Referral Details

Referral Criteria for referring a care home resident needing nutritional support In North Kirklees. Referral to Dietetic Services Mid Yorkshire Teaching NHS Trust.

The individual must reside in a care home within North Kirklees.
The individual is HIGH RISK of undernutrition (MUST score of 2 and above) AND continues to lose weight despite the care home implementing the “HIGH RISK” FOOD FIRST ACTION PLAN for at least 4 weeks, this is in the Nutritional Resource pack from the Locala Care Home Support Team, which includes:
- A fortified diet – ALL the resident’s meals and puddings are fortified
- At least two nourishing snacks each day
- At least two homemade supplements each day
- or the individual has a pressure ulcer category 3 or above
- (THIS NEEDS TO BE SHOWN ON THE FOOD RECORD CHARTS THAT YOU UPLOAD OTHERWISE THE REFERRAL WILL BE REJECTED)

We will not accept a referral if:

The individual is low or moderate risk of undernutrition (MUST score of 0 or 1). If a MUST score of 1 - implement the ‘Medium Risk’ Food First action plan, keep a food and fluid intake chart and repeat MUST screening monthly.
The individual is high risk of undernutrition (MUST score of 2), has had previous dietitian input, BUT their weight is stable or increasing on the ‘high risk’ food first action plan - continue to implement the ‘High Risk’ Food First Action plan, keep a food and fluid intake chart and repeat MUST screening monthly.
The resident is actively dying e.g., a general deterioration, an ongoing pattern of little interest in eating and drinking with no reversible cause and is asleep more than awake. The resident may have anticipatory medication prescribed. Please discuss with the GP at the weekly Home Round their ongoing plan of care. Please refer to the Eating and Drinking at End of Life

Please consider if the resident has recently commenced diuretics and if the weight loss is due to a reduction of fluid retention before proceeding with this referral.

If the resident is under the Care Home Liaison Team (CHLT) for acute mental health needs, then please ask the CHLT to refer to their team dietitian for nutrition support.

If there are any residents’ you are unsure about and would like to discuss a referral with the dietitian, please ring Mid Yorkshire Dietitians on 01924 816046.

You will be asked to attach the following documents when making the referral:

A detailed 3-day food and fluid chart with meals, snacks and drinks recorded - please ensure this includes they are being offered 2 fortified drinks per day and 2 nourishing snacks per day, even if declined it still needs to show it has been offered.
The resident’s nutrition support plan (with start date documented) which outlines what food first actions have been put in place. This is to evidence the care plan has been in place for 4 weeks prior to submitting the referral.

Please be aware the community nutrition support dietitians are offering their service via telephone and remote digital consultations.

Patient Details

Patient title *

Patient name *

Patient preferred name

NHS number *

Date of birth *

Gender *

Address *

Patients contact telephone number *

Patients contact email *

Ethnicity *

Are there any relevant safeguarding concerns or issues? *

Yes

Are there any risks associated with visiting or providing support for this person? *

Yes

GP surgery and address *

GP Telephone number

What is the patients main spoken language? *

Is an interpreter needed? *

Yes

Are there any communication needs for this patient or their parent/carer? For example, related to learning disabilities or autism or due to impaired sight/hearing or any other reason/s?

What might be helpful when communicating with this patient or their parent/carer?

Is the patient a Care Home Resident *

Yes

Referrer details

Referrer name *

Telephone number *

E-mail address *

Referrers relationship to patient (e.g. care home staff) *

Referred from (including hospital ward and ward contact details) *

Care Homes Community Nutritional Support – North Only