9.4.5.1-ONS First Line Products

Oral Nutritional Supplements

General Notes

• Products within the first line choices category are suitable for most people.
  • Products within the other categories should only be considered where first line products are not suitable and there is clinical justification for their use.
  • Some products should only be prescribed under the recommendation of a dietitian, or a health care professional with expertise in this area, see dietitian led products for reference
• Products containing less than 1.5Kcal/ml (1-1.49Kcal/ml e.g. Ensure Liquid and Fresubin Original) should not be prescribed.
• Not all ONS are suitable for vegans and many are not gluten/lactose free, or suitable for patients with specific food allergies. Refer to individual product data sheets for product details for this information.
• Use with caution in CKD Stage 3 patients with hyperkalaemia – use under guidance of dietitian in CKD stage 4 & 5.

Practical Information for Prescribers in Primary Care

• ONS products need to be taken at least twice per day to provide a sufficient nutritional boost.
• Ensure directions for use are clear, e.g. one sachet twice a day between meals.
• Prescribe a limited quantity initially (7 day supply) to reduce wastage and no more than a month’s duration for subsequent prescriptions.
• Review period depends on clinical need, good practice suggests initial review after maximum one month then at least three monthly thereafter.
• Reinforce food fortification advice (link) during each review.

Powdered ONS – Cost Effective Choice for Primary Care

Powdered ONS products are more than 50% cheaper than ready-made ONS and are a cost effective option in primary care. However they are NOT SUITABLE FOR ALL PATIENTS, the following should be considered for each individual patient prior to prescribing:

• Ability to make up shakes? (either patient themselves or carer)
• Access to fridge, fresh milk and adequate storage for both milk and prepared product?
• Ability to adhere to the requirements for safe handling of a fresh milk product?

First Line

Powdered ONS >1.5 kcal/ ml (make up with 200ml whole milk)

 

Ready Made ONS 1.5Kcal/ml Milkshake Style

 

Juice style and Savoury ONS

Prescribing notes

• Consider the following if sweet or milk based alternatives are disliked.
• Please note ‘Foodlink Complete’ can also be mixed with fruit juices or water to make a juice style ONS. If reconstituting ‘Foodlink Complete’ using alternative liquids note that the nutritional profile will vary.
• Juice style supplements are not recommended as first line product for those with diabetes. Where required they should be used with caution.
• Suitable for those who do not like milky products but these are NOT MILK FREE.
• Note protein content is lower than milkshake style products.

Powdered ONS 1.5kcal/ml Savoury (make up with 200ml hot water)

 

Ready Made ONS 1.5kcal/ml Juice style

 

Compact ONS

Prescribing notes

• Compact style ONS should not be prescribed without consideration of the patient’s overall fluid balance and risk of dehydration. See alternative choices above.
• Suitable for those requiring low volume.
• Suitable for those with early satiety.

Powdered ONS 2.4Kcal/ml Compact Milkshake Style (make up with 100ml whole milk)

 

Ready Made ONS 2.4kcal/ml Compact Milkshake style

 

^#Nutritional content per unit (e.g. per ready-made bottle or per sachet made up as directed). Protein content rounded to the nearest whole number