Introduction

1. Prescribing Oral Nutrition Supplements N. O’Sullivan Department of Nutrition & Dietetics, St Vincent’s University Hospital, Dublin 4, Ireland Introduction Oral nutrition supplements (ONS) are recommended for patients who cannot meet their nutritional requirements though normal foods1. The ideal prescribers of ONS are dietitians, as studies have shown that doctors and nurses have little training in this area. However, it was policy that only doctors could prescribe ONS in St. Vincent’s University Hospital prior to 2011. We wanted to improved the speed and accuracy of patients receiving appropriate ONS. Method and Results All patients recommended ONS by the dietitian in a liver unit in an Irish teaching hospital were included in phase 1 and phase 2. Patients in all wards were included in phase 3. We measured i) Percentage of patients who received the correct type and volume of ONS within 24hrs of the dietitian’s recommendation. ii) Time delay in health care professional prescribing the recommended ONS in the drug chart. All cases were audited using the medical notes, drug chart, food and fluid records and by asking the patient what ONS they were offered. Phase1 Quantify the problem Dietitian writes recommendation for type and amount of ONS in patient’s medical notes and doctor prescribes in drug chart (n=28) 29% (n=8) patients offered correct type and volume of ONS within 24hrs of dietitian’s recommendation 71% (n=20*) patients not offered correct type and volume of ONS within 24hrs of recommendation 2010 * Median time delay 5 days ( Range 1-12 days). 4 of 20 when charted after 24 hrs were incorrectly charted Phase2 Proposed Solution Dietitian orders ONS directly in patient’s drug chart as pilot in Liver Unit (n=20) 100% (n=20) patients offered correct type and volume of ONS within 24hrs of dietitian’s recommendation 0% patients not offered correct type and volume of ONS within 24hrs of dietitian’s recommendation 2011 Phase3 Prove the Solution works Dietitian orders ONS directly in patient’s drug chart on ALL wards in St. Vincent’s University Hospital (n=34) 95% (n=36) patients offered correct type and volume of ONS within 24hrs of dietitian’s recommendation 5% (n=2#) patients not offered correct type and volume of ONS within 24hrs of recommendation 2014 # 1 patient inadvertently given Fresubin Energy instead of Fresubin Protein Energy by a nurse. The 2nd patient deemed not to require the ONS by a nurse as they were on NG feeding. • Conclusion • Relying on the medical team to prescribe ONS results in a delay in patients receiving the most appropriate type and volume of ONS. • As a result of phase 2 of the audit, the policy for prescribing ONS changed in 2012 and dietitians now prescribe ONS directly in the patient’s drug chart • 18 months after introduction of the policy for dietitians prescribing ONS, the majority of patients are offered the correct type and volume of ONS in a timely manner • Nurses require education on the different types of ONS. References 1. Irish Nutrition & Dietetic Institute 2009. Position statement: Oral Nutrition Supplements. Accessed via www.indi.ie/docs/1083 on on 7/4/2011. Contact: Niamh O’Sullivan Clinical Specialist Dietitian in Liver Transplant, St. Vincent’s University Hospital, Elm Park ,Dublin 4. E mail: n.osullivan@svuh.ie