Oral Nutritional Supplements (ONS)
Prescribing of oral nutritional supplements (ONS) should not be regarded as first-line treatment in nutrition support and should always follow dietary intervention (see The Best Weight is Up, dietary information leaflet http://intranet.grampian.scot.nhs.uk/foi/files/bestweightisup.pdf).
The need for nutrition support can be identified using the MUST nutritional screening tool to highlight those individuals at risk. (For more information on this or The Best Weight is Up contact Community Dietetic Department Tel: 01224 556305, or Dietetic Department, Dr Grays Hospital Tel: 01343 567350).
- The advisory committee on Borderline Substances (ACBS) recommend 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 and that patients are adequately monitored.
- All patients requiring ONS should be referred to the Community Dietetic Department (Aberdeen) or Dietetic Department (Moray) in the usual way for a detailed nutritional assessment before a prescription is issued.
- Prescriptions should be endorsed ACBS. See BNF, Appendix 7 Borderline substances.
- ONS show most benefit in patients with BMI<20.
- Where appropriate a 1.5kcal/mL rather than a 1.0kcal/mL ONS will be prescribed.
- A choice of flavours and types of drinks are available.
- Prescribing guidelines for substance misusers have been developed by the NHS Grampian Community Dietetic Department, Aberdeen. (See the next web page substance misuse guidelines).
Recommended Supplements (at May 2011):
Milk based, 1.5 kcal/mL
First line choice: Ensure® Plus Milkshake style, 200mL bottle
Second line choice: Fresubin® Energy, 200mL bottle
Fruit juice based
First line choice: Ensure® Plus Juce, 220mL bottle
Second line choice: Provide® Xtra Juice Drink, 200mL bottle
Milk based with fibre
First line choice: Ensure® Plus Fibre, 200mL bottle
Second line choice: Fresubin® Energy Fibre, 200mL bottle
First line choice: Ensure® Plus Yoghurt style, 220mL bottle
Second line choice: Fortisip® Yogurt Style, 200mL bottle
Note: Other types and flavours are available if these are not suitable. Please seek advice from a dietitian.
Other Dietary Supplements:
Calogen®, Calogen® Extra, Pro-Cal®, Pro-Cal® Shot, Polycal®, Maxijul®
These products should be used under specific circumstances. They are not nutritionally complete and should only be used under medical or dietetic supervision.
Scandishake® / Calshake®
These are high energy, low volume supplements which should be used under specific circumstances and therefore should only be prescribed in the community on the recommendation of a dietitian.