Malnourishment

Prescribing Notes:

Oral nutritional supplements (ONS) should not be regarded as a first line treatment of under nutrition and should always follow dietary intervention using principles of Food First to maximise nutritional intake through normal food and fluids, see: Nourishing Ideas leaflet (NHS Lothian intranet); Nourishing Drinks leaflet (NHS Lothian intranet).

• Use of Oral Nutritional Supplements (ONS) must comply with Scottish ONS Short Life Working Group Guidelines for Appropriate Prescribing of ONS in Adults (2018).
• ONS should only be prescribed under the guidance of a dietitian (see the NHS Lothian RefHelp website for details).
• Some ONS may not be appropriate in the presence of certain medical, for example chronic kidney disease, diabetes and pregnancy.
• The Advisory Committee on Borderline Substances (ACBS) recommends products on the basis that they may be regarded as drugs for the management of specified conditions. It is essential that patients prescribed ONS meet the specific indications defined by ACBS.
• Patient centred treatment aims should be agreed and documented when ONS are commenced. Patients should be reviewed regularly to monitor progress against aims and ongoing need for ONS. If aims are not met within 6 months consideration should be given to discontinuing ONS.
• Products should be for that named individual, patients may not receive ONS prescribed for other patients.

Dietitians may request other products based on the clinical need of the patient. Reasons for any such request will be given by the requesting dietitian.

Prescribing Notes:

Refer to the following local links for information on Oral Nutritional Supplements in each Board:

• NHS Borders – Oral Nutritional Supplements
• NHS Fife – Oral Nutritional Supplements
• NHS Lothian – Oral Nutrional Supplements
• NHS Lothian RefHelp – Dietetics

See also national guidance on the Scottish Government Effective Prescribing and Therapeutics Branch website.

Prescribing Notes:

Refer to local guidelines on enteral tube feeding in each Board.

• NHS Lothian - Enteral Tube Feed Products
• NHS Lothian intranet – Enteral Tube Feeding
• NHS Fife - Enteral Nutritional Products