Quick Reference ONS Supplement Guidance for Dietitian Reference

Transcription

1 Quick Reference ONS Supplement Guidance fr Dietitian Reference This guideline shuld be fllwed t ensure apprpriate prescribing practices acrss the primary and secndary care interface in line with Suth West Lndn Interface Prescribing Plicy (sectin 9), and when requesting the prescriptin f an ONS in primary care. SWL Primary Care ONS Prescribing Criteria 1. High Risk f Malnutritin e.g. MUST MUST Calculatr. *ACBS Indicated 3. Fd first and hmemade nurishing drinks trialled fr ne mnth including ver the cunter supplements 4. Assess and supprt regarding the underlying cause f malnutritin Patient des nt meet criteria fr supplement prescriptin: Recmmend fd and fluid based strategies and OTC supplements On requesting an ONS Prescriptin in primary care FIRST: Patient meets criteria fr ONS prescriptin: Prescribe Pwder ONS SECOND: If pwder ONS is nt tlerated r nt suitable fr the patient, trial a Milkshake Style ONS THIRD: If the patient is unable t cmplete the ~0ml vlume f Milkshake Style ONS prescribe a Cmpact ONS IF RECOMMENDING AN ALTERNATIVE PRODUCT AIM TO ENSURE IT IS WITHIN THE GREEN SECTION AMBER= ONLY PRESCRIBE IN PRIMARY CARE IF ONS IN GREEN SECTION ARE INAPROPRIATE RED= ONLY PRESCRIBE IF ONS IN GREEN AND AMBER SECTION ARE INAPPROPRIATE Practical Guidelines t help ensure yur patient is prescribed the apprpriate prduct Prvide a written summary f dietetic treatment including identified gals and a review plan If requesting the GP t review an ONS prescriptin, prvide clear gals f ONS treatment in written cmmunicatin advice regarding re-screening fr risk f malnutritin recmmend a suitable ONS frm the GREEN sectin unless cntraindicated If an alternative ONS is required, cnsider prescribing the cst effective ONS within the supplement grup AMBER Avid prescribing prducts in RED Secndary care dietitians may utilise the ONS Prduct Guidance t recmmend the trial and prescriptin f a clinically and cst effective ONS, within the respective prduct grup. Fr patients nt receiving cntinued dietetic review, this infrmatin will supprt the GP t prescribe in line with SWL Guidelines. This prduct guidance is available t dwnlad frm the Nutritinal-Supplements.aspx including prduct prices, and will be updated quarterly t reflect prduct price changes N.B. This Quick Reference Guidance shuld be used in cnjunctin with the full guidelines SWL Alliance Guideline: The Identificatin, Treatment and Management f Malnutritin in Adults, including the Apprpriate use f Oral Nutritinal Supplements with particular reference t Sectin 5 (page 4 and 5 belw). 1

2 Prduct Name Price Kcal/ serve Prtein(g) /serve Unit Size Pack Size Flavurs Available Pwdered ONS Fr all patients requiring ONS, cnsider prescribing a pwdered ONS first if apprpriate *** Fdlink Cmplete AYMES Shake Cmplan Shake * 386* 387* 18.3* 16* 15.6* 57g 57g 57g 399g 399g 8g B, C, S, N, V B, C, S, N, V B, C, S, N, V Ensure Shake * 17* 57g 399g B, C, S, V Enshake Calshake Scandishake ** 600** 588** 16** **.4** 96.5g 87g 85g 579g 609g 510g B, C, S, V B, S, N, V B, C, S, N, V, Ca Milkshake Style nutritinally cmplete bttled ONS; if pwdered ONS are nt suitable Aymes Cmplete Frtisip Bttle B, C, S, V B, C, S, N, V, Ca, O, TF Fresubin Energy AYMES kcal Ensure Plus Milkshake Style ml 0 ml ml S, TF, V B, S, V B, C, S, N, V, C, FOF, O, P, R Ensure kcal Resurce Energy Frtisip kcal ml 0ml B, S, N, V A, B, C, C, S, R, V V, S Ensure Liquid ml C, C, V Cmpact Style lw vlume/cmpact nutritinally cmplete ral nutritinal supplements Altraplen Cmpact Frtisip Cmpact Ensure Cmpact ml 5ml 5ml B, C, S V B, C, S, V, FOF, A, M B, S, V Juice Style - Patients wh d nt like r are unable t tlerate milk-based sip feeds. Nt nutritinally cmplete. Ensure Plus Juce ml S, P, O, LL, Ap, FP Fresubin Jucy Frtijuice A, O, C, Bl, Pi S, Ap, O, L, FF, TF Resurce Fruit A, O, PCh, R-Bl High Prtein Patients with increased prtein requirements identified fllwing dietitian assessment Fdlink Cmplete g B, C, S, N, V (with 5ml whle milk) Fdlink Cmplete g B, C, S, N, V (with 0ml whle milk) Altraplen Prtein 1.59 S, V Frtisip Cmpact Prtein ml B, S, V, M Fresubin kcal Drink Fresubin Prtein Energy Frtisip Extra Ensure Plus Advance ml N, V, A, C C, S, V, C, TF C, S, V, FOF, M V, Ch, B Fibre Cntaining - Useful fr patients with cnstipatin/requiring fibre supplementatin via ONS Fdlink Cmplete with g 441g V, C, S, B, N Fibre (with 0ml whle milk) 4.5g fibre Fdlink Cmplete with g 441g V, C, S, B, N Fibre (with 5ml whle milk) 4.6g fibre Resurce.0 Fibre S, N, V, A, C, SF Frtisip Cmpact Fibre Fresubin cal Fibre Ensure Plus Fibre Fresubin Energy Fibre ml Semi Slid Dessert Patients with dysphagia prescribe fllwing dietetic and SALT recmmendatins Nutricrem AYMES Crème S, V, C V, C S, V, M C, N, V, C, L, A/P B, C, S, V, R B, C, S, V, Ca, C

3 Frticreme Cmplete Fresubin kcal Crème Fresubin YOcreme Ensure Plus Crème Nutilis Fruit Stage g 600g B, C, V, FF C, S, V, C, Pr L, R, A/P, Bi B, C, N, V S, A (3 = pudding-thick) Mdified Cnsistency - Patients with dysphagia prescribe fllwing dietetic and SALT recmmendatins Sl Milkshake Stage 1,* g 350g C, S Nutilis Cmplete Stage 1, Fresubin Thickened Stge1, ml S, V (1=syrup, =custard) S, V Savury Style AYMES Savury g Chicken Ensure Plus Savury ml Chicken Vitasavury g 0g Chicken, veg, Leek/P. Mush Ygurt Style - Less sweet, and useful fr patients with taste fatigue r taste changes Ensure Plus Ygurt ml S, P Frtisip Ygurt.14 V/R, P/O Specialist ONS Vital 1.5kcal ml C, MB, V Mdulen IBD /g 18g/g variable g N Mdular ONS NOT NUTRITIONALLY COMPLETE. ONLY PRESCRIBE IF RECOMMENDED BY DIETITIAN Altrasht ml 1ml S, V Calgen Calgen Extra Pr-cal sht Pr Cal Pwder Fresubin 5 Cal Sht Vitajule PrSurce PrSurce Plus PrSurce Jelly ml 15g 10g 118ml 0ml 0ml 1ml 510g 1ml 30ml 30ml 118ml S, N S, N B, S, N N N, L N N, O, CB N, O, CB O, Lime, FP A Ap B Bi Bl C Ca Aprict Apple Banana Biscuit Blackcurrant Chclate Caramel C FF FP L Leek/P LL M Flavur Cdes fr Oral Nutritinal Supplements Cffee Fruits f the Frest Fruit Punch Lemn Leek Aand Ptat Lemn Lime Mcha Mush N O P PCh Pi Pr Mushrm Neutral Orange Peach Pear-cherry Pineapple Praline R R-Bl S SF T TF V Raspberry Raspberry-blackcurrant Strawberry Summer Fruits Tffee Trpical Fruit Vanilla ***Pwdered ONS/OTC supplements cntraindicatins:*** *when made up with 0ml whle milk. **when made up with 40ml whle milk. Limited dexterity & inability t prepare Cw s milk allergy r intlerance (check allergen infrmatin frm cmpany) Under 6 years Galactsaemia Require thickened fluids Require additinal fibre via their ONS Nt suitable fr enteral feeding tubes Patients with renal disease shuld be assessed by a dietitian prir t prescribing a pwdered ONS r taking OTC supplements. ONS Prduct Guidance t be utilised in cnjunctin with full guidelines: Suth West Lndn Guidelines n the Apprpriate Identificatin, Treatment and Management f Malnutritin in Adults, including the apprpriate prescriptin f Oral Nutritinal Supplements. The prduct Guidance will be updated quarterly. T ensure up t date prices and seek additinal infrmatin please cntact respective nutritinal cmpanies fr full infrmatin n ONS prducts. Review date: June 18 3

4 ONS Prescribing Acrss the Pathways f Care Guidance prvided within this sectin shuld be fllwed t ensure apprpriate prescribing practices acrss the primary and secndary care interface in line with sectin 9 f the Suth West Lndn Interface Prescribing Plicy (see belw, page 6) and the SWL Guidelines n the Apprpriate Identificatin, Treatment and Management f Malnutritin in Adults, including the apprpriate prescriptin f Oral Nutritinal Supplements. Dietetic Cmmunicatin A dietetic standard discharge letter available t dwnlad frm the Malnutritin Pathway website includes the belw Nutritin Prescriptin Request bx helping t reduce cmmn errrs in prescribing utlined abve. In additin, the letter supprts in prviding clear and relevant infrmatin regarding: Gals f ONS and dietetic interventin Dietetic treatment summary including educatin prvided t the patient/carer Review and mnitring plan Additinal actins required by the GP Assessment f ONS prescribing criteria Underlying cause(s) f cmprmised nutritinal status and supprt prvided T ensure the patient receives the apprpriate ONS prescriptin and supprt the apprpriate review and management f the patient s care, the abve infrmatin shuld be clearly cmmunicated t the GP with all ONS prescriptin requests. The letter shuld infrm the patient that their ONS prescriptin may be changed fllwing discharge t primary care. Name and Manufacturer Milkshake bttle Manufacturer Pwder Manufacturer Flavur Vlume per serve *****NUTRITION PRESCRIPTION REQUEST***** Unit Quantity /serve per day Ttal vlume per 8days Vlume per pack N f packs required fr 8days Durati n (weeks) Prescriptin Type Patient infrmatin fr prescriptin Vanilla 0 ml 11, Acute Midmrning & Mid afternn Strawbe rry 57 g 1 1, Acute Midmrning ONS Prescriptin Requests n Discharge frm Secndary Care ONS are ften prescribed while in hspital and may be included in the transfer f care dcument (e.g. discharge drug summary r t take hme medicatins). Fllwing discharge t primary care, the need fr ONS prescriptin shuld be reviewed in line with lcal guidance and shuld cnsider changes in nutritinal intake and clinical cnditin fllwing discharge. The patient s nutritinal status shuld als be reviewed t ensure an apprpriate treatment and management plan is in place. 4

5 Clear cmmunicatin must be prvided t the GP fr all ONS prescriptin requests. Supplements requested t cntinue in primary care n FP10 prescriptin shuld meet the SWL primary care ONS prescribing criteria. If the patient des nt meet defined criteria, OTC supplements, fd first and hmemade nurishing drinks shuld be recmmended. If the patient meets ONS prescribing criteria, the ONS prduct prescribed shuld be in line with the SWL primary care ONS Prduct Guidance. ONS shuld be prescribed n an acute 4 week prescriptin and reviewed prir t cntinuing the prescriptin. ONS prducts in the AMBER and RED sectin prescribed during secndary care admissin shuld nly cntinue pst discharge if the patient will remain under dietetic review r if ONS in the GREEN sectin are cntraindicated. Ideally, the patient will receive a trial f the ONS prir t changing the prescriptin. If unable t prvide the trial in secndary care advising the GP n a suitable clinically and cst effective ONS t trial in primary care will supprt the GP prescribing in line with SWL Guidelines. The ONS Prduct Guidance fr Dietitians Reference prvides advice n clinically and cst effective ONS available t prescribe within the respective prduct grup. Prmting Integrated Care T prmte the cntinuum f dietetic care acrss the pathway, patients requiring cntinued dietetic input in primary care shuld be directly referred t the relevant cmmunity dietetic team r utpatient clinic by the acute dietitian. On discharging a patient and requesting the GP t review the ONS prescriptin, written cmmunicatin shuld be prvided t the GP and include infrmatin utlined in sectin 5.1. The GP shuld be prvided with advice t supprt in reviewing the patient s malnutritin risk (e.g. re-screening) and actins t take shuld precipitating cncerns increase fllwing discharge (e.g, re-referral t dietetics as apprpriate). 5

6 Suth West Lndn Alliance Interface Prescribing Guidelines Sectin 9: Dressings, Appliances, Enteral Feeds and Glucse Mnitring Strips 9. Suitable lcal arrangements shuld be in place fr the supply f dressings, appliances and enteral feeds. A minimum f 7 days supply shuld be prvided. Sufficient infrmatin abut a patient s dressing, appliance and enteral feed treatment, preferably in the frm f a care plan as part f the discharge summary, shuld be prvided t ensure cntinuity f care in the cmmunity (see als sectin 6. regarding cmmunicatin with GPs). 9.3 Prviders must ensure that measures are in place t ensure that all patients discharged n ral nutritinal supplements (ONS) have: prperly assessed as needing ONS during any episde f care and n discharge have a Nutritinal Management Plan sent t the GP and ther relevant healthcare prfessinals / carers which includes: the reasn fr using ONS (including MUST scre) whether any further supplies are needed nce the prvider s supply runs ut a future fllw up plan including targets and review dates been changed t the mst cst-effective prduct fr primary care n discharge. Nte that SWL CCGs intend t wrk with SWL Trusts t ensure that preferred frmulary prducts in primary care will be available t the Trust fr suitable patients n discharge. 9.4 Prviders shuld nt request GPs t prescribe dressings/ appliances and enteral feeds utside f the CCG agreed frmulary/guidance where available. 9.5 N arrangements shuld be made by the prvider with appliance cntractrs fr nging supplies f dressings r appliances in the cmmunity withut invlving patients in the decisin abut where and hw their further supplies are btained. 6