In healthcare, it is important to be conscious of any waste within services to reduce costs and decrease the impact upon our planet. Our guest blogger, Claire Irlam, RD, offers some tips on how we can implement changes in nutrition support.
“I’ve got hundreds of bottles of those from the GP!” How often have you heard this phrase as a dietitian?
In healthcare, it is important to be conscious of any waste within services, to reduce costs and decrease the impact upon our planet. Nutrition support is a large proportion of the work of dietitians and there is plenty of scope to ensure that oral nutritional supplements (ONS) are prescribed appropriately, and that these products are utilised effectively after being prescribed. There is encouraging work taking place in primary care by prescribing support dietitians. And for the rest of us, we can implement changes within nutrition support to help reduce waste.
Here are some tips to help you get started:
1. Food first
This may seem obvious, but the first way to reduce waste of oral nutrition support products is to avoid them where possible. Consider ways to increase the nutritional content of foods already eaten and advise upon homemade high-calorie drinks.
2. Get real
Recommendations made during a hospital admission may not be applicable in the community. A patient may have been recommended to take a supplement drink three times a day after weaning off an enteral feed; however, without prompting from nursing staff, they may not continue this at home and then have 84 bottles arriving each month. The drinks may also no longer be clinically indicated if this person is more likely to eat better at home.
Discussions with the patient prior to discharge and clear follow-up plans can prevent inappropriate prescriptions. If a dietetic follow-up is not arranged, it may be worth providing clear guidance to the GP. For example, could the supplements be stopped upon reaching their baseline weight?
3. Try before you buy
Most supplement companies now have easy-to-use sample services where patients can try products in a range of flavours delivered directly to their address.
4. What’s your flavour?
This is such a simple one, but so effective. Most supplements these days come in a wide range of flavours and as these preferences are so personal, specifying them upon the drug chart or prescription request can make a significant difference to adherence.
5. Mix it up!
Finding drinks too sweet is an oft-cited reason for disliking them. Diluting them with milk, or a fizzy drink for juice-style ONS, can make them more palatable. Just be sure to check that the supplement hasn’t been chosen for its IDDSI level due to dysphagia.
6. Hot and cold
Changing the temperature of ONS can provide a welcome change; for example, a warmed chocolate drink can mimic a cup of cocoa. Some ONS companies manufacture lolly moulds, which can transform juice-based supplements into a refreshing treat. Always check the supplement provider’s advice before heating supplements and consider that IDDSI levels may be affected by temperature.
7. Get cooking
Supplement fatigue can be avoided by using products within recipes. Many companies have suggested recipes, such as cakes, mocktails and casseroles.
8. First in, first out
If you keep a stock of products in your office, make sure that there is a system for checking ‘use by’ dates and that the oldest ones are used first.
9. Learn something new every day
Larger office stocks that may not be able to be provided to patients before they expire can be used for department learning sessions. Trial tasting and recipe testing is helpful to understand patients’ perspectives, or you can link up with the speech and language therapists to complete some IDDSI flow testing.
10. It’s in the bag
Enteral feeding waste can also be minimised by keeping to whole bags where possible for feeding regimes. If requirements cannot be met with one bag, consider adding in a bolus rather than using a small amount of a second bag.
Things to think about , but all can make a difference to reducing waste.
Claire Irlam, RD
Claire is a Registered Dietitian for the
Manchester Macmillan Supportive & Palliative Care Service.
She is also Chair of North West England and North Wales
British Dietetic Association Branch