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 Formulary Chapter 19: Oral Nutritional Supplements in Adults - Full Chapter
19  Expand sub section  Oral Nutritional Supplements
 note 

Steps for prescribing nutritional Supplements.

Use ‘MUST’ (Malnutrition Universal Screening Tool) toolkit to identify nutritional risks.Assess underlying cause of malnutrition and consider availability of adequate diet.
Set realistic goals for target weight gain.

Promote 'FOOD FIRST'  high calorie high protein dietary advice -  Use dietary advice sheets

Patient Advice Sheet – Food First

Patient Advice Sheet - Snack Suggestions 100 calorie boosters

 

and promote over the counter products such as Complan sachets, Build-up, Nourishment, Nutriment. 

Prescribing of Oral Nutritional Supplements should only be undertaken if the above steps have failed and should be limited to the formulary choices given below unless advised otherwise by a dietitian.

(Oral Nutritional Supplements (ONS) should only be prescribed to patients who meet the Advisory Committee for Borderline Substances (ACBS) prescribing criteria )


Please note: 'Complan' is an over the counter supplement that is not available on prescription. 'Complan Shake' can be prescribed but is no longer on the formulary. See First choice Milkshake Powder Products

19.01  Expand sub section  Milkshake Powder Products
 note 

Advisory Note - These products should not be prescribed for Home Enterally Fed (HEF) patients

 

Foodlink Complete
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; natural, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 385 Kcals
  • 18g Protein
 
Aymes Shake
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; neutral, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 388 Kcals
  • 19g Protein
 
Ensure Shake
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 7x57g sachets of one flavour.
  • No Starter pack available.

Flavours available; strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 389 Kcals
  • 17g Protein
 
EnergieShake Powder
View adult BNF View SPC online View childrens BNF  Track Changes
First Choice
Green
  • 57g powder sachet to be mixed with 200mls whole milk.
  • 4x57g sachets of one flavour.
  • Starter Pack 5x57g sachets of one flavour each.

Flavours available; neutral, vanilla, chocolate, strawberry or banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 381 Kcals
  • 15.8g Protein
 
Foodlink Complete with Fibre
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Second Choice
Green

*This is the recommended First Line product for care home residents that are unlikely to manage more than one supplement a day.

For all patients this can be prescribed OD for those unlikely to consume more than one supplement. It has a higher calorie and fibre content than the other first line products.

  • 63g powder sachet to be mixed with 220mls whole milk.
  • 7x63g
  • Starter Pack 5x63g sachets of one flavour each.

Flavours available; natural, strawberry, vanilla, chocolate and banana.

  • Gluten Free

Nutritional Profile (including added milk)

  • 421 Kcals
  • 19.7g Protein
  • 4.7g Fibre
 
   
19.02  Expand sub section  Standard Volume Ready to Drink Products
 note 

Advisory Note – Ready Made ONS should only be prescribed if the patient is unable to make up the powder ONS (and does not have family / carers who could to do so)

19.03  Expand sub section  Juice Style Products
19.04  Expand sub section  Compact (Small Volume) Ready to Drink Products - Second Line to top
19.05  Expand sub section  Specialist Recommendation Only - Milkshake Powder Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See first choice milkshake powder products

Advisory Note – These products should not be prescribed for Home Enterally Fed (HEF) patients.

19.06  Expand sub section  Specialist Recommendation Only - Standard Volume Ready to Drink Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for standard volume ready to drink

19.07  Expand sub section  Specialist Recommendation Only - Compact (Small Volume) Ready to Drink Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Compact (Small volume) Ready to drink

19.08  Expand sub section  Specialist Recommendation Only - Juice Style Products
 note 

To be prescribed on recommendation of an appropriate specialist such as Dietitian or SLT, providing there is a suitable rationale that meets ACBS criteria and recommended treatment plan including review or follow up plan.

See preferred green formulary choices for Juice Style Products

19.09  Expand sub section  Specialist Recommendation Only - Dessert Style/Pre-Thickened Products to top
 note 

NB these products are relatively low in calories and protein compared to liquid ONS, they should therefore only be used when a patient requires a thickened product and it is not possible to use thickeners on a liquid supplement.

19.10  Expand sub section  Specialist Recommendation Only - Modular Supplements
 note 

Provide one or more macronutrient. Requires a Dietitians assessment. Patients must be under active management by a Dietitian.

19.11  Expand sub section  Thickeners for dysphagia
 note 

Ensure the recommendation to prescribe a thickener has come from an appropriately trained healthcare professional, e.g. a Speech and Language Therapist (SALT) after a diagnosis of dysphagia has been made.

NB. The descriptors for the levels of thickness are changing: previously 'stage' and now 'level'

The consistency of fluid needed is described by new International Dysphagia Diet Standardisation Initiative (IDDSI) descriptors in increasing order of thickness: Level 1 (slightly thick) Level 2 (mildly thick) Level 3 (moderately thick) or Level 4 (extremely thick).

Please see Dysphagia guidance

Advise patients and carers to REFER TO THE INDIVIDUAL PRODUCT TIN for the manufacturer’s instructions to make up each consistency, using the correct number of scoops per volume of fluid, and the correct scoop for the product.

Clear gum-based thickeners are now the preferred choice (over starch-based) as they are the most palatable and safest. https://www.prescqipp.info/thickeners-for-dysphagia/viewcategory/339

The use of tins, not sachets or pre-thickened drinks is preferred as they are more cost-effective.

 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Black

Comment : Not routinely commissioned in any care setting. This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. Deviation from this position may be considered by prescribers on an individual basis, where exceptional circumstances exist. Otherwise, funding via Individual Funding Request (IFR) only.   

Red

Initiation : Specialist or hospital only
Repeat Prescribing : Specialist or hospital only
Monitoring : Specialist or hospital only
Comment : These medicines should be prescribed by clinicians in a hospital setting only for the duration of treatment (primary care prescribing is not appropriate). Prescribing and monitoring should be retained within the hospital setting by an appropriate clinician and the medicines supplied by the hospital for the duration of treatment. In exceptional circumstances a GP may be asked to prescribe/administer but the specialist must provide adequate information and support and retain overall clinical responsibility.   

Amber

Initiation : Specialist only
Repeat Prescribing : Any care setting
Monitoring : As defined in Effective Shared Care Agreement (ESCA)
Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis BEFORE the transfer of prescribing responsibility.   

Blue

Initiation and /or Recommendation : Specialist only
Repeat Prescribing : Any care setting
Monitoring : Any care setting
Comment : Suitability as to whether the medicine should be initiated by the specialist or can be recommended by the specialist for Primary care initiation will be clearly documented in each drug monograph on the formulary. If there is a period of stabilisation before transfer of care this will also be stated. Information sheets to support continued Primary care prescribing will be developed if appropriate. The decision will reflect the agreement of the Area Prescribing Committee.   

Green

Initiation : Any care setting
Repeat Prescribing : Any care setting
Monitoring : Any care setting
Comment : Suitable for non-specialist initiation   

Grey

Prescribing in approved, specialist tertiary care settings only  

OTC

Available to buy Over-The-Counter. Patients should be advised to purchase if appropriate.   

Non Formulary

Non-formulary  

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