This document provides prescribing tips for Home Enteral Feeds. Home Enteral Feeding (HEF) describes being fed into the gastrointestinal tract via a tube in a domiciliary environment following hospital discharge; it may be used in patients who are unable to meet their nutritional requirements orally.
Products used for HEF can include specifically designed tube feeds, or Oral Nutritional Supplements (ONS) which are fed via a tube instead of taken orally.
HEF products need to be prescribed in a different way to other nutrition products and medications; therefore this document aims to provide GP Practices with practical tips to ensure patients receive their feed in a timely manner and to reduce the risk of duplicate dispensing.
HEF Prescriptions in SWL
In SWL the Enteral Feeding contract is held by Nutricia®. All prescriptions for HEF products (for adults and children) must be sent to the Nutricia® Homeward Pharmacy and not the patient’s local community pharmacy (unless agreed otherwise with the patient or carer). Nutricia® Homeward will then deliver products directly to the patient.
For Practices using EMIS, this can be done using the Electronic Prescription Service (EPS) using ‘one off’ nominations. Practices using Vision do not have this function and will need to continue to print and post prescriptions.
Nutricia® will no longer deliver feed without a prescription. For many patients the feed is their sole source of nutrition; therefore it is vital that prescriptions are managed in the correct way.
‘One off’ nominations
‘One off’ nominations can be used to send a single prescription to a different pharmacy without changing the primary nomination. To enable a ‘one off’ nomination, prescribers should:
- Right click on the medication they want to issue and choose ‘issue’.
- The issue box will open. At this stage, the prescriber should select EPS ‘nomination’ at the top right hand corner.
- ‘Mange EPS Nomination’ box will open.
- Click on ‘Find’ in top box which states ‘would you like to choose one off pharmacy nomination?’.
- One off nomination pharmacy search box opens:
- In post code type ZE1 0AA and click on search.
- From the three companies that show up, choose Homeward Pharmacy and click ‘ok’.
- Ok’ everything and then clinician can authorise (or prescription clerk can forward and send to clinician for signature).
These instructions will need to be followed every time a HEF prescription is issued.
Printing and posting prescriptions
Sending prescriptions via EPS using ‘one off’ nominations is the preferred method. However for Practices who cannot use this method, there is the option to print and post prescriptions. To send a paper FP10, send to Nutricia® via FREEPOST PLUS RSTX-URZX-BHSR (Nutricia Homeward, Newmarket Avenue, White Horse Business Park, Trowbridge, Wiltshire, BA14 0XQ). Or email [email protected] to ask for a supply of pre-printed Freepost envelopes.
Ensure prescriptions are posted with sufficient time before the patient’s delivery is due, to avoid delays in patients’ deliveries.
Additional prescribing considerations
- Update SNOMED coding to indicate patient is receiving enteral nutrition: SNOMED CT Code 229912004 Enteral Feeding.
- Consider keeping HEF products on acute or variable use repeat lists.
- Add Pharmacy Info message e.g. ‘send prescription to Homeward Pharmacy ZE1 0AA using one off nomination’.
- Add major alert to pop up when anyone goes to issue a prescription. This reminds prescribers to amend the EPS nomination to ensure the prescription is sent to Homeward Pharmacy (ZE1 0AA).
- Add or amend screen message to remind all practice staff to send enteral feed prescriptions to Nutricia® Homeward Pharmacy via EPS. Message example: ‘Send Nutrison® and Fortisip® Prescriptions to Homeward Pharmacy (ZE1 0AA) via ‘one off’ pharmacy nomination’.
- There may be a small number of patients, parents or carers who choose to have all or part of their prescription sent to their local pharmacy instead of Nutricia®. In these cases this choice should be reflected in major alerts, screen messages and Pharmacy Info messages.
- If the patient requires an urgent supply of feed, the prescription may also need to be sent to the local pharmacy. Future non-urgent prescriptions should then revert back to being sent to Nutricia®.
- Monitor prescription requests received from Nutricia®:
- Before issuing a prescription (or raising a prescription request issue) check the latest issue date.
- Nutricia® should request a prescription every 28 days, in advance of the expected delivery date.
- Check with the patient or carer that the prescription is required, if a supply seems too soon.
- The quantity requested to be prescribed may be altered based on stock checks (which Nutricia® should complete with the patient or carer during each 28 day cycle).
- Ensure Practice has a process in place to ensure all GP’s, pharmacists, reception staff and prescription clerks know how to activate and issue ‘one off’ prescriptions for Nutricia®.
Local HEF Dietitians
Enterally fed patients will be under the ongoing care of a Dietitian who will communicate the product names and quantities required to be prescribed to the GP Practice.
GP Practices should:
- Ensure HEF prescriptions (products and quantities) are in line with Dietitian’s recommendations. Check latest correspondence for details.
- HEF prescriptions should be reviewed at least annually. If there is no Dietitian review letter in the past 12 months, contact the patient’s Dietetic service to request an update.
For any queries regarding the patient’s prescription or feeding regime please contact the managing Dietitian. Check latest correspondence for contact details (the managing dietitian may be part of the local HEF team, or a tertiary centre).
Troubleshooting
If patient has not received their delivery, or Nutricia® report they have not received the prescription:
- Check date of last prescription issue. If recent, check which pharmacy the prescription has been sent to. If required, use EPS tracker or contact the community pharmacy, Nutricia® Homeward, patient or carer as needed, to check if the patient actually requires or has received the enteral feed.
If HEF prescriptions are sent to the patient’s local community pharmacy in error:
- Check if patient has received the prescription.
- If yes, do not re-issue another prescription. Inform Nutricia® and review internal processes to ensure future prescriptions are sent to Nutricia® Homeward Pharmacy.
- If not, ask local pharmacy to return prescription to GP Practice for cancellation. Then issue a new prescription to Nutricia® Homeward Pharmacy.
Please contact your local Prescribing Support Dietitian or Medicines Optimisation Team for additional support if required.
The Nutricia® prescriptions team can also be contacted directly on 0800 0933672 – option 5 (8:30 am to 5:15 pm Monday to Thursday and 8:30 am to 4 pm Friday) or via secure email: [email protected]
Document History
Version: V1.0
Approval Date: October 2024