Management of malnutrition should be linked to the level of malnutrition risk. For guidance on how to assess and record the risk, agree goals of intervention and monitor progress go to: Managing Malnutrition According to Risk Category using 'MUST'

MUST is a step by step screening tool to identify adults, who are:

• malnourished, or at risk of malnutrition, or
• obese

It is for use in hospitals, community and other care settings and can be used by all care workers and to re-assess individuals identified at risk as they move through care settings.

Do not assume that a patient with a BMI of more than 30Kg/m² (obese) is well-nourished. They may have significant nutritional deficiencies in spite of high body weight or unintentional weight loss.

In most cases malnutrition is a treatable condition that can be managed using, first line, dietary advice on optimising food and oral nutritional supplements (ONS). Management of malnutrition should be linked to the level of malnutrition risk.

Options can include good food, assistance with eating, addressing social issues, ensuring ability to shop (physical and financial) and prepare food, texture modification, dietary advice to maximise nutritional intake (also known as 'food first') and ONS to complement dietary strategies in order to support individuals to meet their nutritional requirements.

There are two leaflets available to help patients and carers: Guide to making the most of your food and Advice for patients and carers who are prescribed nutrition drinks (oral nutritional supplements)

GP practices should have a system in place ensuring that all care homes report the patients' weight change when requesting further supplies of nutritional supplements.

If there are no improvements please follow MUST management guidelines with regard to referring to a Dietitian.

A multidisciplinary team including Dietitians, Occupational Therapists, Speech and Language Therapists, Community Matrons and Community Therapists may need to be involved according to an individual's clinical condition.

Please refer to local guidance available from Dietetics Departments:

• Torbay and South Devon Healthcare NHS Foundation Trust
• University Hospitals Plymouth NHS Trust

Pathway for using ONS in the management of malnutrition

• Please refer to: Pathway for using ONS in the management of malnutrition

This pathway will guide you in setting goals, deciding on dose and duration of ONS, how and when to monitor progress and when to discontinue prescription.

Once the initial decision to use ONS sip feeds has been made, monitoring and reassessment are vital.

ONS dose and duration

Most ONS provide approximately 300kcal, 12g of protein and a full range of vitamins and minerals per serving.

Clinical benefits of ONS are often seen with: 300-900kcal/day (e.g. 1-3 ONS servings per day) with benefits seen in the community typically with 2 - 3 month's supplementation, however supplementation periods maybe shorter, or longer (up to 1 year) according to clinical need.

Further information on Oral Nutritional Supplements

Managing malnutrition with ONS- advice for healthcare professionals

Please use the links above for information on:

• the range of ONS products
• commencing ONS
• discontinuing ONS

See Formulary choice oral nutritional supplements (sip feeds)

Patients should be given an initial prescription for a one-week supply. This will allow a trial of different flavours and wastage is then kept to a minimum. Sample packs of ONS may also be available.