Development of a clinical guideline to allow dietitians to prescribe oral nutritional supplements on National Inpatient Medication Charts (NIMCs) at the North West Regional Hospital and the Mersey Community Hospital

Mrs Sarah O’Keefe1, Ms Kate Stanfield1

1THS – North West, Burnie, Australia

Senior staff from the THS-North West Dietetics and Pharmacy Departments have worked together to develop a clinical guideline allowing Dietitians to prescribe oral nutritional supplements by writing on the National Inpatient Medication Charts (NIMCs). This is a first for Tasmania. The development of the guideline has involved an in-depth investigation of all pros and cons, and the development of a risk management plan which was submitted to the Medication Management Committee for consideration.

The provision of adequate nutrition to inpatients is an integral part of treatment and care, and is associated with improved health outcomes. Clients who are malnourished on admission to hospital or who become malnourished while in hospital have poorer health outcomes and increased lengths of stay. If these patients are not managed appropriately, it can lead to a wide range of adverse outcomes for the patient and the health care system.

The use of the NIMC by Dietitians for prescribing oral nutritional supplements ensures that patients who are malnourished or at risk of malnutrition receive the appropriate types and amounts of supplements at the correct times that they have been prescribed.

The Australian Commission on Safety and Quality in Health Care ‘NIMC User Guide’ (Feb 2016) states that the NIMC is a “standardised tool for communicating patient medication information consistently between health professionals … it reflects best practice and is evidence-based”. The aim of having standardised NIMCs is to assist health professionals improve the safety and quality of medication management.

Although the NIMC was not specifically designed for ordering and recording the administration of oral nutritional supplements, the NIMC User Guide states that health services may choose to use it for this purpose if they undertake a risk assessment and develop a written local protocol to support the process.


Sarah O’Keefe is an Accredited Practising Dietitian, and over the last 20 years has held a variety of different dietetic positions in Tasmania, New South Wales and England. In 1998 she began her career as a new grad at the North West Regional Hospital, and after not being able to find anywhere else in the world quite as amazing as Tasmania she moved back in 2009 after being appointed as the Manager of the THS-North West dietetics department. At this point in her career she is very committed to quality improvement and the growth and development of upcoming Dietitians.

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