Birmingham, Sandwell, Solihull and environs APC Formulary
Maintained by Midlands and Lancashire Commissioning Support Unit
 
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9 Nutrition and blood

 Principles of using Oral Nutritional Supplements (ONS)

 

FIRST LINE Option

ONS Option

Food First

[Dietary measures (food fortification, increased frequency, nutritious snacks and drinks - using everyday ordinary foods)]

 Please note:- hygiene considerations/infection control

Except where patient has special dietary

requirements/ restrictions

·         Supplements should be given in-between meals and snacks NOT INSTEAD OF MEALS.

 

·         Most supplements contain milk – in diagnosed /milk intolerance – refer to dietitian

 

 

 

Homemade milkshake

 

Exceptions:-

·         Lactose intolerance

·         Milk allergy or intolerance

·         CKD 4 and 5

·         Tube feed patients (not licensed)

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control)

·         Liver/hepatobiliary and pancreatic disease/conditions.

 

 

Preferred option: Powdered Feeds

Alternative option, where powdered feed is unsuitable:

Ready-made/ready to drink feeds (e.g. bottled)

Make up with whole (full fat) milk

Exceptions:

·         Lactose intolerance

·          Milk allergy or intolerance

·         CKD 4 and 5

·         Tube feed patients (not licensed)

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control)

Note – can be made in a smaller volume, on the advice of a dietitian, for volume intolerance.

·         Unable to tolerate large amounts of lactose

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control - while in acute setting)

Dietary advice sheets and guidance available from local nutrition and dietetic services.

Please note- Not all patients will be able to meet their specific nutritional requirements with food first measures alone and supplements are required for some conditions e.g. very high protein requirement in liver transplantation, sarcopenia. The supplements will be recommended by the specialist dietitian.

Review criteria

·         All patients on ONS should be monitored and for adult patients an appropriate nutritional screening tools should be used (e.g. MUST, Birmingham learning disability screening tool).

·         Review the MUST score at least every 3 months or as advised by specialist dietitian

·         Patients on active dietitian case load will be monitored upto the point of discharge.

·         If no dietetic input, other healthcare professionals should monitor ONS for its effectiveness.

·         Please contact your local dietetic service for advice, guidance or referral criteria.

 

 

 

 

09-06-07 Multivitamin preparations

Healthy Start Vitamins
Formulary
  • Available free of charge from designated centres
  • Link  BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
    Link  Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
     

    Green View adult BNF  View SPC online  View childrens BNF
    Multivitamin preparations Abidec®
    Formulary
  • contains arachis ( peanut) oil
  • Link  BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
    Link  Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
     

    Green View adult BNF  View SPC online  View childrens BNF
    Multivitamin preparations Dalivit®
    Formulary
    Link  BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
    Link  Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
     

    Green View adult BNF  View SPC online  View childrens BNF
    Mutivitamins
    Formulary
    Link  BSOL CCG: Conditions for which over the counter items (OTC) should not routinely be prescribed in primary care
    Link  Conditions for which over the counter items should not routinely be prescribed in primary care: Guidance for CCGs
     

    Green View adult BNF  View SPC online  View childrens BNF
    Multivitamin  Viteyes®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF
    Multivitamin including lutein PreserVision®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF
    Multivitamin including lutein Vitalux Plus®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF
    Multivitamin including lutein and zeaxanthin  ICaps®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF
    Multivitamin including lutein and zeaxanthin  Macushield®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF
    Multivitamin including lutein and zeaxanthin  Ocuvite®
    Non Formulary
    Link  Patient Information Leaflet
     

    Black View adult BNF  View SPC online  View childrens BNF