MEDPass versus conventional administration of Oral Nutritional Supplements: a randomized controlled trial comparing coverage of energy and protein requirements

Introduction  Oral nutritional supplements (ONS) are used to reach protein and energy goals in patients at risk of malnutrition [1]. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass) [2]. We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional administration.
Material and Methods  The MEDPass Trial is a randomized, controlled, open-label trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group received 50ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight (BW) appetite, nausea and 30-day mortality.
Results  From November 2018 until November 2021, 204 patients were included in the trial (MEDPass group n=100, control group n=104). 203 patients were analyzed in the intention-to-treat analysis. There was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p=0.38). Similarly, no differences were found for the coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p=0.57, average daily intake of ONS (170 vs 173 ml (Δ – 3 ml, 95% CI -14 to 8 ml), p=0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p=0.15). The course of HGS, BW, appetite and nausea did not differ between the groups (p=0.29, p=0.14, p=0.65 and p=0.94, respectively). The per protocol analysis showed similar results.
Conclusion  We found high compliance for ONS intake and high coverage of protein requirements but no further improvement regarding any of the endpoints was found when ONS was administered using MEDPass compared to conventional care. However, MEDPass administration may provide an alternative that is easy to integrate into nursing routines which may lead to lower workload with cost benefits and reduction of food waste.