The malnutrition universal screening tool "MUST" can give an indication of malnutrition risk. This can be downloaded on SystmOne or accessed via www.bapen.org.uk. The first line approach to managing malnutrition is "Food First". This means offering advice on food fortification to increase calories and protein in everyday foods. Additional snacks will be needed to meet requirements for those with a small appetite. Oral nutritional supplements (ONS) should not be used as first line treatment.
Care homes should be able to provide adequately fortified foods and snacks and prepare homemade milkshakes and smoothies, which should negate the need to prescribe ONS in the majority of cases. In addition, for patients in care homes, food fortifying care plans can be inserted into the individual's care plan to instruct staff regarding food fortification.
If a Food First approach alone does not meet nutritional goals and ACBS criteria are met then an ONS can be prescribed. See "Considering Prescribing Oral Nutritional Supplements" Formulary. Where possible a patient should be referred to the dietitian for full nutritional assessment and individualised advice prior to commencing ONS. Where ACBS prescribing criteria are not met then patients should be encouraged to follow a Food First approach and can purchase over the counter products such as Complan® milkshakes or soups, Build-Up® milkshakes or soups, or Nurishment® milkshakes.
The Food First Programme is delivered by two teams across Bedfordshire:
Services provided by the Food First teams include:
The Food First teams work as part of the wider clinical dietetic teams. When referring a patient please complete the appropriate referral form for your local team.
Please note that as part of the extended Food First service:
Patients within Bedford, Ivel Valley and West Mid Beds Localities will be seen by the clinical dietetic service at Bedford Hospital NHS Trust. A copy of the referral form can be found here.
Patients within Chiltern Vale and Leighton Buzzard localities will be seen by the clinical dietetic service at SEPT Community Health Services. A copy of the referral form can be found here.
There is a guideline for GPs to support the detection and management of malnutrition - ONS Formulary. Laminated copies are available to display in consulting rooms and an electronic version is available here.
Fabulous Fortified Feasts (PrescQIPP) Recipe book https://www.prescqipp.info/nutrition-toolkit/finish/189-nutrition-toolkit/529-fabulous-fortified-feasts-hd
Last updated: 24/04/2018
Update due: 24/04/2019