Managing Prescriptions of Nutritional Products in the Community October 2016 Title: Identifying and managing malnutrition in primary care. A presentation brought to you by the Food First Project, a division of SEPT community health services. The Food First Project

Introduction to the team Title: Introduction to the teams. SEPT community health services. We have a range of dieticians, assistant dietetic practitioners and social care workers. This team manages Luton and South Bedfordshire. Bedford hospital dieticians deal with Bedford and …

Aims and Objectives Aim: To increase prescription clerk understanding of appropriate prescribing of nutritional products in Luton to ensure clinical and cost effective care. Objectives: To improve confidence when processing repeat prescription requests for nutritional products. To develop a greater understanding of the Food First Project. Demonstrate awareness of local prescribing guidelines for oral nutritional supplements and specialist infant formulas. To be aware of Nationwide Coeliac UK guidelines on prescribing gluten free products. To be able to recognise when to contact Food First team regarding care home oral nutritional supplement prescription request.

The Food First Project Timeline 2009- Food first are commissioned by Beds PCT to reduce inappropriate prescribing of oral nutritional supplements (ONS). November 2010 Creation of the Food First care home award scheme. 2011 The GULP dehydration risk screening tool was developed. 2011 Project extended to Luton PCT and additional commissioning to support prescribing of specialist infant formulas. January- May 2012 The team won an award for Leadership at the Advancing Healthcare Awards. June- August 2012 All older people care homes receive monthly contact from dietetic service with an open referral policy for clinical dietetics. Commissioned by Bedfordshire PCT in 2009 to reduce inappropriate prescribing of oral nutritional supplements (ONS). 2010: following stakeholder engagement, the creation of Food First care home award scheme; training around screening and treatment of malnutrition. homes can achieve certificate status if meeting Food First standards, with 6-monthly audits to ensure standards are implemented and maintained. 2010-2011- Project extended to Luton PCT and additional commissioning to support prescribing of specialist infant formulas; including development of Countywide guidelines. Summer 2012- All older people care homes receive monthly contact from dietetic service with an open referral policy for clinical dietetics. December 2015 commissioned by Hertfordshire Valley CCG for 2 yrs. September 2016: Paediatrics dietitan is now involved within the team to stop inappropriate prescribing. December 2012 The team won the East of England Award for the Hydration Swapper resource. March 2013 NHS England awarded Food First a £100,000 research grant to run a regional trial to evaluate the effectiveness of the Food First project. December 2015 Commissioned by Hertfordshire Valley CCG to role out the project. October 2016 Paediatric Specialist Dietitian has joined The Food First Project. We are now a team of 11!

Nutritional Products The Food First Project supports Luton CCG and GP practices with the prescribing the following products; Oral nutritional supplements (Adult & Paediatrics) Specialist infant formulas (Birth to 2 years) Gluten free products (Adults & Paediatrics) We complete prescribing audits for each Luton GP practice this involves reviewing whether the prescribing guidelines are followed, prescriptions are appropriately reviewed and to ensure products are prescribed in line with ACBS criteria. We will start by discussing oral nutritional supplement prescription which in the community are general issued for those with disease related malnutrition. I will hand you over to Fran who is going to explain a bit about malnutrition and how we can identify it.

What is malnutrition? ‘Malnutrition is defined as a state in which a deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on body composition, function or clinical outcome’. (NICE, 2006). ‘Malnutrition is defined as a state in which a deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on body composition, function or clinical outcome’. For the purpose of this presentation malnutrition does not refer to excessive nutrition linked to conditions such as obesity. Undernutrition can occur is those that are overweight and obese. NICE guidelines

Signs and consequences of malnutrition Loose clothes, jewellery, belts. Dizziness. Dry skin with decreased elasticity. Fatigue. Consequences: Impaired immune function. Bone and muscle weakness. Poor libido and fertility. Altered G.I structure and function. Mood changes and depression. Falls Delayed wound healing and pressure ulcers. Title: Signs and consequences of malnutrition include, but there are multiple signs & consequences. Signs: - Loose clothes, jewellery, belts from unintentional weight loss. Confusion. Dizziness which can cause falls. Dry skin with decreased elasticity. Being lethargic, feeling tired all the time and lacking energy. Consequences: Impaired immune function, increasing susceptibility to infection and sepsis. Increased risk of UTI’s Bone and muscle weakness which can effect respiratory & cardiac function and mobility. Poor libido and fertility. Altered G.I structure and function. Mood changes and depression. Delayed wound healing and increased risk of pressure sores. Falls

How many people in the U.K. are malnourished? A 1.5 million B 3 million C 5 million D 10 million

How many people in the U.K. are malnourished? A 1.5 million B 3 million C 5 million D 10 million

What is the annual health cost of malnutrition in England? A £572 million B £10.45 billion C £19.6 billion D £5.32 billion Does not include cost of ONS.

What are the annual health cost of malnutrition in England? A £572 million B £10.45 billion C £19.6 billion D £5.32 billion

What does that mean for your population in Luton? 5% of U.K population at risk of malnutrition. Mid-Year Population Estimate for Luton in 2015 was 214,700 people. (Office for National Statistics) 10,735 people are at risk of malnutrition in Luton! The National Institute for Health and Care Excellence (NICE) defines a person as being malnourished if they have: a body mass index (BMI) of less than 18.5 kg/m2 unintentional weight loss greater than 10% within the past 3–6 months a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the past 3–6 months