Oral Nutrition Supplements: a review of patients and prescribing practices
Authors: Forrest C. 
Published: July 2008

Background:  Malnutrition in the UK is an important public health problem; both physiologically and financially (Stratton, 2005). The cost of treating the consequences of malnutrition annually is £7.3 billion, 50% of which is spent in the community setting (NICE, 2006). Oral Nutrition Supplements (ONS) are utilised to supplement a patient's nutritional intake to meet requirements. ONS is commonly prescribed by healthcare professionals in the PCT without appropriate screening, monitoring or dietary advice (Jones & Jones, 2006). A 6‐month project was undertaken to nutritionally assess patients receiving ONS and the potential cost saving of reducing inappropriate prescribing practice.

Methods:  Inclusion criteria were all adults currently prescribed ONS in the top five ONS spending GP practices. Patients were screened for suitability by each GP practice and invited to attend an individual consultation with a registered dietitian; clinic, domiciliary or telephone consultations were offered. Exclusion criteria were those patients currently receiving dietetic or palliative care and individuals deemed unsafe to be seen. Full nutritional screening and assessment was conducted using criteria from the Malnutrition Universal Screening Tool (MUST) plus a food diary and ONS history questionnaire. Written and verbal dietary information was provided. GPs were notified of inappropriate ONS prescription. Cost analysis was conducted by the Medicines Management Team.

Results:  A total of 117 patients were invited to attend individual consultations; 24 attended including two domiciliary visits. None of the patients were monitored as recommended by NICE (2006) and 75% were found to be receiving ONS inappropriately. This equates to an average of 13% ONS patients across the practices; an annual saving of £12 622. The total PCT annual ONS expenditure from September 2006 to August 2007 was £378 281; this equates to a predicted cost saving of £47 398.

Discussion:  The ONS Project provides evidence of poor prescribing practices and the need for continued education and dietetic support. The low number of patients willing to attend clinic greatly limited the assessment process and consequently the cost saving forecast. Further investigation into patient's medical record suggests a further 20% should discontinue ONS. Limitations included the relatively short timeline; other PCT's have realised significant cost savings over a longer project period.

Conclusion:  This project highlights the inappropriate prescribing practices of ONS; posing a large financial burden on the PCT. In addition to this, those patients requiring ONS are not receiving the full benefit as they do not receive appropriate dietary advice nor are they sufficiently monitored. It is proposed that prescribing practices and expenditure will greatly improve with the introduction of a local prescribing pathway and malnutrition screening and monitoring tools. Funding a prescribing dietitian from the indicated cost savings is recommended in order to provide support and maintain savings.

References  Jones, J. & Jones, I. (2006) A review of nutrition support prescribing practices amongst health care professionals in Kensington and Chelsea PCT and Westminster PCT, published 2006.

National Institute for Health and Clinical Excellence (NICE). (2006). Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition’ in February 2006. National Institute for Health and Clinical Excellence.

Stratton, R.J. (2005) Elucidating effective ways to identify and treat malnutrition. Proc. Nutr. Soc.64, 305–311.