G_CS_26 Guidelines for the Management of Malnutrition in Adults

The causes of malnutrition are both social and clinical: they include underlying disease, decreased mobility and limited transport to local shops, social isolation and poverty.

 The purpose of these guidelines is to implement a co-ordinated and uniform approach to the management of malnutrition in adults in the community setting. The guidance has been updated and includes the process for the identification of adult patients at risk of and those with malnutrition and their subsequent management. These guidelines reflect the NICE recommendations stated in "Nutrition Support in Adults" and should be used in conjunction with them. The guidelines conform to Lincolnshire Community Health Service(LCHS) statutory and organisational requirements and national guidance to promote holistic and safe practice.

 The National Institute for Clinical Excellence (NICE) recommends that nutritional screening should be carried out in all groups at risk of malnutrition (e.g. patients in community hospitals and residential care homes, patients with chronic diseases and the elderly). Nutritional screening should be undertaken using the Malnutrition Universal Screening Tool(MUST).

These guidelines set out the process for the identification of adult patients in the community and community hospital setting with malnutrition using an evidence- based nutritional screening tool and guidance on their subsequent management. The purpose of the guidelines is to ensure that:

  • Nutritional screening in accordance with British Association for Parenteral and Enteral Nutrition(BAPEN) guidance using the MUST tool is undertaken. It is a mandatory requirement for this to be completed for all new patients and, for those in the community, every subsequent three months or for those in hospital, every week; clinical indicators may require more frequent assessment.
  • Those who are identified as being malnourished or at risk of malnutrition follow a pathway that begins with dietary advice and nutritional interventions, continuing with ongoing assessment.
  • The Eat Well Feel Better (Appendix 1) leaflet is available to all practice, care home and community staff, clinicians, and patients to ensure that practical advice is readily available on the use of the Food First approach and improving nutrition.
  • A clear pathway is defined where food is used as a first line measure, fortified food is second line (incorporating guidance on Complan and Build Up) and oral nutritional supplements(ONS) are reserved for third line use.

Guidance is given to ensure that where ONS are prescribed, the appropriate product is selected for the appropriate duration and with appropriate supportive care.

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