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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...
09.05.01.01  Expand sub section  Calcium supplements
Alliance Calcium Syrup®
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Formulary
Amber Recommended
  • Replacement for Calcium Sandoz ® (discontinued)
 
   
Calcichew®
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Amber Recommended
 
   
Sandocal-1000®
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Amber Recommended
 
   
 ....
Key
note Notes
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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
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Link to children's BNF
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Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
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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 suitable for routine use within primary care. Initiation and maintenance of prescribing by Specialists, GPs and other qualified clinicians.   

Amber Initiation

Amber Specialist Initiation: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing when appropriate. This may be supported by a RICaD, annotated within the formulary entry.  

Amber Recommended

Amber Specialist Recommendation: Initiation and maintenance of prescribing in Primary Care following recommendation from a Specialist.  

Amber SC

Amber Shared Care: Initiation and maintenance of prescribing by Specialists and transfer to Primary Care prescribing, in accordance with an ESCA, annotated within the formulary entry.  

Red

Medicines for initiation and maintenance prescribing by Specialists only.  

Black

Non-formulary Medicines which APC/Trust DTC has actively reviewed and do not recommend for use.  

Grey

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

The term 'Specialist' refers to Consultants, General Practitioners and Independant Prescribers with a Specialist Interest.  

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