Advanced Care

INPAC & the INPAC Toolkit

Many hospitals already have available processes for promoting energy and protein dense food intake (e.g. prescribed diets, nourishments) to treat malnutrition. Medication pass (medpass) of supplements is not as commonly used, but can be a vital mechanism for improving intake while limiting waste of these products. It is important to note that systems or processes to implement medpass may need to be worked out with each unit.

Tips to implement medpass in your hospital (expand +/-)

  • Learn from other units/hospitals in your region if they have already implemented medpass.
  • Work with the RD on the unit and the nurse manager/practitioners/educators to plan how to roll it out on the unit.
  • Don't forget about the budget. Consider prioritizing supplement delivery options (i.e., make medpass the first choice if patient requires a supplement; then provide supplements with meals etc.).
  • Create criteria for indications/contraindications and guidelines for ordering /discontinuing, operational processes for delivery of supplement to unit, storage, shelf-life of opened product etc. 
  • Determine the process for discontinuing medpass promptly when it is determined to no longer be safe due to viscosity intolerance (i.e. patient requires thickened fluids) or patient refusal.
  • Put medpass on the Medicine Administration Record (MAR). This can take time. Work with existing processes and as part of a team that includes pharmacy, food services, and other unit/hospital members to achieve this goal.
  • A paper or pseudo MAR may be suitable if you are unable to get medpass on the actual MAR.
  • Work with those who usually supply the product to set up a process for procuring it, as well the equipment that will support use (cups, lids, fridges etc.). Contact your supplier to see if they can provide any of the required supplies or training.
  • Provide training about what is medpass, why is it important, and allow staff to sample the product. Training may need to be tailored to the specific needs of a unit.
  • Continue to provide training, as the process becomes part of the team. Use creative reminders.
  • Track and monitor compliance and intake of the product; report this back to the staff.
  • Track wastage (from expired/opened product); report this back to the staff. Identify any challenges they experience with delivery of the product to patients and work around through these problems.
  • Database systems (e.g. CBORD) to track/print reports of patients receiving medpass is helpful to dietitians to ensure timely follow-up and for Food Services for establishing and modifying product requisitions.


Clinical guidelines for using MedPass
This documented was created by the Winnipeg Regional Health Authority

Information sheet for staff about MedPass



MedPass on a pseudo-Medication Administration Record (MAR)
Example of how a pseudo-MAR used by a More-2-Eat site.

Why should hospitalized patients’ diets be liberalized?
Learn about the problem, why and how we should change practice…

Acknowledgment: The ideas and resources included on this page are provided in part by the hospitals involved in the More-2-Eat project.

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