1. Nursing Home Dietetics Service update
NHS Eastern Cheshire CCG Governing Body Meeting held in public November 2016
Nursing Home Dietetics Service update
Catherine Voyce & Eva Portillo
Community Nutrition Support Service

2. 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

3. Service timeline Clinical service GP referrals
Acute to community dietetic service
Nursing home rota
Domiciliary visits
Service planning & set-up
Audit of oral nutritional supplements with MMT
MMT meeting
CCG Care home workshop
NH GP meeting
Liaising with CQC
Dementia EOL team
SLTs
CCG Quality team
Dietetic assistant competency training
Service standards & processes
May
June
July
August
Sep
Oct
Nov
Dec
2016

4. 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

5. Results - overall If ONS indicated and appropriate
Number of residents reviewed
272
Number of nursing homes 29
Number of prescriptions reviewed
315
% ONS stopped 48
% ONS continued 30
% ONS changed 22
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

6. Results – stage of ONS % of ONS prescriptions by stage Stage Pre-audit
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
% of ONS prescriptions by stage
Stage
Pre-audit
Post-audit 1 35 61 2 29 23 3 7 5 4 9 21
57%
95%

7. 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.

8. Financial Savings

9. NH baseline audit - education
Nutrition training
Malnutrition risk training
Nutrition & MUST training is needed!

10. Performance monitoring
Dietetic outcome measures
User experience - Service user feedback
Patient safety - Audit of nutrition care pathways in nursing homes
Service performance

11. The next 6 months Education & training EMIS outcome data
Malnutrition -Identification and first-line treatment
Nutrition support for dementia – care pathway
EMIS outcome data
Coded dietetic outcomes in EMIS
Audit of service effectiveness
Prescribing
CPD for dietitians
Ongoing support for MMT to implement ONS prescribing policy
Clinical service

12. 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