Information for Carers and Health Care Professionals

This information is solely for the purpose of General Practitioners, Prescription Clerks, Health Visitors or other Allied Healthcare Professionals within Luton and South & West Mid Bedfordshire. This page contains general information about prescribed oral nutritional supplements (ONS) and the referral criteria for the care home service.
Members of the public can explore the resources page for information on a food based approach to support somebody at risk of malnutrition. We would advise you to contact your G.P. if you have any concerns about malnutrition or your nutritional needs.
It is important to maximise food and fluid intake for those that are malnourished or at risk of malnutrition.

Oral Nutritional Supplements:

Oral Nutritional Supplements (ONS) should only be prescribed to patients who meet the Advisory Committee for Borderline Substances (ACBS) prescribing criteria, have been screened using the validated malnutrition screening tool ‘MUST’5 and deemed to be at nutritional risk. Food First advice such as nourishing drinks, high energy snacks and food fortification should be implemented for at least a 4 week period where appropriate before prescribing oral nutritional supplements. When requesting or prescribing oral nutritional supplements please remember some of these points:

Do’s

  • Food First advice should generally be first line for service users identified at risk of malnutrition (‘How to gain a pound a week’) before prescribing.
  • Prescribe to service users identified at nutritional risk using ‘MUST’ and meet ACBS prescribing criteria.
  • Issue initial 1 x starter pack to establish taste preference and avoid wastage.
  • Prescribe as an acute prescription with regular review of nutritional goals (i.e. monthly).
  • Set clear nutrition outcome goals (e.g. weight gain, weight maintenance) with service user prior to starting.
  • Review effectiveness of prescription after 12 weeks to prevent inappropriate long term prescribing
  • Issue therapeutic dose of two sachets/ two bottles daily (monthly prescribing quantities overleaf).
  • Advise service users to take in between meals.
  • Take caution when issuing ONS for service users with complex conditions (e.g. renal disease, liver disease & diabetes) where they may require; specialist products, dietetic input and more regular medical monitoring.
  • Consider over the counter (OTC) supplements such as Build Up™, Complan™,Nurishment™ for those who request ONS but do not meet the ACBS criteria.

Don’ts

  •  Don’t prescribe less than the therapeutic dose of two bottles/ sachets daily, as the energy and protein content can be easily met with Food First advice.
  • Don’t prescribe non formulary (e.g. Fortisip Bottle, Calogen, Pro-Cal, Forticreme) unless advised by a Dietitian.
  • Don’t prescribe if on hospital discharge unless advised by a dietitian. Instead please ‘MUST’ screen service user and if at risk follow prescribing guidelines.
  • Don’t routinely prescribe to service users who are substance misusers or in the final stages of life.
  • Don’t issue more than one starter pack due to cost and avoid repeat prescriptions.
  • Don’t recommend as meal replacements.
  • Avoid prescribing to residents in older people care homes unless advised by a Dietitian as care homes have direct access to the Nutrition and Dietetic service.

How and when to refer?

The referral information below is only for residents in Food First care homes in Luton and South Bedfordshire (for the list of care homes that we support, please see below). For service users in Hertfordshire Valley, please refer to information given on the Hertfordshire Valley page. If you are a local healthcare professional and would like to refer someone who does not live in a residential or nursing home please email epunft.admin@nhs.net for the relevant referral form.

Care home staff in Luton and South Bedfordshire can refer at risk service users directly into the service by completing the Food First referral form. To request a copy of the Food First referral form; please email food.first@nhs.net.

In order for a care home resident to be assessed by a Food First Dietitian they must have one or more of the following:

  • A ‘MUST’ Score of 1 or above WITH evidence of the Food First approach implemented for at least 1 month (as per ‘MUST’ Management Guidelines) AND continued weight loss the following month.
  • A stable BMI of <18.5kg/m2, be motivated to gain weight and the Food First Approach has not led to weight gain.
  • Been admitted to the Nursing/Residential Care Home already on a prescription of Oral Nutritional Supplements (ONS) (for example Aymes Shake, Complan Shake, Fortisip Compact, Forticreme or Calogen). This includes residents discharged from hospital on ONS or started by the GP without a recommendation from a dietitian.
  • A Grade 3 or 4 Pressure Ulcer/Non-healing wound OR has had Frequent Falls AND a MUST of 1 or above WITH evidence of at least 1 month of the Food First Approach.

Additionally, we will also provide dietetic support to:

  • Care home residents’ requiring weight management support services who are unsuitable for BeeZee Bodies or Livewell Luton.
  • Care home residents’ requiring nutrition support/weight management advice who have diabetes which is diet controlled OR managed with metformin, pioglitazone or gliptin AND HbA1c of <58mmol/mol.

Please note that incomplete referral forms will not be accepted. It is also essential that all referrals include a 3 day food and fluid chart.

Training requests

As well as providing a training and education programme to older people care homes, we are able to offer sessions to other health and social care professionals, domiciliary care providers, charity groups and patients groups upon request within the Luton and South Bedfordshire area. These sessions can include information on screening and management of malnutrition, the appropriate prescribing of ONS and maintaining hydration status. If you feel you or your team would like to find out more about our training sessions please contact us using the email address: food.first@nhs.net.

Food First Care Homes

Below is a list of care homes in Luton and South Bedfordshire for which we currently accept referrals:

Luton

  • Alicia
  • Ambassador House
  • Ambleside
  • Capwell Grange
  • Castletroy
  • Collinson House
  • Edwardian
  • Georgiana
  • Little Bramingham Farm
  • Milliner House
  • Moorland Gardens
  • Mulberry Court
  • Osborne House
  • Rosedale
  • Rowles House
  • St Anne’s
  • St Brendan’s
  • St Mary’s
  • Trefoil
  • Victoriana
  • Widecombe
  • Woodside
  • Chiltern Vale
  • Ashton Lodge
  • Chiltern View
  • Dukeminster
  • Friar’s Lodge
  • Knoll House
  • Lady Spencer House
  • Ridgeway Lodge
  • Rosalyn House
  • Rosewood Court
  • Sharnbrook Lodge
  • Tudor House

Leighton Buzzard

  • Carrington House
  • Claremont House
  • Elm Lodge
  • Orchard Lodge
  • Swiss Cottage
  • The Knolls
  • Westlands
  • White House

The Food First Team also provides the training and audit programme to older people care homes in West-Mid Bedfordshire. However the clinical service is provided by Bedford Hospital Dietetic Service. Any referrals for the care homes (below) in West-Mid Bedfordshire please contact:
Nutrition & Dietetics, Bedford Hospital: 01234 792171 or dietetics@bedfordhospital.nhs.uk

West-Mid Bedfordshire

  • Burlington Hall
  • Danecroft
  • Devon Lodge
  • Ferndale
  • Orchid Lawns
  • Taymer