PrescQIPP

Nutritional Products Prescribing Dashboard, used strategically by Prescribing Support Dietitian to reduce the spend of inappropriate prescribing of oral nutritional supplements and specialist infant formula (2025)

Surrey Downs Place part of Surrey Heartlands ICB

Project summary

Since beginning this role, as a part time prescribing support dietitian, within the medicines optimisation team at Surrey Downs Place in 2019, a key part of my role is to reduce spend on Oral nutritional supplement (ONS) and specialist infant formula prescribing. Another aspect is also reducing or stopping enteral tube feed duplicate prescribing.

With initially over 30 GP surgeries to manage and potentially 3 hospital Trusts, the task for a part time dietitian was at first rather daunting.

My priority was to firstly identify, who initiated ONS prescribing and why. As well ascertaining the type and amount of ONS prescribed. I audited 3 GP surgeries, and my findings included –

  • 50% ONS prescribed initiated by GPs for patients that were resident in care homes
  • 15% ONS prescribed initiated by GPs for patients with low appetites being cared for by NOK
  • 5% ONS prescribed initiated by GPs because of a patient discharge summary
  • 5% ONS prescribed initiated by GPs for patients with mental health or addictions
  • 25% ONS on the recommendation of a specialist dietitian mostly oncology and gastroenterology

The results of my initial audit led to collaborative working with medicines optimisation pharmacists and technicians to develop a dashboard, an excel spreadsheet produced from a search ran in the prescribing systems (we use EMIS and SystemOne), it is run annually. The dashboard separates patients prescribed all nutritional products into 3 categories-

  1. Patients living in care homes
  2. Patients living in their own homes
  3. Paediatrics

The dashboard prepared annually by the pharmacy technicians, provides an instant snapshot of –

Type of nutritional product prescribed, whether it was a preferred ONS or preferred specialist infant formula milk product, gluten free products etc

  • When the prescription started
  • The amount being prescribed
  • Weight, BMI and MUST score
  • Repeat or acute prescribing
  • Patient’s usual GP

An additional monthly dashboard was recently created to capture newly initiated high cost ONS so that they can be reviewed in a more timely manner.

With the information, I have been able to work strategically, choosing which surgeries and patients to review. I then worked collaboratively with –

  1. Acute hospital dietitians and pharmacy to improve discharge summary wording to avoid wrongful ongoing ONS prescribing in the community. Adapt the dietitian letter to GP following patient discharge to include our preferred ONS products in the community
  2. Dietetic community providers to increase adult community dietitian provision in order that care home residents and community hospital patients are also seen by a dietitian
  3. Surrey Heartlands ICB dietitians to develop community ONS prescribing guidelines and produced a protocol for care homes to follow.
  4. Our adult community dietitians, to align their referral process, so that care home staff can refer directly to community dietitians. No need for GP to initiate ONS prescribing
  5. The community paediatric dietetic team provider, to increase their staff numbers, therefore improving wait times for patients. Amendments were also made to their patient / GP letters following a CMPA educational session, to include a plan and end date for specialist infant formula prescribing, thus avoiding parent expectation that formula will be continued indefinitely. Also amended patient discharge letters following 2nd DNA, to include a note to GP to stop ONS prescribed.
  6. GPs, their pharmacists and prescription clerks to educate and train them on our current guidelines, tasked them with actions to take following my review of patients prescribed nutritional products. Updated tube feed guidelines and provided GPs with a list of patients prescribed tube feeds