Step 5-Prescribe ONS
If food first dietary advice has been maximised for 4 weeks and it is not possible to meet nutritional requirements from food intake alone and there are clinical benefits and clear nutritional goals to work towards and patient’s condition falls into one of the following ACBS categories:
| ►Short bowel syndrome
►Following total gastrectomy ►Intractable malabsorption ►Proven Inflammatory Bowel Disease ►Bowel fistulae |
►Disease related malnutrition
►CAPD or haemodialysis ►Dysphagia ►Pre-op preparation of undernourished patients
|
then consider prescribing 2 x ONS per day (600 to 800 Kcals)
- Give directions for use, i.e. one sachet/bottle twice a day, between meals. Do not advise ‘as directed’
- Prescribe a limited quantity initially (e.g. 7 day supply) to reduce wastage and no more than a month’s duration for the subsequent prescriptions and reinforce food fortification advice
- For longer term treatment, as per dietetic recommendation, consider adding the review month and year to the dosage instructions and limiting the repeat period to 3 months
- Record the weight, MUST score, ACBS indication, goal and review plan in the patient’s record