nursing home dietetics service update
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Nursing Home Dietetics Service update
Catherine Voyce & Eva PortilloCommunity Nutrition Support Service
NHS Eastern Cheshire CCG Governing Body Meeting held in public 30 November 2016
The service
Aim of service• Improve equity of access
to dietetic services• Cost-effective prescribing
of oral nutritional supplements
• Education and support of staff in nutritional care
• Admission avoidance• Aid recovery
Service timeline
May NovOctSepAugustJulyJune Dec
2016
Service planning & set-up
Audit of oral nutritional
supplements with MMT
Clinical service• GP referrals• Acute to community dietetic service• Nursing home rota• Domiciliary visits
NH GP meeting
MMT meeting
CCG Care home workshop Liaising with CQC
Dementia EOL teamSLTsCCG Quality team
Dietetic assistant competency training
Service standards & processes
Oral Nutritional Supplement audit
Audit questions• Does indication for prescription
meet – ACBS criteria– MMT prescribing policy for
ONS?• Is patient on most appropriate
ONS to treat nutritional diagnosis?
Outcome of audit• Recommendations:
– Stop prescription– Change prescription to new
product– Continue with current
prescription• Communicated by letter to GP
& NH• Summary of outcomes sent to
MMT
Results - overall
• If ONS indicated and appropriate– Changed to a nutritionally dense product & 45% cheaper!
• Cost savings from implementation of MMT ONS policy– Collaboration between MMT and prescribing support dietitians– Savings are being collated by MMT
Number of residents reviewed 272Number of nursing homes 29Number of prescriptions reviewed 315% ONS stopped 48% ONS continued 30% ONS changed 22
Results – stage of ONS
Stage Pre-audit Post-audit1 35 612 29 233 7 54 9 95 21 2
Green Recommended first stage products - provide the most cost-effective and optimum nutritional content. Most cost effective first line products and less cost effective products
Amber Alternative products if there is a physical or medical reason that a patient cannot take the first stage product or if the first stage supplement is not tolerated.
Pink Listed for information. To be prescribed on dietetic recommendation only
57%
95%
% of ONS prescriptions by stage
Year To Date Financial savings
Between May and September 2016, the service has saved £144,000
(£345,000 Full Year Estimate) on the prescribing of nutritional supplements.
NH baseline audit - education
Nutrition & MUST training is needed!
Nutrition training Malnutrition risk training
Performance monitoring
• Dietetic outcome measures• User experience - Service user feedback• Patient safety - Audit of nutrition care
pathways in nursing homes• Service performance
The next 6 monthsEducation & training
Malnutrition -Identification and first-line treatment Nutrition support for dementia – care pathway
EMIS outcome data
Coded dietetic outcomes in EMISAudit of service effectiveness
Prescribing
CPD for dietitiansOngoing support for MMT to implement ONS prescribing policy
Clinical service
Summary
• Equitable access to dietetics for pts in NH or housebound
• Dietetic pathway from acute to community
• Cost savings for CCG• Plan for training• Networking with community teams
for integrated working• Positive feedback from service
users
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