Routine prescribing of dessert-style ONS in primary care is not supported.
Review prescriptions of dessert style oral nutritional supplements (ONS).
Where people have a MUST score 0-1:
- Issue one further months supply of ONS, then stop ONS prescription, consult prescribing algorithm and convert person onto food first add link to the diet sheet once available.
Where people have a MUST score > 2:
- Issue one further months supply of ONS, then stop ONS prescription, consult prescribing algorithm and convert person onto first choice ONS formulary product.
Do not change or stop dessert style ONS in the following patient cohorts:
- Ongoing swallowing difficulties or a diagnosis of dysphagia with a high risk of malnutrition (MUST 2)
- CKD Stage 4/5 (eGFR<20)
- Those recommended a dessert style product by a specialist dietitian with a clinical rationale, or those under the care of a dietitian.
There is a need to optimize the cost-effectiveness of ONS prescribing while maintaining patient care.
The nutritional content of dessert-style ONS can easily be replicated by food and there are a wide range of products with equivalent calorie and protein content available to purchase in supermarkets.
For clinical and cost effectiveness, powdered and liquid supplements are favourable alternatives in those who need ONS (without dysphagia or swallowing difficulties). They contain higher energy and protein then most dessert style ONS.
This change is in line with other regions across England. Retail puddings, yoghurts and desserts are readily available and often more palatable.
Identify patients prescribed dessert style ONS using the S1 search:
Dorset System One GPs> PINH 2627> Work to do: Dessert style ONS, consult ONS prescribing algorithm, stop and convert to food first (where MUST 0-1), or switch to first choice formulary ONS product (where MUST > 2), consult exclusion criteria prior to making changes.
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):
- Ongoing swallowing difficulties or a diagnosis of dysphagia with a high risk of malnutrition (MUST 2)
- CKD Stage 4/5 (eGFR<20)
- Those recommended a dessert style product by a specialist dietitian with a clinical rationale, or those under the care of a dietitian
Use the patient text messages and letters within SystmOne comms annexe to notify people of the relevant change to ONS:
- Encourage food first options as per the attached resource: 'Retail or Homemade Nourishing Snacks and Dietary Boosters' for patients with MUST 0-1 or at low risk of malnutrition
- Prescribe an alternative product for those at high risk of malnutrition with a MUST score >2. Use the prescribing algorithm on the Dorset formulary to pick the most suitable of the four 'first choice' products
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 with scheduled reviews.
SystmOne search:
Dorset System One GPs> PINHS 2672> F4b Oral nutritional supplements> Work to do: Dessert style ONS, consult ONS prescribing algorithm, stop and convert to food first (where MUST 0-1), or switch to first choice formulary ONS product (where MUST > 2), consult exclusion criteria prior to making changes.
Template patient letter "PINH 2627 Dessert style ONS prescription cessation MUST 0-1" available in SystmOne comms annexe
Template patient letter "PINH 2627 Dessert style ONS prescription switch MUST > 2" available in SystmOne comms annexe
Template patient text messages available in SystmOne comms annexe
Dessert style ONS prescription cessation MUST 0-1:
"In line with other regions across England, NHS Dorset has asked all GP teams to stop the prescription of dessert style oral nutrition supplements (ONS). The nutritional content of dessert-style ONS can be found in food available to purchase in supermarkets; such as puddings, desserts, high protein and standard yoghurts. From next month, your prescription of dessert style supplement will be stopped, and we recommend purchasing dessert or yoghurt pots from the supermarket to consume in between regular meals. For more information please see retail or homemade nourishing snacks and dietary boosters sheet.
Dessert style ONS prescription cessation MUST >2:
"In line with other regions across England, NHS Dorset has asked all GP teams to review the prescribing of dessert style oral nutrition supplements (ONS) and change prescriptions to NHS Dorset preferred ONS product choices. From next month your prescription of dessert style supplement will be changed to a powdered or liquid supplement that has a higher nutrient content, but will have a change to brand name. If you have any issues tolerating the new products, please discuss with your Community Pharmacist, GP practice or Dietitian."
Position statement: Prescription of dessert style ONS
Prescribing algorthim
Dorset Formulary
Dietary resource: Retail or homemade nourishing snacks and dietary boosters
Tracking achievement:
Q4 ONS spend pro rata divided by Denominator PCN normalised population
