Sip Feeds and Guidelines

1. Jon Durand Medicines Management NHS Hampshire Sip Feeds and Guidelines

2. What are we trying to achieve? • Weight gain • Patient survival • Better health/healing • Better nutrition? • Good patient experience?

3. Elderly Undernourished Terminally ill Drug addicts Care home patients Anybody What type of patient might be using sip feeds?

4. What are the pressures on clinicians to prescribe sip feeds? • Patient requests • Patient’s relative requests • Care home requests • Poor catering facilities • Caring GP/Nurse requests/prescribers • Guidelines

5. How appropriately are sip feeds used? Scenario – elderly patient in care home is given a sip feed for lunch. What happens next? • Patient drinks whole carton happily • Patient is left alone/forgotten about • Cannot use straw • Doesn’t like sip feed – texture/taste • Sip feed gets taken away before patient can finish it • Patient cannot communicate their needs

6. What do we need to do? • Regular reviews of all patients • Monitor patients • Prescribe appropriately • Use appropriately • Follow guidelines – see next slides

7. Who are sip feeds for? • Patients with a MUST score ≥ 2 or BMI ≤ 18.5. • N.B. Patients with a BMI > 18.5 can still be malnourished. • This could include patients with dysphagia or malabsorption. • Patients who do not meet the criteria, but may be at risk might need sip feeds or some nutritional support from OTC products such as Complan and Build-Up. • (MUST Tool available at www.bapen.org.uk).

8. What do I give? Treatment should be two bottles a day in addition to usual food intake for 30 days, or less if you wish to review earlier. Certain patients who rely on sip feeds as their sole source of nutrition will need advice from a dietitian and more than two bottles a day. To aid patient choice, endorse “mixed flavours”. Some manufacturers offer starter packs to assist with taste choice. Prescribe acutely, do not put on repeat. Review before prescribing again. Consider giving food fortification advice and appropriate diet/recipe sheets.

9. What are my options at review? • Check weight and compliance. • Continue for another month unchanged if necessary. • Adjust quantity to suit patient requirements. • Give dietary advice and or leaflets if available. • Consider changing to OTC foods as a meal replacer such as Build-Up and Complan (non-prescribable, but available OTC). • Refer to a Registered Dietitian if you feel it is necessary. • Reassure patients that they have “permission” to eat foods that they might perceive to be unhealthy. E.g. full fat dairy foods. • If no longer required, stop prescribing. (Target weight achieved, improved MUST score)

10. How do I stop prescribing? • Re-screen and reassess. • If patient no longer malnourished and no longer at risk, sip feeds should not be required. • In order to maintain improved nutritional status, consider possible options as above plus care plans and motivational assistance from a Registered Dietitian.

11. Guidelines for Review of Patients on Long Term Sip Feeds A Review should include the following: • A re-assessment of patient’s current weight and comparison to expected weight. An assessment of nutritional requirements • An assessment of current intake alongside patient’s social and physical circumstances. • An estimate of which nutrients may be in short supply. • An individualised action plan. • A mechanism to ensure that the patient is reweighed at monthly intervals.

12. Who do I ask for advice? • Registered Dietitians (RDs) are the only qualified health professionals that assess, diagnose and treat diet and nutritional problems at an individual and wider public health level. • Dietary resources and advice leaflets are available from Dietetic Departments and/or Registered Dietitians. • Community Nurses who have received full MUST training are also able to undertake such an assessment and understand when to refer on to a dietitian.

14. Remember • Prescribe Acutely • Reassess and or Refer Before Repeating • Review Frequently Thank you!