30 Apr 2020

Acute and community dietetic teams should work collaboratively and agree patient care pathways within their local area.

Some areas formularies may be different in the community; therefore, ensure the acute hospital dietitians are aware of the formulary.

Agree a referral process to support acute dietetic staff who are likely to have significant time pressures. Acute staff should inform community colleagues of the nutritional care plan for discharged patients. These discharges may be rapid and may include both COVID-19 and non-COVID- 19 patients.  It would be beneficial for community staff to receive regular, brief updates from the acute setting to understand when COVID- 19 patients are starting to transition out into the community and what level of support they will require.

Identify rehab services to which patients may be transferred and what nutritional support options are available in each of those settings.

Identify what is the local contractual agreement to supply nutrition related products and equipment to any additional community rehabilitation beds. 

Work with local Prescribing Support Dietitian/s and/or CCG or Health Board Medicines Management Teams to review current local formulary to see if additional products need to be added that would support rehabilitation of patients suffering/recovering from COVID-19 as patients may require more concentrated ONS that are high in protein.

Consider making your formulary more flexible in case of supply issues with certain products (although no supply issues are currently anticipated) and work with local Prescribing Support Dietitian/s and/or CCG or Health Board Medicines Management Teams to make the necessary changes such as altering Optimise RX/ScriptSwitch pop ups and allowing non formulary products to be prescribed if necessary.

If clinically appropriate, ONS in powder form are the most cost-effective supplement available; however the following considerations need to be made on suitability:
1. Does the patient/carer have the physical ability to make up the powdered ONS as directed on the package?
2. Does the patient/carer have access to both a fridge and milk (fresh or UHT)?
3. Does the patient have adequate storage for the powder ONS?

Patients with inherited metabolic disorders may have multiple prescribed food products and it would be beneficial to ensure the pts GP practice are aware of the need to ensure there is no disruption in obtaining these products on prescription. It may be beneficial to have additional notes on the patients’ record regarding this.

For patients that are managed by Home Enteral Feeding (HEF/ HETF) Dietetic teams and for whom a contract company dispenses and delivers enteral feed, try to ensure there is no a delay in prescription transfer from GP practice to contract company. Good ongoing communication with the community dietetic department and the local Prescribing Support Dietitian or CCG or Health Board Medicines Management Team can help to resolve any issues a GP surgery may have with issuing feed prescriptions.

GPs are currently being encouraged to move to electronic prescribing. Contact your local Prescribing Support Dietitian or CCG or Health Board Medicines Management Team to clarify the processes in your area at this time.

EMIS WEB and SystmOne have different issues with sending the prescription electronically to the contract company and contract companies can be listed as either a community pharmacy or as a dispensing appliance contractor (DAC). Discuss with your local Prescribing Support Dietitian or CCG or Health Board Medicines Management Team if there are concerns about this in your area and consider advising GP surgeries to submit a change request to their local IT Service to allow more than one DAC to be assigned. If the local IT service cannot resolve this, then they will escalate to NHS Digital.

Please note this does not apply to areas that have ‘off FP10’ contracts for supply of home enteral tube feeds.

Dietetic departments that provide community care should fast track telephone reviews for adult or paediatric patients who may require nutrition support and nutritional products on prescription. This is in line with NHS England and NHS Improvement – ‘Prioritisation of community services’.

 

Please note: this content was updated on 4 May 2020.