Oral Nutritional Supplements

Assessment for oral nutritional supplement

• Calculate MUST score to quantify risk
  • MUST Score 0
    • Low risk
    • no action needed
  • MUST Score 1
    • Medium risk
    • Fortification of usual diet with high energy and high protein foods
    • Aim to achieve 600 cal/day from meals and snacks
    • provide and discuss ‘Food as Treatment’ leaflet with patient/carer
  • MUST Score 2
    • High risk
    • Fortification of usual diet with high energy and high protein foods
    • Aim to achieve 600 cal/day from meals and snacks
    • provide and discuss ‘Food as Treatment’ leaflet with patient/carer
    • consider 1 month trial of ONS in line with ONS formulary
    • If no improvement after 1 month consider referral to Dietitian 
• ONS can only be prescribed for specific indications as advised by the Advisory Committee on Borderline Substances (ACBS)
• All prescriptions for ONS should be endorsed with ACBS:
  
  • Disease-related malnutrition
  • Intractable malabsorption
  • Pre-operative preparation of malnourished patients
  • Dysphagia
  • Proven inflammatory bowel disease
  • Following total gastrectomy
  • Short-bowel syndrome
  • Bowel fistula

Review of oral nutritional suplement

• Month 1 then 6 monthly
• Calculate MUST Score – you will need current weight, height, weight 3-6 months ago
• If MUST ≥2 and improvement in weight: continue with chosen treatment
• If MUST ≥ 2 and no improvement in weight: continue for one month and refer to dietitian
• If MUST <2: stop prescription