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9.9 Nutrition (oral)

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

Enteral Nutrition

 

Enteral Feeds (non-disease specific), Nutritional supplements (non-disease specific), Specialised formulas and Feed supplements

Due to separate contractual arrangements in place for the supply of products to the hospital, the designated categories do not apply to prescribing for inpatients at the hospital.

The choice of product from the list for use only within the hospital remains the clinical decision/recommendation of the hospital dietitians.

 

Please refer to our Complete Adult Oral Nutritional Supplement Formulary

 

Initiating Oral Nutritional Supplements (ONS) in Primary Care

Food First advice should be trialled for 2- 4 weeks. If goals are not achieved, consider prescribing ONS twice daily, supported by a planned review process.

The other criteria that should be fulfilled before an ONS is prescribed, as discussed in the NICE guideline CG 32, are essentially that:

  • Patient’s MUST score is appropriate
  • Patient’s condition is ACBS approved

ONS are only available on FP10 prescriptions for specific indications as agreed by the Advisory Committee on Borderline Substances (ACBS).

 

Standard ACBS Indications: Disease-related malnutrition, intractable malabsorption, pre-operative preparation of patients who are undernourished, dysphagia, proven inflammatory bowel disease, following total gastrectomy, short bowel syndrome, bowel fistula.

 

Useful sources of information

 

 

 

 

 

 

 

 

 

 

 

 

 

Infant Formulae

 

 

 

 

 

 

 

 

Feed additives

Feed thickeners and pre-thickened drinks

 

Resources to support safer modification of food and drink 27 June 2018

Products

Instant Carobel powder (Cow & Gate Ltd)

Nutilis® Clear (Nutricia Ltd) - subject to robost implementation plan 

 

 

 

Nutrition in special diets

Coeliac disease

Milton Keynes CCG does not routinely fund gluten free foods on prescription for coeliac disease and dermatitis herpetiformis.
If a clinician considers that a patient’s specific circumstances mean that they could be at risk of dietary neglect then they can request that their case is considered by MKCCG.


You will need to complete this proforma and include as much information as possible so that the case can be fully reviewed by the team.

If a patient is approved for NHS prescriptions, the only products that can be prescribed are bread and flour mixes as listed in the Drug Tariff

 

 

Phenyketonuria (PKU), Maple Syrup Urine Disease (MSUD) and other low protein diets

Patients with a diagnosis of PKU, MSUD or other diagnoses requiring a low protein diet who are prescribed low protein products that are also gluten free must remain on such products.

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only
  • Double Red: These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.

 

 

 

 

 

Return to Chapter: 9. Nutrition and Blood

Last updated by: Sheila Wood on 06-06-2019 11:01