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Audit on the use of Oral Nutrition Supplements in an Adult Intellectual Disability Service

Author:

Laura Mary Hayden

North Dublin, HSE, IE
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Abstract

Introduction:  A pilot audit on the prescription and provision of Oral Nutritional Supplements (ONS) for residential clients in St.Joseph’s Intellectual Disability Service (IDS) in North Dublin was performed by the dietitian between September and December 2014. The clients were located across nine residential units. While previously referred for nutritional assessment of dysphagia or poor appetite, there had been no regular review by either General Practitioner (GP) or dietitian since these clients were commenced onto ONS.

Theory/methods: The dietitian performed full dietetic assessments on fourteen clients from September-December 2014. This involved gathering information on: weight history & BMI (prior to ONS and current), past medical history, recent bloods, current medical status, current diet history (3days) including ONS intake and ONS prescription, dosage and quantity consumed.

Results: All fourteen clients were found to have a BMI range of 21-31kg/m2. This indicated that they were in the healthy BMI range (one client being obese with BMI = 31kg/m2). Of the fourteen clients: 64% were discharged and all ONS stopped as:

20% did not tolerate the ONS they were prescribed.

80% were not consuming full dose of ONS and were meeting their full nutritional requirements orally.

50% had an average weight gain of 20% since commenced onto ONS (Note: One client entered the obese BMI range after receiving ONS).

36% were kept on the senior dietitian’s case load for further review.

All fourteen clients involved in the pilot audit had their ONS prescriptions reduced or discontinued. This highlights the need for regular dietetic review and assessment of ONS need.

Discussion: During the audit, the dietitian developed a comprehensive ordering system with stores. The dietitian kept an excel file with all ONS amounts per unit and sent this to stores after every ONS order was changed or commenced. This prevented over ordering, inappropriate provision and ensured close monitoring of ONS prescriptions. These findings highlighted the need for a nutrition risk screening tool. The dietitian developed a tool based on the BAPEN MUST (2005) validated tool and is currently piloting this across the community units. The dietitian also gathered costings from the stores department. A comparison was made between 2014; when there were no ordering procedures for ONS in situ and 2015; when ONS ordering procedures above were actively in force. This showed a reduction of €11,850. A previous audit perfomed on enteral feeds and dietetic input showed a reduction of€8,600.There was a combined saving of €20,200.

Conclusion: A substantial cost saving can be achieved by the implementation of a standard operating procedure on the use of ONS in a residential Intellectual Disability Service. This must be supported by ongoing dietetic assessment and review of all residents at risk of malnutrition or requiring enteral feeding, in conjunction with the multidisciplinary team.

Lessons learned: Implementing focus groups to discuss findings of research is a useful tool in encouraging support in the development of the standard operating procedure on the use of ONS.

 Limitations: This research was locally basedand would need to be adapted for national implementation.

Suggestions for future research: To work with primary care settings to audit the use of ONS within the community. This would likely show a further significant cost saving for the HSE.

How to Cite: Hayden LM. Audit on the use of Oral Nutrition Supplements in an Adult Intellectual Disability Service. International Journal of Integrated Care. 2017;17(5):A541. DOI: http://doi.org/10.5334/ijic.3861
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Published on 17 Oct 2017.

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