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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

 

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
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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
  • 16g 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

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 to be routinely commissioned (prescribed) in any care setting (primary or secondary care). 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. As such, drugs classified as Black should be considered as non-formulary.   

Red

Initiation : Specialist only
Repeat Prescribing : Specialist
Monitoring : Specialist
Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe the specialist must provide adequate information and support.   

Amber

Initiation : Specialist only
Repeat Prescribing : Primary care OR specialist
Monitoring : Primary care OR specialist
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.   

Blue

Initiation/Recommendation : Specialist only
Repeat Prescribing : Primary care
Monitoring : Primary care
Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

Green

Initiation : Primary care or specialist
Repeat Prescribing : Primary care
Monitoring : Primary care
Comment : Suitable for non specialist initiation   

OTC

Patients should be advised to purchase if approriate.  

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