9.4 Oral nutrition

General Notes
Oral nutritional supplements (ONS) should not be regarded as a first line treatment of under nutrition and should always follow dietary intervention using principles of Food First.
Prior to prescribing ONS, it is best practice to apply the Malnutrition Universal Screening Tool (MUST) and to establish and agree realistic treatment goals with the individual patient.
 
  • The Advisory Committee on Borderline Substances (ACBS) recommends products on the basis that they may be regarded as drugs for the management of specified conditions. Doctors should satisfy themselves that the products can be safely prescribed, that patients are adequately monitored and where necessary, expert supervision is available.
  • Oral Nutritional Supplements when commenced should be monitored by a health care professional with appropriate training. Guidance is available in the Lothian Best Practice Statement.
  • At least a 1.5kcal/ml supplement should be prescribed.
  • The patient should be advised that the use of ONS will initially be a trial period of up to 3 months with set goals/outcomes. If goals/outcomes are not met or the product is found to be ineffective then consideration should be given to stopping the product.
  • It is recommended that ONS prescriptions are placed on acute prescription only unless otherwise requested by a dietitian.
  • Products where prescribed should be for that named individual, patients should not receive ONS prescribed for other patients.
 
Oral Nutritional Supplements

Dietitians may request other products based on the clinical need of the patient. Reasons for any such request will be given by the requesting dietitian.

 

First Choice:
Complan Shake 57g sachet
(requires to be reconstituted with 200mls whole milk)
Milk Style
Second Choice:
Ensure ® Plus Milkshake Style 220ml
orFortisip ® Bottle 200ml
Fruit Juice Style
Second Choice:
Ensure ® Plus Juce 220ml
orFortijuce ® 200ml
Yoghurt Style
Second Choice:
Ensure ® Plus Yoghurt Style 220ml
orFortisip ® Yoghurt Style 200ml
Milk Style with fibre
Second Choice:
Ensure  ® Plus Fibre 220ml
orFortisip Multifibre ® 200ml
Prescribing Notes
  • Nutilis Clear is a xanthan gum based food and fluid thickening powder designed to modify the texture of both food and fluids. It is for specialist use only.
9.4.2 Enteral Nutrition
If a patient is unable to meet their nutritional requirements through diet alone or is unable to eat, then enteral feeding may be recommended. This may be nasogastric (NG), gastrostomy e.g. PEG (percutaneous endoscopic gastrostomy) or RIG (radiologically inserted gastrostomy) or jejunal feeding. There are a number of enteral feeding products available within the contract for Lothian. The dietitian will recommend a prescribable feed to meet the patients nutritional requirements. All adult patients within Lothian on enteral feeds are monitored and reviewed in conjunction with the Community Enteral Nutrition Team (CENT) contact: 0131 537 9514. All ancillaries for enteral feeding are non prescribable products. The supply of these is co-ordinated by CENT. Refer to ‘Lothian Enteral Tube Feeding. Best Practice Statements for Adults and Children. 2007'