food <strong>for</strong>tification are identified by ward dietitians during <strong>nutrition</strong>alassessment and the requirement <strong>for</strong> a <strong>for</strong>tified “supplemented” diet is recorded at ward leveland in the Catering Department.The menus of patients requiring a supplemented diet are identified and amended by thedietetic assistant or designated person checking the menus, who highlights the items chosen<strong>for</strong> <strong>for</strong>tification and collates the figures <strong>for</strong> the Catering Department.The diet chef <strong>for</strong>tifies the number of items required using standard recipes calculated by theDietetics Department.The highlighted menus are visible on the service belt and the supplemented items preparedare placed on the tray <strong>for</strong> the named patient <strong>for</strong> transport to the wards.6.0 PRESCRIBABLE ORAL NUTRITIONAL SUPPLEMENTSIn certain conditions some foods have characteristics of drugs and the Advisory Committeeon Borderline Substances (ACBS) advises as to the circumstances in which suchsubstances may be regarded as drugs. More details are given in section A7 of the BritishNational Formulary. Prescribable products used at ECT to <strong>for</strong>tify food are on the ACBS list.Prescribable <strong>oral</strong> <strong>nutrition</strong>al supplements are ordered, stored and managed by wards atMacclesfield, Congleton & Knuts<strong>for</strong>d hospitals. Each ward should have a designatedindividual responsible <strong>for</strong> this task, who should liaise with the Supplies and DieteticsDepartments. The procedure <strong>for</strong> ordering feed and supplements is outlined in Appendix 1.Certain borderline substances are also ordered by the Catering Department from theSupplies Department and from the collated figures wards can be recharged <strong>for</strong> the productsused at the end of each month.CNSG 003 <strong>East</strong> <strong>Cheshire</strong> <strong>NHS</strong> <strong>Trust</strong> <strong>Guidelines</strong> <strong>for</strong> Oral Nutrition Support in Adults Page 6 of 17
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