NHS Gloucestershire Clinical Commissioning Group are promoting the 'Five Foundation of Food First'. This has been developed from a nationally recognised 'Food First' approach to improve the nutritional well-being of those who are at risk of malnutrition or 'under-nutrition'. This approach encourages people at risk of malnutrition to use every day nourishing foods and drinks to boost their intake rather than rely on manufactured alternative products.
Oral Nutritional Supplements (ONS) or 'sip feeds' are often prescribed as an easy approach to attempt to address malnutrition. However, they are a relatively expensive approach to providing calories and nutritional support and can also be a source of significant wastage. Through working with Prescribing Support Pharmacists and our Prescribing Support Dietitian, we have identified that in many cases, the prescribing of sip feeds is unnecessary when more pro-active promotion of a 'food first' approach could be equally, if not more successful and in many cases provide more palatable options to patients.
Gloucestershire's spend on sip feeds prescribed by GPs last year was around £1.2 million. We have therefore developed the following revised pathway for the management of those at risk of malnutrition which places more emphasis on the 'Food First' approach and limits sip feed prescribing.
Please click the relevant flowchart box to be taken directly to the easy-to-follow steps on how to implement this guidance in practice.
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All prescription requests for oral nutritional supplements (ONS) should be dietitian led. If a request is received from another healthcare professional including specialist community nurisng teams, then please contact the GCCG Prescribing Support Dietitian for further advice. The purpose of this will be to ensure that a Food First approach has been trialled first.
Letter should be received from dietitian including:
Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients on refeeding following a period of starvation (NICE, 2006). This is particularly common in patients receiving artificial refeeding, but is possible with oral refeeding (particularly if oral nutritional supplements are prescribed). The patient should be considered at risk of refeeding syndrome if they meet the following criteria (NICE 2006).
Please see the National and NICE Guidance section.
Significant Variations for this Pathway
Please see the Clinician Education section.
|Specialist Prescribing Support Dietitian||
Gloucestershire Clinical Commissioning Group
GCCG are promoting the ‘Five Foundations of Food First’, developed from a nationally recognised ‘Food First’ approach to improve the nutritional well-being of those who are at risk of malnutrition or ‘under-nutrition’. This approach encourages people at risk of malnutrition to use every-day nourishing foods and drinks to improve their nutritional status.
For further information on when this pilot will roll out please contact the Prescribing Support Dietitian: firstname.lastname@example.org