Resources for Pharmacy Technicians
Malnutrition Pathway Primary Care Network Portal
PCN RESOURCES HOME PAGE RESOURCES A-Z RETURN TO MAIN SITEPharmacy Technicians are responsible for supporting Clinical Pharmacists/PCN Pharmacists to implement effective medicine management, assist with medicine reviews, medicine reconciliation and medicine synchronisation, discharge management and managing the issuing of prescriptions.
Pharmacy Technicians can monitor patients and identify:
- Those at potential risk of malnutrition, offer them first line advice and then refer them on to the Practice Pharmacist / Clinical Pharmacist for further support and Oral Nutritional Supplements, ONS, if indicated
- Those who have been on an ONS for a long time and may need a review of their dietetic goal and to document if ONS is to continue, to change or to stop.
Actions for consideration include:
Request and document biometrics (weight and height) to provide background information. Build into conversations questions about:
- New medicines or treatments
- Is a Structured Medicine Review needed with the Practice Pharmacist/Clinical Pharmacist to see if side effects are causing the problem?
- Changes in appetite
- Unexplained weight loss
- Swallowing issues (dysphagia)
- Any fatigue
Document any clinical concern use a validated screening tool (e.g., BAPEN Malnutrition Universal Screening Tool ‘MUST’). A management pathway for Managing Malnutrition According to Risk Category using ‘MUST’ can be found HERE
Consider the potential underlying causes of malnutrition:
- Some treatments and medications can have side effects which can impact on nutritional status, eating and drinking and should be identified and flagged to the Practice Pharmacist/PCN Pharmacist for a Structured Medicine Review
- The Malnutrition Pathway has produced a useful list of questions and resources to help to obtain information to assist in selecting the most appropriate course of action and dietary advice for the patient: GO TO RESOURCE
- Dietary advice leaflets are available to provide further ideas on managing the diet-related problems/symptoms HERE Local guidance and advice sheets may also be available.
Patients at risk of malnutrition should be given advice on optimising food intake, encouraged to increase the frequency of eating and drinking nourishing drinks and advised on food. It is important that patients understand the importance of adopting such dietary advice particularly if they have historically followed healthy eating plans. Some discussion regarding following a more calorific diet may need to be had: the leaflet YOUR GUIDE TO MAKING THE MOST OF YOUR FOOD includes advice on food fortification and can support conversations and provides simple ideas on how patients can get the most nutrition from the food
Those who cannot achieve an adequate nutritional intake through these first line ideas should be referred to the GP/Practice Pharmacist/Dietitian for further assessment which may include consideration for an ONS ON PRESCRIPTION
- Monitor progress against the agreed goals identified on any prescription with a conversation at each issue of the ONS:
- modify intervention and adjust care according to patient/family/carer feedback
- consider weight, strength, physical appearance, mood, appetite, ability to perform activities of daily living and compare with the goal originally set/discussed
- Continue to monitor and make regular assessment of progress to check patient remains stable especially those in whom a medical condition can have a marked and sudden effect on intake (consider relapsing conditions e.g., Chronic Obstructive Pulmonary Disease, (COPD), Irritable Bowel Disease, (IBD))
- Discontinue ONS when adequate oral intake is established, goals / targets have been met, factors that were contributing to malnutrition have been addressed and the patient is considered stable
- Carry out audits in practice to ensure patients are reviewed and prescriptions for ONS remain appropriate including checking compliance to ONS prescription ensuring that volume, format, type and flavour are appropriate for the patients’ needs.
