e.g. Patient is malnourished (problem) due to reduced access to food through financial and social situation (Aetiology) as evidenced by BMI of 16kg/m2, clinically significant weight loss of 16% in four months and inadequate nutritional intake reported by patient Further information for Diet Therapy Goal To help determine the outcome of the intervention. These may include direct nutrition outcomes (improved nutritional status) but may also include the following Clinical and health status outcomes (laboratory values, weight, risk factor profile changes, and symptoms) Patient/client-centred outcomes (quality of life, satisfaction, self-management, functional ability) Box 2a: Additional actions to be completed by named healthcare professional delete if – not applicable GP/Consultant/CNS/Other/AHP Actions E.g biochemistry monitoring / psych referral / vit D correction Box 3: Prescription Request - delete if not applicable *****NUTRITION PRESCRIPTION REQUEST***** Name and Flavour Volume Unit Quantity Total Volume No of Duration Prescription ‘Patient Manufacturer per serve /serve volume per serve required (weeks) Type information’ per day per for for 28days 28days prescription Altraplen Vanilla 200 ml 2 11200 800 14.0 4 Acute Mid Protein morning and mid afternoon Phlexy Vits N/A 1 5 140 180 0.8 12 Repeat 5 tablets (SHS) per day Aymes Banana 57 g 2 3192 399 8.0 4 Mix with Shake full fat (Aymes) milk Calogen Neutral 30 ml 3 2520 250 10.1 4 Acute Mix into (Nutricia) milky drinks Alfamino N/A 32.2 g 5 4508 400 11.3 12 Repeat 7 x 4.6g (Nestle) scoop with 210ml water per feed Please note information on volume’ and volume for 28 days’ and of packs required for ‘Unit ‘Total ‘number 28days’ has been included to ensure the correct volume of supplement is prescribed to the patient
e.g. Patient is malnourished (problem) due to reduced access to food through financial and social situation (Aetiology) as evidenced by BMI of 16kg/m2, clinically significant weight loss of 16% in four months and inadequate nutritional intake reported by patient Further information for Diet Therapy Goal To help determine the outcome of the intervention. These may include direct nutrition outcomes (improved nutritional status) but may also include the following Clinical and health status outcomes (laboratory values, weight, risk factor profile changes, and symptoms) Patient/client-centred outcomes (quality of life, satisfaction, self-management, functional ability) Box 2a: Additional actions to be completed by named healthcare professional – delete if not applicable GP/Consultant/CNS/Other/AHP Actions E.g biochemistry monitoring / psych referral / vit D correction Box 3: Prescription Request - delete if not applicable *****NUTRITION PRESCRIPTION REQUEST***** Name and Manufacturer Flavour Volume per serve Unit Quantity /serve per day Total volume per 28days Volume per serve No of required for 28days Duration (weeks) Prescription Type ‘Patient information’ for prescription Altraplen Protein Vanilla 200 ml 2 11200 800 14.0 4 Acute Mid morning and mid afternoon Phlexy Vits (SHS) N/A 1 5 140 180 0.8 12 Repeat 5 tablets per day Aymes Shake (Aymes) Banana 57 g 2 3192 399 8.0 4 Mix with full fat milk Calogen (Nutricia) Neutral 30 ml 3 2520 250 10.1 4 Acute Mix into milky drinks Alfamino (Nestle) N/A 32.2 g 5 4508 400 11.3 12 Repeat 7 x 4.6g scoop with 210ml water per feed Please note information on ‘Unit volume’ and ‘Total volume for 28 days’ and ‘number of packs required for 28days’ has been included to ensure the correct volume of supplement is prescribed to the patient
discharge.docx