Sip Feeds and Guidelines

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Sip Feeds and Guidelines

• Jon Durand
• Medicines Management
• NHS Hampshire

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What are we trying to achieve?

• Weight gain
• Patient survival
• Better health/healing
• Better nutrition?
• Good patient experience?

3
What type of patient might be using sip feeds?

• Elderly
• Undernourished
• Terminally ill
• Drug addicts
• Care home patients
• Anybody

4
What are the pressures on clinicians to prescribe
sip feeds?

• Patient requests
• Patients relative requests
• Care home requests
• Poor catering facilities
• Caring GP/Nurse requests/prescribers
• Guidelines

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How appropriately are sip feeds used?

• Scenario elderly patient in care home is given
  a sip feed for lunch. What happens next?
• Patient drinks whole carton happily
• Patient is left alone/forgotten about
• Cannot use straw
• Doesnt like sip feed texture/taste
• Sip feed gets taken away before patient can
  finish it
• Patient cannot communicate their needs

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What do we need to do?

• Regular reviews of all patients
• Monitor patients
• Prescribe appropriately
• Use appropriately
• Follow guidelines see next slides

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Who are sip feeds for?

• Patients with a MUST score 2 or BMI 18.5.
• N.B. Patients with a BMI gt 18.5 can still be
  malnourished.
• This could include patients with dysphagia or
  malabsorption.
• Patients who do not meet the criteria, but may be
  at risk might need sip feeds or some nutritional
  support from OTC products such as Complan and
  Build-Up.
• (MUST Tool available at www.bapen.org.uk).

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What do I give?

• Treatment should be two bottles a day in
  addition to usual food intake for 30 days, or
  less if you wish to review earlier.
• Certain patients who rely on sip feeds as their
  sole source of nutrition will need advice from a
  dietitian and more than two bottles a day.
• To aid patient choice, endorse mixed flavours.
  Some manufacturers offer starter packs to assist
  with taste choice.
• Prescribe acutely, do not put on repeat.
• Review before prescribing again. Consider giving
  food fortification advice and appropriate
  diet/recipe sheets.

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What are my options at review?

• Check weight and compliance.
• Continue for another month unchanged if
  necessary.
• Adjust quantity to suit patient requirements.
• Give dietary advice and or leaflets if available.
• Consider changing to OTC foods as a meal replacer
  such as Build-Up and Complan (non-prescribable,
  but available OTC).
• Refer to a Registered Dietitian if you feel it is
  necessary.
• Reassure patients that they have permission to
  eat foods that they might perceive to be
  unhealthy. E.g. full fat dairy foods.
• If no longer required, stop prescribing. (Target
  weight achieved, improved MUST score)

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How do I stop prescribing?

• Re-screen and reassess.
• If patient no longer malnourished and no longer
  at risk, sip feeds should not be required.
• In order to maintain improved nutritional status,
  consider possible options as above plus care
  plans and motivational assistance from a
  Registered Dietitian.

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Guidelines for Review of Patients on Long Term
Sip Feeds

• A Review should include the following
• A re-assessment of patients current weight and
  comparison to expected weight. An assessment of
  nutritional requirements
• An assessment of current intake alongside
  patients social and physical circumstances.
• An estimate of which nutrients may be in short
  supply.
• An individualised action plan.
• A mechanism to ensure that the patient is
  reweighed at monthly intervals.

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Who do I ask for advice?

• Registered Dietitians (RDs) are the only
  qualified health professionals that assess,
  diagnose and treat diet and nutritional problems
  at an individual and wider public health level.
• Dietary resources and advice leaflets are
  available from Dietetic Departments and/or
  Registered Dietitians.
• Community Nurses who have received full MUST
  training are also able to undertake such an
  assessment and understand when to refer on to a
  dietitian.

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Commonly Prescribed Sip Feeds and Alternatives Commonly Prescribed Sip Feeds and Alternatives Commonly Prescribed Sip Feeds and Alternatives Commonly Prescribed Sip Feeds and Alternatives Commonly Prescribed Sip Feeds and Alternatives  
Manufacturer Milk Shake Style Fruit Juice Style Pudding Style Powdered Products Powdered Products
Fresenius Kabi Fresubin Energy (300kcal in 200ml) Fresubin 2Kcal (400kcal in 200ml) Fresubin Energy Fibre (300kcal in 200ml) Fresubin 2Kcal Fibre (400kcal in 200ml) Provide Xtra (300kcal in 200ml) Fresubin Crème (225 kcal in 125g)
Nutricia Fortisip Bottle (300 kcal in 200ml) Fortisip Compact (300 kcal in 125ml) Fortisip Multifibre (300 kcal in 200ml) Fortijuice (300 kcal in 200ml) Forticreme Complete (200 kcal in 125g)
Abbot Ensure Plus (305 kcal in 220ml) Ensure Plus Fibre (305 kcal in 220ml) Ensure Plus Juice (305 kcal in 220ml)  
Nestlé Resource Energy (300kcal in 200ml) Resource Energy 2.0 Fibre (400kcal in 200ml) Resource Fruit (254kcal in 200ml) Resource Dessert Energy (200kcal in 125g) Build - up (263kcal per sachet with 200ml of FULL FAT milk) NB OTC only. Build - up (263kcal per sachet with 200ml of FULL FAT milk) NB OTC only.
Complan Complan Shakes, various flavours (251 kcal in water, 387kcal with 200ml milk)     Complan (382kcal per sachet with 200ml of FULL FAT milk) NB OTC only. Complan (382kcal per sachet with 200ml of FULL FAT milk) NB OTC only.
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Remember

• Prescribe Acutely
• Reassess and or Refer Before Repeating
• Review Frequently

Thank you!