Sip feeds: dietetic prescribing
Do dietitians need to be sip feed prescribers? Looking at the Sip Feed Project in Bolton
Dimple Thakrar Prescribing Support Dietitian, Bolton Clinical Commissioning Group (CCG)
Dimple works with Bolton GPs and ONS prescribers to advise and provide training on appropriate ONS prescribing and food first. She is also a member of the BDA Prescribing Support Dietitians, Neurosciences Specialist, Freelance Dietitians groups and a BDA media spokesperson.
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Malnutrition can be defined as: ‘a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function and clinical outcome’ (1). The cost of disease-related malnutrition is in excess of £13 billion per year, of which ~93 percent live in the community (2). Tackling malnutrition can improve nutritional status, clinical outcomes and reduce healthcare use (2). The National Institute for Health and Clinical Excellence (NICE CG32) has shown that substantial cost savings can result from identifying and treating malnutrition, CG32 is ranked third in the top clinical guidelines shown to produce savings (3). Sip feeds are often used to treat malnutrition; however, they should only be considered when diet alone has proved to be, or clearly will be, insufficient to sustain or improve oral intake (4). Sip feeds are also referred to as oral nutritional supplements (ONS).It has been documented that ONS are often prescribed without involvement of a dietitian and with no attempt to improve oral intake by conventional dietary methods (4). The Project purpose
Over the last two years there has been a significant rise in spend on ONS in Bolton. In 2011/12 the amount spent was in the region of £1.4m and in 2012/13 it was £1.5m (sourced from 5). This represents an average growth of nine percent year on year to Bolton Clinical Commissioning Group (CCG). The purpose of this project was to establish the current prescribing practices of sip feeds within Bolton CCG to
NHDmag.com June 2015 - Issue 105
ensure the NHS commitment to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources (6). The prescribing of ONS has a significant impact on local prescribing budgets which are often prescribed inappropriately due to of lack of dietetic assessment (4). In order to identify if the CCG was spending inappropriately on ONS, a Medicine Optimisation Dietitian (MOD) was employed with the aims discussed below. Project aims
• Identify and evaluate current inappropriate ONS prescribing within the CCG for adults in Bolton Community, who are not under the care of a dietitian. • Audit the presence of nutritional screening by GPs or in care homes prior to prescribing ONS. • Stop and reduce inappropriate prescribing by investing in dietetic support. • Support GPs with screening, assessing and treating malnutrition appropriately. • Develop guidance on nutritional screening and prescribing of ONS for adults in Bolton community. • Educate prescribers of ONS on appropriate prescribing and the principles of ‘food first’ Food first, being defined as ‘using everyday foods to increase protein and/ or energy density of the diet, including drinks’, is often achieved through adding high fat/carbohydrate/protein foods/ drinks to the diet in food and/or drinks. It is not intended to achieve nutritional completeness for micronutrients.
