Oral nutritional supplements in care homes
The aim of this project was to test the concept of dietetic-led ordering of oral nutritional supplements (ONS) for residents in care homes in Northern Ireland without the need for generation of a GP prescription. A new model of dietetic-led ordering was developed involving extensive stakeholder engagement. Data was audited for a 1-week period at the start (April 2021) and end (June 2021) of the pilot. The new model described in this project demonstrated dietitian-recommended, formulary compliant practice with a range of benefits to residents, clinicians and care workers, delivering the right product at the right time to the resident, resulting in cost savings, improved supply mechanisms for care homes, and reduced requirement for GP input. The project demonstrated benefits for care home residents, clinicians and the Health and Social Care system. The results improve understanding of ways to improve the adoption and implementation of evidence-based nutritional support interventions into routine practice.
Demands on access to primary care are increasing with the rising prevalence of long-term conditions, multi-morbidity and the impacts of Covid-19 (Greenhalgh et al, 2020; Julia et al, 2020; Pettigrew et al, 2020). Medicines use is increasing, and with one in four adults in primary care in the UK taking five or more medicines daily, there is a need to workforce plan in order to meet prescribing needs (Avery et al, 2012). Mobilising the primary care workforce, including non-medical advanced practice health professionals, is important in order to address UK primary care prescribing and medicines optimisation needs (National Prescribing Centre, 2010).
The number of healthcare practitioners in Northern Ireland (NI) who are eligible to prescribe continues to increase each year. In addition to the more traditional medical prescribers, appropriately qualified nurses and pharmacists have been able to prescribe independently since 1997. Additional professional groups such as podiatrists, optometrists and physiotherapists have more recently joined this list of authorised non-medical prescribers. Traditionally, prescribers have worked in either primary or secondary care, and mechanisms to facilitate prescribing are largely reflective of these two environments (National Prescribing Centre, 2010).
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