Oral nutritional supplements (ONS) are commonly prescribed for patients at risk of malnutrition. Ensuring repeat prescriptions align with local and national guidelines is crucial for patient safety and healthcare efficiency.
The necessity of regular monitoring is underscored by the National Institute for Health and Care Excellence (NICE) Clinical Guideline 32. Baseline data from December 2020 showed gaps in ONS prescription reviews conducted at a General Practice (GP) surgery by an Interface Pharmacist, such as use of outdated BMI records to calculate MUST scores to inform on repeat prescribing of ONS at the Practice.
This quality improvement project aimed to review 75% of adult patients with repeat ONS prescriptions within two months at the Practice, assessing for patients stopping their ONS prescription based on an updated MUST score, dietician referrals, and identifying patient monitoring follow-up needs.
Method: Educational sessions were organised to upskill the new Primary Care Network (PCN) Pharmacy team in September 2021, focusing on Body Mass Index (BMI) calculations, Malnutrition Universal Screening Tool (MUST) score assessments, and providing them with local protocol and national guidelines update. A Plan-Do-Study-Act (PDSA) cycle was implemented, with the pharmacy team conducting patient reviews.
In the subsequent review cycle in 2022, the approach was adapted, involving an experienced pharmacist for initial reviews who referred to a named General Practitioner (GP) for complex cases that required follow up. Results: In October 2021, after four weeks, 32 (94%) patients were reviewed by the Pharmacy Team, with 13 (38%) patients stopping ONS prescriptions based on updated MUST scores, and five patients referred to dieticians. Further analysis of results identified 6 patients who hadn't received monitoring follow-up, highlighting the need for enhanced training for the Pharmacy Team and additional support from a Senior Clinician where patients were complex.
Adaptation made to the review process in October 2022 led to 100% of patients being reviewed, with improved identification of complex patients and management of those requiring ongoing monitoring.
Conclusion: The project demonstrated improvements in ONS review processes for the Practice in 2022 against the measured outcomes, demonstrating a more efficient patient management and compliance with guidelines. Patient reviews involving both Pharmacy Team and GP were key to these improvements. Future efforts at the Practice will focus on sustaining these changes, enhancing training, and ensuring robust follow-up of patients. It is hoped that this project will be useful for other Clinical Pharmacists embarking on ONS reviews for the first time in Primary Care.
