9.4.2 Enteral nutrition

General guidance
 

• The aim of nutritional support should be to promote weight gain or prevent further weight loss by optimising energy and nutrient intake.
• A state-registered dietician should preferably give dietary advice.
• Formal assessment of nutritional status using a recognised assessment tool such as the Malnutrition Advisory Group tool is essential before considering nutritional support.
• After assessment of nutritional status, first-line treatment should involve the use of appropriate standard foods that have been fortified to increase nutritional intake.
• Food can be fortified easily by the addition of milk, butter, cheese or cream.
• Food should be liquidised for those experiencing swallowing difficulties in the first instance rather than use of a proprietary enteral feed in those were one is unnecessary – this is especially important in nursing homes.
• Simple measures to increase appetite such as exercise, fresh air and eating in the company of others should also be used. Alcohol, in moderation, can be an effective appetite stimulant. Patients should be advised to have small, frequent meals and snacks that are high in energy and protein.
• The use of oral nutritional supplements such as sip feeds should only be considered if the use of fortified standard foods have failed to improve nutritional intake or status after about four weeks, depending upon the individual patient.
• Nutritional supplements should not be used on a long-term basis without regular monitoring and re-assessment. If there is no improvement in weight and/or intake after four to six weeks, the patient should be referred to a dietician.
• Nutritional supplements should be given between meals and not with or instead of a meal.
• Nutritional supplements prescribed on the NHS should generally be for ACBS approved conditions. No more than four weeks supply should be given, as the patient should be re-assessed after this time.
• The precise number of packs required or the daily quantity and length of treatment should be stated on the prescriptions. Do not use the term “OP”.

Click here for - Prescribing Pathway for Adult Patients on Home Enteral Feed

Click here for - Oral Nutritional Supplements (ONS) GP request letter

Click here for - Oral Nutritional Supplements (ONS) Prescribing advice

Click here for -  Nutritional Support (Oral) - A guide to eating well if you have a small appetite or are trying to gain weight

Click here for -  Malnutrition Identification and Management in Adults Guideline

Click here for - Nutritional support (Oral) - A guide to good nutrition in dementia for patients and carers V1