A pathway has been devised for direct referral for care homes into the Nutrition and Dietetic service following high risk Malnutrition Universal Screening Tool (MUST) assessment for residents that have lost weight to ensure appropriate prescribing of nutritional supplements.Initially training was provided for care home staff on MUST nutritional screening, food fortification and menu and care planning.
Following MUST two high risk the care home implement food fortification advice and review and if further weight loss they refer directly to our service by completing a referral form and 5 days food and fluid charts
A Dietitian telephones the care home staff to provide a dietetic assessment and a meal plan is sent to the care home. A letter is sent to the GP and care home with treatment and type and quantity of nutritional supplement if meets ACBS Criteria.
All residents prescribed a nutritional supplement are then reviewed by Nutrition and Dietetics resulting in 100% under Dietetic care rather than sporadic referral improved quality and cost savings.
Working with GP’s on feasibility of quick referrals for patients with High risk score.
On the back of the success with the work we have done with managing nutritional support with care home patients, the Trust’s Medicine Management together with Nene and Corby CCG requested that we look into the feasibility of creating pathways for patients living in their own home.
We worked with a lead GP and GEM/Arden IT to develop a GP MUST template for SystmOne.
Once completed, we provided training to GP’s at 4 surgeries in the Kettering area, and then audited in May and sent questionnaires to surgeries for feedback.
One of the concerns identified is the length of time to review before referring to the Dietitian. This time frame is too long for the type of patient’s that require nutrition support intervention. We are now in the process of reviewing the pathway to make the template easier to use and a meeting with the lead GP has been scheduled in August.
The plan is to add on additional surgeries, to develop an EMIS template and to identify what additional dietetic time is required to implement the pathway of care throughout Northamptonshire.
Dietetics Innovation: Pathway for management of cow’s milk protein allergy in babies
It can take an average of 3 months to diagnose a milk allergy in babies during which time parents can be at the end of their tether with a screaming baby with reflux, diarrhoea and possibly skin problems too.
Guidelines have been produced to for GPs and Health Visitors in the management of this condition, advising the mothers of breast fed babies to exclude cow’s milk from their own diets or to prescribe an appropriate hydrolysed or amino acid formula depending on the severity of symptoms.
These interventions can bring about an almost immediate improvement. Babies should then be referred to a paediatric dietitian to check the intervention is working, provide milk free weaning advice and advice on management of the condition after one year of age i.e. stopping the prescription of the expensive formulas and gradually reintroducing cow’s milk as over 90% of babies should grow out of this by the age of 2 years.
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