Nutrition Support

• Patients with complex nutritional needs eg renal disease, cystic fibrosis or gastrointestinal disorders

• Non-healing wound/high grade pressure ulcer

• On texture modified diet and at risk of malnutrition

• Very restricted diet

• Clinical concern eg very low BMI

• Nutritional goals not being met after following ‘Food First’ advice for 1 month, followed by trial of 2 first line oral nutritional supplements for 2 weeks.

• At risk of re-feeding syndrome – please see criteria below Please note urgent referral is needed if service user at risk of refeeding syndrome.

Management of malnutrition

Please follow guidance as per MUST (Malnutrition Universal Screening Tool) where a score of 2 or more is deemed high risk and requires treatment -

https://www.bapen.org.uk/pdfs/must/must-full.pdf

Local resources to assist with implementation of first line advice–

Six steps to appropriate prescribing of Oral Nutritional Supplements

https://www.eclipsesolutions.org/UploadedFiles/314_Six%20steps%20to%20appropriate%20prescribing%20of%20ONS%20for%20adults.%20July%202017.pdf

Quick Reference Formulary (Oral Nutritional Supplements)

https://www.eclipsesolutions.org/UploadedFiles/404_2019%20ONS%20quick%20reference%20formulary.pdf

Patient information leaflets-

Making the Most of your Food

https://www.eclipsesolutions.org/UploadedFiles/262_Making%20the%20most%20of%20your%20food%20-%20Leaflet%20for%20patients.pdf

Homemade Fortified Drinks

https://www.eclipsesolutions.org/UploadedFiles/263_Homemade%20Fortified%20Drinks%20-%20Leaflet%20for%20Patients.pdf

Request referral to the Dietetic department via eRS if no response after 8 weeks despite implementation of advice.

Please note: Should you suspect an individual is at risk of refeeding syndrome please contact the Dietetic department for advice.

Criteria for determining risk of refeeding syndrome

Patient has one or more of the following:

BMI less than 16 kg/m²
unintentional weight loss greater than 15% within the last 3–6 months
little or no nutritional intake for more than 10 days
low levels of potassium, phosphate or magnesium prior to feeding.

Or patient has two or more of the following:

BMI less than 18.5 kg/m²
unintentional weight loss greater than 10% within the last 3–6 months
little or no nutritional intake for more than 5 days
a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics.

Malnutrition, ‘Food First’ and oral nutritional supplements training

This training is available to community healthcare professionals across Cornwall who are working with people in their own homes at risk of malnutrition. It covers the following areas:

malnutrition and screening
first line nutrition advice
local nutrition resources
oral nutritional supplements and their appropriate prescription
appropriate referral to a dietitian.

If you would like to book this training for your team please email: kccg.prescribing@nhs.net