Making Every Nutritional Supplement Count Mar 09, 2017 Reducing Oral Nutritional Supplement Wastage In The Community Prescribing oral nutritional supplements as part of the management and treatment of malnutrition in the community is known to be clinically effective, and there is significant evidence from systematic reviews that demonstrate this.1,2 Oral nutritional supplements, such as AYMES Shake, are typically used in addition to a patient’s regular diet when this alone is insufficient to meet daily nutritional requirements and therefore help prevent weight loss and promote weight gain in malnourished patients and care home residents.1,2 Patients receiving nutritional supplements have reduced complications such as pressure sores; poor wound healing; infections; hospital admissions and mortality.1,2 Reduce Inappropriate Prescribing To Help Save The NHS Money Inappropriately prescribed oral nutritional supplements are costly for the NHS. If a patient is found to be at high risk of malnutrition, then a referral should be made to a Registered Dietitian who can assess the underlying cause of weight loss and reduced appetite. The Dietitian will then recommend an appropriate nutritional care plan, which may involve prescribing oral supplements.3 Once prescribed, oral supplements require on-going monitoring and review to ensure residents and patients continue to enjoy the drink and are compliant taking the supplement. Monitoring oral intake and regularly reviewing the nutritional care plan will also enable healthcare professionals to determine if supplementation is still required to achieve the desired nutritional outcomes. How To Reduce Wastage Of Oral Nutritional Supplements With the NHS in England spending over £91million on oral nutritional supplements annually, it is imperative that every supplement prescribed provides benefits for patients.4 How To Ensure Cost-Effective Prescribing Before regularly prescribing oral nutritional supplements on a monthly basis, healthcare professionals should recommend that the patient try various supplements first. AYMES direct to patient sample service is available for healthcare professionals to order a range of AYMES supplements for the patient to try. To establish the patient's preferences before starting a prescription, it is highly recommended to use the direct-to-patient supplement sample service. You can get more information about AYMES Direct to Patient Sample Service by clicking here. Reduce Taste Fatigue And Increase Variety A patient’s preferences may change over time, and this may affect their oral intake. Taste fatigue is often a problem for patients taking supplements (5), and this leads to a patient refusing to take their prescribed product. Swapping to a different flavour or even to a different style of the product increases variety and reduces taste fatigue. For example changing a patient’s prescription from AYMES Shake Vanilla flavour or AYMES Complete vanilla flavour to one of the alternative chocolate, strawberry or banana flavours, may increase compliance and improve oral intake once again. Regularly Reviewing Patients Prescribed Nutritional Supplements Ensures Compliance Regular monitoring by a Dietitian, to assess a patient’s compliance and acceptance, prevents nutritional supplements from being wasted. Also, a Dietitian can determine whether a patient is meeting their nutritional goals and whether to continue prescribing supplements. A Dietitian-led patient review should ascertain the quantity of sip feed consumed. If the patient does not consume the supplement drinks entirely, then finding out why is important. The prescription of ONS may be amended and other ways to increase oral intake considered. Carers and nursing staff can also request a review by a Dietitian if a patient has regained weight and their oral intake has improved. How To Improve Compliance And Reduce Non-Compliance Ensuring the patient or carer understands how to take their supplements and providing any instructions for mixing and serving suggestions can improve compliance.5 AYMES provides written on mixing AYMES Shake and on thickening AYMES Complete. It is recommend that AYMES Shake and AYMES Complete be chilled before serving, although they can be served warmed if preferred. Using a supplement in a recipe can add more variety and flavours and increases enjoyment and compliance for those taking them. AYMES provides delicious and tasty recipes that can be accessed here. Asking how a patient would prefer to receive their drink in advance of serving can also improve supplement compliance. For instance, would they prefer their milkshake served in a cup, mug, or glass or are they happy to sip from the bottle with a straw?5 Reducing Oral Nutritional Supplement Wastage – At A Glance Always trial first using a Direct to Patient Sample Service. Consider short-term prescriptions Ensure all necessary mixing instructions and serving suggestions are provided. Provide several flavours and offer change regularly to avoid taste fatigue Try variations in consistency (if appropriate), temperature, and serving suggestions. Use the supplement as part of a recipe. Give smaller doses more frequently Provide meal time encouragement and assistance with eating and drinking as required To find out more about cost-effective prescribing of AYMES Shake and AYMES Complete, or if you would like further information about reducing wastage of supplements, Partnership Managers would be happy to arrange a visit to your department or surgery. Please click here to arrange a visit. References 1. Managing adult malnutrition in the community – Including a pathway for the appropriate use of oral nutritional supplements (ONS), produced by a multi-professional consensus panel, May 2012, available at http://malnutritionpathway.co.uk/downloads/Managing_Malnutrition.pdf2. Stratton RJ, Green C and Elia M. Disease related malnutrition; an evidence-based approach to treatment. Oxford: CABI, 2003 3. Combating Malnutrition: Recommendations For Action (2008) http://www.bapen.org.uk/pdfs/reports/advisory_group_report.pdf. Redditch, UK, BAPEN. 4. National EPACT data http://www.nhsbsa.nhs.uk/3230.aspx 5. Hubbard GP, Elia M, Holdoway A, Stratton RJ. A systematic review of compliance to oral nutritional supplements. Clinical Nutrition 2012; 31(3): 293-312.