Much has been reported on the subject of obesity but, while a lower profile problem, malnutrition is estimated to affect at least three million adults in the UK and costs £13 billion annually. It can lead to a number of problems including weight loss, increased hospital admissions, longer periods in hospital and higher mortality risk.
One often prescribed treatment is Oral Nutritional Supplements (ONS), which help to improve the nutritional status of patients. However, a patient can sometimes continue with ONS unnecessarily or, on occasions, not be prescribed appropriate to the individual's needs.
Catherine Blaikley, Specialist Prescribing Support Dietitian for NHS Central Southern Commissioning Support Unit, explains, 'I believed that one improvement would be to prevent inappropriate prescribing of ONS and began by visiting all 55 GP surgeries in West Berkshire to audit their use of ONS.
'At the permission of the GP, this involved studying patient cases of anyone over 16 years of age who had been prescribed ONS within the last three months and had not seen a dietitian. These patients were then called or visited in order to agree a care plan, which was forwarded to their GP.'
The evaluation of existing medicines management enabled the dietitian to identify improvements in the use and prescription of ONS, leading to a number of new protocols that benefited both patient and staff:
- The dietitian worked with those individuals who were at low risk of malnutrition, advising them on how to replace the calories once they had stopped using ONS
- Many patients were pleased to have their ONS stopped as they didn't always enjoy them
- The result was the patients were empowered to take responsibility for managing their medication and managing their diet
- Good practice was reinforced at surgeries through the creation of a flow chart to help GPs reduce inappropriate initiations onto ONS
- Malnutrition training was also carried out in care homes, which included educating chefs on food fortification and staff on requesting high energy powdered shakes
Catherine Blaikley added, 'While the project improved levels of satisfaction from both clinician and patient, simply by reducing the use of ONS or stopping their use altogether also led to first year annualised savings of over £170,000.'
Dr Elizabeth Johnston, Chair of South Reading CCG, commented, 'Catherine's work has helped GPs to more accurately assess each patient's requirement for ONS, based on their clinical need. This has resulted in less wastage and, for those patients who are found to be malnourished, receive the treatment they need.'
Awards and future plans
Catherine's efforts were recognised with a Quality Improvement 3rd place Award by Berkshire Healthcare NHS Foundation Trust, plus the project is being submitted for the Health Service Journal Value and Improvement in Medicines Management award. Furthermore, Catherine presented the success of this project via a poster at the Pharmacy Management National Forum in London which has since helped recruit dietitians in other areas.
Catherine is about to undertake a similar project to review the use of gluten-free food and infant milks.