Nursing Home Dietetics Service update NHS Eastern Cheshire CCG Governing Body Meeting held in public 30 November 2016 Nursing Home Dietetics Service update Catherine Voyce & Eva Portillo Community Nutrition Support Service

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

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

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

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

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%

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.

Financial Savings

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

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

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

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