HNY Policy and Pathway Repository - Humber

The oral nutritional support pathway is a means of identifying patients who are undernourished or are at risk of becoming undernourished. The pathway gives guidance on how to implement timely and appropriate nutritional interventions according to the level of nutritional risk across both acute and community care.

Practices should access the pathway when alerted to do so by completion of the relevant section of the IDL or when a there is concern regarding under nutrition. The pathway is not limited to those with recent inpatient admission. It may be used with any patient where there is a nutritional concern.

History of unintentional / unexplained weight loss is a red flag and warrants further investigation to identify cause.

Exclude Red Flag Symptoms

The following should receive referral to the relevant dietetics team regardless of nutritional risk score:

• All patients that are enterally fed
• Clinical condition requiring immediate therapeutic dietary advice e.g. Patients with newly diagnosed coeliac disease, new diagnosis of diabetes, malabsorption, gastrointestinal disorders such as irritable bowel syndrome, Low FODMAPs, iron deficiency anaemia.

DO NOT REFER

Patients who approaching the end of their life should not be referred for dietetic intervention.

This pathway is not suitable for paediatrics.

Nutritional risk information during the inpatient admission should be available on the immediate discharge summary (IDS). Practices are encouraged to re-screen patients for nutritional risk post discharge according to the score recorded on the IDS.

Re-screening can be undertaken by any person trained to do so e.g., healthcare assistants, practice nurses. Re-screening can be performed using the Malnutrition Universal Screening Tool (MUST). Practices can provide written advice if not already been received or if the nutritional risk has changed.

Practices may initiate oral nutritional supplements to provide timely nutritional intervention and refer to the relevant community dietetic team for full dietetic assessment and treatment. Practices may be requested to continue a prescription of oral nutritional supplements by the acute dietitian. This will be requested separately to the IDS.

Referral for specialist dietetic input within secondary care, please send referral via letter to:  hyp-tr.dietetics.admin@nhs.net

For community dietetics, compete the community dietetic referral form Hull & ER Dietetics Referral Form on ARDENS

Referrals

Referrals are accepted by the triaging clinician within the dietetics department and the patients contacted accordingly.

Information to Include

Mandatory information for referral is to explain the presenting complaint that requires dietetic intervention

Additional useful information:

• Height
• Current Weight
• Previous Weight / amount of weight lost and timeframe
• Relevant biochemistry e.g., HbA1c, haematinics, urea and electrolytes

Community Referrals CHCP guidance

HUTH Referrals guidance

Green 'Eating Well BDA' Leaflet

Amber 'Making the most of your food BDA' leaflet

Red 'Using Nutritional Drinks BDA' Leaflet

Screening and MUST Calculator

MUST Guidance