Caring

Information for health professionals and carers

This information is solely for the purpose of General Practitioners, Prescription Clerks, Health Visitors or other Allied Healthcare Professionals within Luton and South & West Mid Bedfordshire. This page contains general information about prescribed oral nutritional supplements (ONS), the service provided to care homes and the referral criteria.

Members of the public can explore the resources page for information on a food based approach to support somebody at risk of malnutrition. We would advise you to contact your G.P. if you have any concerns about malnutrition or your nutritional needs.

It is important to maximise food and fluid intake for those that are malnourished or at risk of malnutrition. Please refer to our resources pages for more information. 

Oral nutritional supplements

Oral nutritional supplements (ONS) should only be prescribed to patients who meet the Advisory Committee for Borderline Substances (ACBS) prescribing criteria, have been screened using the validated malnutrition screening tool ‘MUST’ and deemed to be at nutritional risk. Food First advice such as nourishing drinks, high energy snacks and food fortification should be implemented for at least a 4 week period where appropriate before prescribing oral nutritional supplements.

When requesting or prescribing oral nutritional supplements please remember some of these points:


Do’s  

  • Food First advice should generally be first line for service users identified at risk of malnutrition (‘How to gain a pound a week’) before prescribing.
  • Prescribe to service users identified at nutritional risk using ‘MUST’ and meet ACBS prescribing criteria.
  • Issue initial 1 x starter pack to establish taste preference and avoid wastage.
  • Prescribe as an acute prescription with regular review of nutritional goals (i.e. monthly).
  • Set clear nutrition outcome goals (e.g. weight gain, weight maintenance) with service user prior to starting.
  • Review effectiveness of prescription after 12 weeks to prevent inappropriate long term prescribing
  • Issue therapeutic dose of two sachets/ two bottles daily (monthly prescribing quantities overleaf).
  • Advise service users to take in between meals.
  • Take caution when issuing ONS for service users with complex conditions (e.g. renal disease, liver disease & diabetes) where they may require; specialist products, dietetic input and more regular medical monitoring.
  • Consider over the counter (OTC) supplements such as Build Up™, Complan™, Nurishment™ for those who request ONS but do not meet the ACBS criteria.

Don’ts

  • Don’t prescribe less than the therapeutic dose of two bottles/sachets daily, as the energy and protein content can be easily met with Food First advice.
  • Don’t prescribe non-formulary (e.g. Fortisip Bottle, Calogen, Pro-Cal, Forticreme) unless advised by a Dietitian.
  • Don’t prescribe if on hospital discharge unless advised by a dietitian. Instead please ‘MUST’ screen service user and if at risk follow prescribing guidelines.
  • Don’t routinely prescribe to service users who are substance misusers or in the final stages of life.
  • Don’t issue more than one starter pack due to cost and avoid repeat prescriptions.
  • Don’t recommend as meal replacements.
  • Avoid prescribing to residents in older people care homes unless advised by a Dietitian as care homes have direct access to the Nutrition and Dietetic service.

 

Training requests

As well as providing a training and education programme to older people care homes, we are able to offer sessions to other health and social care professionals, domiciliary care providers, charity groups and patients groups upon request within the Luton and South Bedfordshire area. These sessions can include information on screening and management of malnutrition, the appropriate prescribing of ONS and maintaining hydration status. If you feel you or your team would like to find out more about our training sessions please contact us using the email address: food.first@nhs.net.

Referrals

If you are a local healthcare professional and would like to refer someone who does not live in a residential or nursing home please email ccs.beds.nutrition@nhs.net for the relevant referral form.  

Prescribing guidelines

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