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.

Financial Savings

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