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Birmingham, Sandwell, Solihull and environs APC Formulary
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 Formulary Chapter 9: Nutrition and blood - Full Chapter
Notes:

 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.

 

 

 

 

 Details...
09.04  Expand sub section  Oral nutrition
09.04  Expand sub section  Nutritional supplements for metabolic diseases
09.04  Expand sub section  Glutaric aciduria (type 1)
09.04  Expand sub section  Glycogen storage disease
Corn flour and corn starch
(Powder)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • For glycogen storage disease
  • Slow release CHO to prevent hypoglycaemia in GSD
  • Slow release carbohydrate to prevent hypoglycaemia in all types of GSD. Cheaper than glycosade and easier to mix. Used in less severe forms of GSD. Between 1 to 2g/kg body weight is prescribed dependent on age, weight and clinical symptoms of hypoglycaemia. Doses may be given at regular intervals during the day and night or at bedtime only. The dose and frequency of dose should always be advised by the specialist dietitian according to the needs of the patient.
 
   
Glycosade®
(Powder)
View adult BNF View SPC online View childrens BNF
Formulary
Amber
  • Slow release CHO to prevent hypoglycaemia in GSD
  • The only specially formulated slow release carbohydrate to prevent hypoglycaemia in severe forms of GSD e.g. Type I and III which allows extended fasting time. The dosage is dependent on age, weight and clinical symptoms of hypoglycaemia. Doses may be given at regular intervals during the day and night or at bedtime only. The dose and frequency of dose should always be advised by the specialist dietitian according to the needs of the patient. Glycosade is in a pre-measured sachet. The dose and type of product should always be advised by the specialist dietitian according to the needs of the patient.
  • A nutritional supplement for use in the dietary management of glycogen storage disease and other metabolic conditions where a constant supply of glucose is essential. Not suitable for use in children under 2 years.
 
   
09.04  Expand sub section  Homocystinuria or hypermethioninaemia to top
09.04  Expand sub section  Hyperlysinaemia
09.04  Expand sub section  Isovaleric acidaemia
09.04  Expand sub section  Maple syrup urine disease
09.04  Expand sub section  Methylmalonic or propionic acidaemia
09.04  Expand sub section  Other inborn errors of metabolism to top
09.04  Expand sub section  Phenylketonuria
09.04  Expand sub section  Tyrosinaemia
09.04  Expand sub section  ALD
09.04  Expand sub section  Other powder feeds
09.04  Expand sub section  Rarely Used to top
09.04.01  Expand sub section  Foods for special diets
09.04.02  Expand sub section  Enteral nutrition
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Prescribing in children

The APC notes that the informed use of unlicensed medicines or of licensed medicines for unlicensed applications (‘off-label’ use) is often necessary in paediatric practice.

The APC advises GPs to consider specialist prescribing recommendations for Green and Amber medicines that are not subject to ESCAs or RICaDs in combination with the information provided in the BNFC which goes beyond that of marketing authorisations. The BNFC has been designed for rapid reference and the information presented has been carefully selected to aid decisions on prescribing.

  

Green

Medicines which are suitable for initiation and maintenance prescribing by primary and secondary care clinicians. These medicines should be initiated and prescribed within their licensed indications.  

Amber

Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate, or initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.

Some amber medicines require agreement with the local (internal) medicines committee prior to initiation; others may require a framework to support safe transfer and maintenance of care such as a RICaD or ESCA. The Formulary will be annotated to reflect these requirements.   

Red

Medicines for initiation and maintenance prescribing by Specialists only  

Black

Non-formulary medicines- medicines not recommended for routine primary care prescribing.  

Grey

Positive NICE TA and /or awaiting local clarification on place in therapy ; Please contact your Medicines Optimisation team for more information.  

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