Identify patients prescribed ONS supplements which are not in line with the first choice Dorset formulary options. Review the need for ONS prescription and where appropriate to continue, change prescription to a first-choice formulary option (see prescribing algorithm).
Products should not be changed in the following patient cohorts:
- Tube fed
- Dysphagia/swallowing difficulties
- Eating disorder
- Under the care of a specialist dietitian in the last 6 months (e.g. gastroenterology/oncology or other) with a request for a specific product)
- Chronic kidney disease stage 4 or 5 (eGFR <20)
There is a need to optimise the cost-effectiveness of ONS prescribing while maintaining patient care. The Dorset Formulary has been reviewed, taking into account nutritional content and cost effectiveness of ONS products, to provide first-choice recommended options for people requiring ONS prescriptions in primary care.
Identify patients prescribed relevant ONS products using the SystmOne search provided:
Exclude the following patient cohorts from the product switches (coded entries have been built into the searches but information below or dietetic input may be in the patient notes and not coded, hence clinical oversight is required):
- Tube fed
- Dysphagia/swallowing difficulties
- Eating disorder
- Under the care of a specialist dietitian in the last 6 months (e.g. gastroenterology/oncology or other) with a request for a specific product)
- Chronic kidney disease stage 4 or 5 (eGFR <20), due to complex electrolyte needs
Assess whether the patient still requires ONS, using the ONS Prescribing Algorithm in primary care.
If ONS is indicated (e.g. MUST 2 and ACBS criteria fulfilled), swap to the suggested product.
Provide an acute prescription (e.g. up to 3 months).
Organise a review for before 3 months to assess progress against treatment goals, and suitability to wean off/stop the product or continue longer term.
Notify patients of changes to ONS using the patient template texts and letters provided in the SystmOne Comms Annexe.
- SystmOne searches are available in the DorsetSystmOneGPs> PINH 2627> F4b Oral Nutritional Supplementation
- Template patient letters – in SystmOne comms annexe
- Template patient text messages – in SystmOne comms annexe
- ONS Prescribing Algorithm for primary care
- Primary Care ONS formulary – first choice product table
- SOP: Implementing ONS formulary changes
Tracking achievement:
Q4 ONS spend pro rata divided by Denominator PCN normalised population
