89CAN AN ICE CREAM BASED ORAL NUTRITIONAL SUPPLEMENT HELP ADDRESS THE ISSUE OF MALNUTRITION IN ORTHOGERIATRIC PATIENTS?

Abstract

Introduction: Older people in hospital are at risk of malnutrition. We embarked on a quality improvement project using an oral nutritional supplement (ONS) modified into an ice cream to address this issue in older people admitted to hospital with fragility fractures. Using a Plan-Do-Study-Act framework, we described the first cycle of our project. Methods: An initial nutritional survey was conducted among older patients admitted to orthopaedic wards. The average daily intake was 732 kcal. ONS was not well-tolerated and ice cream was one of the most preferred meal options. In collaboration with the Department of Orthopaedics, Dietetics and Catering, a Scandishake nutritional supplement-based vanilla flavoured ice cream was developed and piloted across a 28- bedded ward over 3 days. All patients during a 'build-up round' at mid-afternoon were offered 100 g portions (240 kcal and 3.6 g protein per-portion), except those who were 'nil-by-mouth' or had diabetes mellitus. Acceptability and calorific intake were assessed. Results: Over 3 days, the ONS-ice cream was accepted 77% of the times offered. 27 patients accepted it (85% female; median age, 75years, IQR 12.5; mean BMI, 24.3, SEM 1.2; 16 had neck of femur fractures). When taken, the portions were completed 70% of the time; and less than 10% took less than a quarter. Among the 27 patients, the average calorific intake including and excluding the ONS-ice cream was 959 kcal and 849 kcal respectively. This accounted for an average increase of 110 kcal or 11% of a patient's average intake per day. When surveyed, patients described the ONS-ice cream as better tasting than the hospital issued ice cream and the standard ONS; and 84% would have it again. Future Plan: An ONS-ice cream intervention to improve calorific intake in older people is feasible. Discussions are ongoing regarding cost-efficient options to increase production and up-scale the project.