Oral nutrition support service: guidance for healthcare professionals

Referral criteria

The service is for adults aged 18 and over who are registered with a Newcastle GP, where:

• Patient consents to referral to oral nutrition support service.
• Must score ≥2 with evidence of underlying physical cause which has not responded to first line guidance (see supporting resources section below).
• Lower must considered if: ‘dysphagia significantly impacting oral intake and weight loss’? e.g. MND or pressure damage Grade 3+.

Exclusion criteria

The team is small and in high demand, referrals are rejected in the following situations:

• Referrals from intermediate care teams which do not fund dietetics as part of their service.
• Out of area (does not have a Newcastle GP).
• Patient appropriate for 1st line advice but not given or implemented (see supporting resources section below).
• Eating disorders, ARFID, ADHD – consider referral to appropriate mental health services or signpost to Eating Distress North East.
• Stable patients (lower nutritional risk or have completed previous dietetic intervention). We are unable to provide routine, longer term review of patients prescribed nutritional supplements.
• Patient has unstable mental health condition, active alcohol and substance misuse (if underlying cause of malnutrition, patient should be referred to and be engaging in appropriate services to support)

Newcastle malnutrition management pathway

We suggest health professionals follow the below local pathway when considering a referral.

Step1: Nutrition screening to check level of risk

• Use MUST tool
• Underlying barriers to poor intake are identified and addressed e.g. low mood, difficulties shopping/food prep, poor dentition, gastro symptoms e.g. nausea, constipation, diarrhoea

Step 2: Screening identifies person at malnutrition risk (score >1)

• Issue/implement food-based guidance to maximise calorie intake (see supporting resources)
• Monitor weight and intake (appropriate care plan and charts implemented if care home)
• Food based guidance alone not enough (still losing weight, unable to increase intake from food). Follow 1^st line ONS prescribing guidance (section 3 of NENC ICB ONS prescribing guidelines).

Step 3: Consider referral to the oral nutrition support service if meets referral criteria in addition to the following

• Step 2 interventions not working after 1-3 month trial.
• Patient requires specialised oral nutrition support prescribed products (e.g. pre-thickened supplements).
• Has special dietary requirements e.g. coeliac, diabetes and first line guidance inappropriate.
• Avoid routine prescribing of supplements prior to requesting a dietitian to assess (unless patient at very high risk)  as dependence on supplements may reduce scope to implement dietary changes

Referral and contact information

GPs can refer to the service via the existing e-referral System (e-RS)

Nursing and care homes can refer to the service directly.  A copy of the current referral form is available in the Forefront Discover Digital Training platform or by contacting the Dietetic Department on 0191 2823557 or emailing  [email protected]

Supporting resources

BAPEN: Guidance on nutritional screening

Eating Disorders, ARFID, ADHD-

Consider referral to appropriate mental health services or signpost to Eating Distress North East

Food-based first line advice for patients

• Small and often, high calorie diet guide, for people with a poor appetite and unplanned weight loss
• Guide for patients with COPD and experiencing poor appetite and unplanned weight loss

Guidance for care homes

We are currently rolling  out a digital training platform for care homes called ‘Forefront Discover’ if you would like to be signed up for this training platform or would like to discuss face to face training options please contact the Dietetic Department 0191 2823557 or email  [email protected] and one of our team will be in touch to discuss your requirements

Guide on good nutritional care in care homes

Care home digest – Menu planning and food service guidelines for care homes