Dietetic care pathway for oral nutrition support patients

NHSL Guidelines
NHS Lanarkshire

This is a framework based on professional consensus and does not negate or over-ride individual clinical judgement.

Initial Assessment

Initial Assessment with Dietitian:

Completes assessment 

Agrees aim of dietetic treatment (with patient where possible, and with relevant colleagues where appropriate)

Agrees initial targets and / or dietetic discharge parameters (with patient where possible, and with relevant colleagues where appropriate). It may be appropriate to have 'short' and 'long' term targets and parameters. 
Include timescales where possible

Agrees initial treatment plan, including Small, Measureable, Achievable, Realistic, Timescale (SMART) goals to help achieve aim of treatment and targets (with patient where possible, and with relevant colleagues where appropriate) 

Include timescales where possible

REVIEW consultation

If required:
  • INPATIENTS to be reviewed as clinically indicated
  • OUTPATIENTS reviewed 4-8 weekly for up to 6 months.
These can be by a Healthcare Support Worker (HCSW) if appropriate.

At each REVIEW consultation, clinician will:

Check progress against: aim of treatment, targets / discharge parameters, treatment plan and goals
Based on progress, reinforce current plan / revise plan 
Consider discharge if targets / discharge parameters met

Further REVIEW after 6 months

If patient requires further REVIEW after 6 months move onto maintenance pathway. Dietitian to complete full review of: 
Aim of treatment
Targets / discharge parameters
Treatment plan and goals
REVIEW consultations drop to 8 - 12 weekly 

Further REVIEW after 12 months

If patient remains on caseload 1 year after first NEW consultation, dietitian to complete full review of:
Aim of treatment
Targets / discharge parameters
Treatment plan and goals
If patient to remain on caseload:
REVIEW consultations drop to 6 monthly
If HCSW involved in patient reviews, patient must have at least one REVIEW consultation per year with a dietitian

Examples of treatment/targets/discharge parameters/SMART goals

Aim of dietetic treatment examples:
Improve nutritional status 
Improve nutritional intake 
Optimise nutritional treatment within physical, biochemical, medical / surgical parameters  
Promote weight gain
Reduce risk of malnutrition 
Maintain weight 
Maintain nutritional status  
Improve / maintain quality of life 
Minimise further weight loss 
Slow rate of weight loss 
Targets / discharge parameters examples: 
Reduce Malnutrition Universal Screening Tool (MUST) Score to 0
Reduce MUST Score to 1
increase Mid Upper Arm Circumference (MUAC) to 25 cm
BMI to remain stable for 3 months 
Improvement to British Association of Parenteral and Enteral Nutrition (BAPEN) subjective assessment measures
promote weight gain to 65 kg
promote weight gain to BMI 20
Examples of SMART goals for treatment plan: 
By review within 3 days, 2 additional snacks per day  
By review in 4 weeks time, 3 regular meals daily at 9am, 1pm and 5pm 
2 Ensure Compact per day, after lunch and dinner for 1 month
3 Ensure Compact per day for duration of hospital stay 
1 pint full fat, fortified milk per day until next review in 8 weeks 
Reduce Ensure Plus to 1 per day, after dinner, for 4 weeks 

References

Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition (2006) NICE clinical guideline CG32. Last updated 4 August 20217

NHS Scotland Guidelines for appropriate presribing of Oral Nutritional Supplements in adults. (2018) NHS Scotland. Updated December 2018

The Model and Process for Nutrition and Dietetic Practice (2021) The Association of UK Dietitians BDA. Review date 2024

Editorial Information

Last reviewed: 05/02/2026

Next review date: 05/02/2029

Author(s): Lynsey Robinson, Lead Dietitian - Community .

Version: 1

Author email(s): Lynsey.Robinson@lanarkshire.scot.nhs.uk.

Approved By: CGGEG

Reviewer name(s): Lynsey Robinson.

Document Id: February 2026