(P23-023-23) Implementing the Nutrition As Medication Program in Long-Term Care: First Lessons Learned

Objectives: Oral nutritional supplements (ONS) are often used in long-term care facilities (LTC) to prevent weight loss and malnutrition, but consumption levels can be low. Providing small ONS doses with medication rounds was shown to improve consumption. Using this approach, we co-designed the Nutrition as Medication Program (NAM) for LTC settings which includes a tool kit providing: 1) clinical guidelines for health professionals, detailing the who, when and how to prescribe ONS doses and ensure proper follow-up of the intervention; and 2) an implementation guide to mobilize key actors, implement the program, and ensure its sustainability. The present study aims to evaluate the implementation process of the NAM Program in LTC settings using our tool kit.

Methods: This multimethod study is ongoing in 3 LTC settings in Montreal (Canada), which include 325 residents requiring >3h of care per day. Funded by the Canadian Institutes of Health Research (CIHR), the quantitative component of this study assesses usage of the NAM Program, adherence to treatment and reasons for non-consumption of the ONS doses. To this end, all medical records, including medication administration records, of those receiving the NAM Program are reviewed monthly for six months once the program started. The qualitative part will determine barriers and facilitators to the implementation process using semi-structured interviews to be conducted in March-April 2023.

Results: To date, 19% of residents had a NAM prescription, while 34% of them presented clinical indications for the program, mostly significant weight loss, increased metabolism and low body weight. Nonetheless, 91% of ONS doses offered to residents during medication rounds were consumed as prescribed, which is similar to the 90-95% adherence rates observed in previous studies. Reasons for non-consumption were either unspecified (64%) –although requested in guidelines for proper follow-up of the intervention–, refusal (15%), hospitalisation (15%), or others (6%).

Conclusions: The NAM program led to high level of ONS consumption. However, discrepancies with clinical guidelines suggest that the program is underused and misapplied. The qualitative component of this study will help to understand the reasons underlying these results.

Funding Sources: Financial support was provided by the CIHR, Excellence Canada and University of Sherbrooke.