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  • Nutrition

An innovative solution to patient care will mean a more responsive approach to those who need it

With an increasing caseload of patients needing long term oral nutritional support, reduced capacity and the subsequent delay in seeing new referrals, the dietetic team at Leeds Community Healthcare NHS Trust knew that something had to change. They quickly realised that a significant proportion of their long-term patients were stable and being repeatedly reviewed with no changes needed to their care plan. Consequently, the team began to consider a new way of patient management – and after three years of development and improvements – the ‘ONS Passport’ has now been successfully integrated into everyday practice.

The ‘ONS Passport’ was designed to allow patients, who have been nutritionally stable on their oral nutritional supplement for at least 6 months, to self-manage – thereby eliminating the need for regular dietetic reviews. Passport holders range from 25 to 99 years old, the average being 76 years, with a variety of diagnoses including dementia, respiratory, cancer and Type 2 diabetes. Patients must meet stringent criteria before being given a passport, which contains details of their oral nutritional support regimen and outlines ways to help them, and their carers, recognise changes in their nutritional status and what to do if this occurs.

In a recent review of the project, supported by Abbott, the team found that since the passport was rolled out, there has been a positive knock-on effect on waiting times for all patient groups, due to freed-up capacity. Staff feel their workload is more manageable and are more confident in discharging appropriate patients onto the passport. Many are finding that they are now introducing the idea early to patients, sometimes months before transitioning them onto the passport – a concept that is proving to be very beneficial as its promotes constructive conversations which can address areas of concern and provide reassurance to the patient.

Commenting on the project, the dietetics team at Leeds Community Healthcare NHS Trust said “We are delighted to have seen the Passport be so successful. Projects that enable teams to provide more timely support when a patient needs it, while increasing efficiency, are few and far between. Constant improvement and striving for excellence are at the heart of everything we do at Leeds Community Healthcare, and we are so proud to have managed this in the Dietetics Team.”

But it’s not just the Leeds community team who have seen improvements since the implementation - many patients also gave positive feedback, with their focus being improved convenience at not having to wait for appointments, as well as its straightforward nature and role in support stability.

In an environment of increasing demand and reduced capacity, it is vital that patient management evolves to suit everchanging needs. Self-management tools like the ‘ONS Passport’ allows patients, and their carers, to take ownership of their nutritional care, whilst also having a positive impact on wider patient groups and over-stretched waiting times – meaning that vulnerable patients receive the responsive care and attention they need.

Further information can be found in the June 2018 edition of Dietetics Today or by clicking here (BDA membership login required). If you have any questions on the ‘ONS Passport’ implementation, please email the dietetics teams at


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