Local guidance

Subject Description Links
Adult sip feeds (ONS) in primary care A quick reference for health and care professionals (including care home staff) regarding identification and treatment of malnutrition in the community. It contains links to all other ‘food first’ documents on the CCG website, in addition to essential guidance on when it is (and is not) appropriate to prescribe ONS and the most cost effective ONS to prescribe.

  • Malnutrition should be identified using the Malnutrition Universal Screening Tool (MUST) before treatment is commenced (medium or high risk = malnourished)
  • Treatment of malnutrition should start with a ‘food first’ approach using the resources below
View the Managing Malnutrition Pathway

 

Food First – Eating well for small appetites A self-explanatory leaflet designed for patients at medium or high risk of malnutrition according to MUST. It focuses on enabling patients to increase their nutritional intake by at least 500 calories per day and can be given out by any healthcare professional without additional explanation View Guidance
Food First – Quick guide A short version of the above leaflet. It demonstrates how an additional 500 calories can be consumed simply by making 3 or 4 small dietary changes each day View guidance
Food First – Homemade supplements Designed for patients at high risk of malnutrition according to MUST and should be provided together with ‘Food first – Eating well for small appetites’. It is equally suitable to be used for patients living in their own homes or in care homes View guidance
Eating and drinking at end of life A self-explanatory leaflet designed for the relatives and carers of people who are reaching the end of their lives. It has been requested by a number of GPs and Dietitians, in order to help reassure carers that loss of appetite and reduction in food intake is a normal and expected part of the dying process and that prescribed nutritional products are unlikely to be appropriate at this stage. View guidance

Food First

Fortifying food is a brief practical guide for Care Home cooks/chefs on how to fortify food for residents at medium or high risk of malnutrition according to MUST. It guides cooks/chefs to use fortifiers which contain more than just fat, and to use an adequate amount of each fortifier so that this counts towards intake of an additional 500 calories per day. For more details about fortifying food click here

 

Ways to adapt the recipe Energy Kcal (calories)
Food 1 Portion Adapt by: Before After
Milk 1 pint Add 4 heaped tablespoons dried skimmed milk powder (DSM) to 1 pint whole milk 375 774
(106% extra)
Custard Large ladle (125mls) Add 1 heaped tablespoon DSM powder & 2 tablespoons double cream to custard made with whole milk 140 340
(143% extra)
Soup Large ladle (125mls) Add 1 heaped tablespoon DSM powder & 2 tablespoons double cream 80 280
(250% extra)
Porridge Large ladle (125mls) Add 1 heaped tablespoon DSM powder & 2 tablespoons of double cream to porridge made with whole milk 170 370
(118% extra)
Mashed Potato 1 scoop Add an extra heaped teaspoon of margarine / butter and tablespoon of cream to mashed potatoes 70 190 (170% extra)
Vegetables 2 Tablespoons Add 1 heaped teaspoon of margarine / butter to vegetables. Allow to melt. 15 85
(460% extra)
Ice Cream 1 Small Scoop Pour 2 tablespoons of double cream over ice cream 100 200
(100% extra)
Sponge Pudding 2 Tablespoons Place an extra 2 teaspoons of jam or syrup on the sponge when serving. Serve with a high calorie custard or ice cream 340 540
(58% extra)
Breakfast
Cereal
Small serving (25g) Use fortified milk with 2 tablespoons of double cream and 2 teaspoons of sugar 200 430
(115% extra)
Milk Pudding Large ladle (125mls) Add 1 heaped teaspoon DSM powder & 2 tablespoons double cream to the milk pudding made with whole milk. Serve with 2 teaspoons jam 200 500
(150% extra)