SERVICE OUTLINES AND STANDARDS. 6.1 As ONS are not Prescription Only Medicines (POM) an NHS GGC Approved Prescribing Protocol for the management of specified ONS products by Registered Dietitians will be used (Appendix 5). This authorises Registered Dietitians to directly request a prescription for specific categories and doses of ONS. 6.2 On receipt of an ONS Dietetic Request Form (Appendix 2) the Community Pharmacy will: • Explain the service to the patient; • Register the Patient using the Patient Registration form - (Appendix 3); • Supply the patient with supplements detailed on the ONS Dietetic Request Form (Appendix 2); • Identify patient follow-up arrangements and use the Community Pharmacy Guidance Pathway (Appendix 1) to decide and undertake next steps. It would be reasonable to obtain verbal consent (for housebound and care home patients) and document this when a signature can’t be obtained. Please note that this consent is informed and voluntary. If there are any concerns about the individuals capability to consent the Dietitian will already have indicated this on the ONS request form. 6.3 On receipt of an ONS Monitoring Transfer form (Appendix 4) the Community Pharmacy will: • Undertake the monitoring detailed on the ONS Monitoring Transfer Form (Appendix 4), to monitor progress for patients that have been discharged from active dietetic review against the targets / markers provided on the form, reducing and discontinuing ONS prescriptions or re-referring to dietetics as indicated. 6.4 The pharmacy will supply the patient with the specified ONS product and dose for the duration indicated. The duration indicated will be either: ‘Ongoing’ - in which case the pharmacy should prescribe every 28/31 days until further instruction is received from the Dietitian (usually within 3 months); Time limited - e.g. 1 week for trial purposes, or for 4 weeks only following hospital discharge. 6.5 ONS prescribing should be discontinued when: • A time limited duration has ended; OR • A Dietitian contacts the pharmacy to advise discontinuation of ONS: OR • The patient successfully achieves the targets set by the Dietitian as per the ONS monitoring form (Appendix 4). 6.6 The pharmacy will refer the patient back to the dietitian if: • The patient’s nutritional status declines to markers as specified on the ONS Monitoring Transfer Form: OR • If the patient is still prescribed ONS after 12 months of community pharmacy monitoring (in this instance, ONS prescribing by the pharmacy should continue until further notice is received from the Dietitian). 6.7 The Pharmacy Contractor will utilise the “Local Services” tab on the UCF to obtain payment for the cost of the supplements provided. 6.8 Details of the patient will be securely shared (electronically) with the patient’s GP practice via a locally agreed process. Standard forms e.g. letter to GP re ONS discontinuation or letter to GP re ONS discontinuation will be used. 6.9 Completed claim form(s) will be returned to the Community Pharmacy Development Team (CPDT) on: - Initial sign up; - Registration of each patient entering the service; - The provision of monitoring for any patient once discharged from active direct dietetic review. 6.10 Patients re-presenting to the community pharmacy after having been discharged from the service will be assessed using the MUST tool and if appropriate will be referred to their GP or Dietitian for further review.
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SERVICE OUTLINES AND STANDARDS. 6.1 As ONS are not Prescription Only Medicines (POM) an NHS GGC Approved Prescribing Protocol for the management of specified ONS products by Registered Dietitians will be used (Appendix 5). This authorises Registered Dietitians to directly request a prescription for specific categories and doses of ONS.
6.2 On receipt of an ONS Dietetic Request Form (Appendix 2) the Community Pharmacy will: • Explain the service to the patient; • Register the Patient using the Patient Registration form - (Appendix 3); • Supply the patient with supplements detailed on the ONS Dietetic Request Form (Appendix 2); • Identify patient follow-up arrangements and use the Community Pharmacy Guidance Pathway (Appendix 1) to decide and undertake next steps. It would be reasonable to obtain verbal consent (for housebound and care home patients) and document this when a signature can’t be obtained. Please note that this consent is informed and voluntary. If there are any concerns about the individuals capability to consent the Dietitian will already have indicated this on the ONS request form.
6.3 On receipt of an ONS Monitoring Transfer form (Appendix 4) the Community Pharmacy will: • Undertake the monitoring detailed on the ONS Monitoring Transfer Form (Appendix 4), to monitor progress for patients that have been discharged from active dietetic review against the targets / markers provided on the form, reducing and discontinuing ONS prescriptions or re-referring to dietetics as indicated.
6.4 The pharmacy will supply the patient with the specified ONS product and dose for the duration indicated. The duration indicated will be either: ‘Ongoing’ - in which case the pharmacy should prescribe every 28/31 days until further instruction is received from the Dietitian (usually within 3 months); Time limited - e.g. 1 week for trial purposes, or for 4 weeks only following hospital discharge.
6.5 ONS prescribing should be discontinued when: • A time limited duration has ended; OR • A Dietitian contacts the pharmacy to advise discontinuation of ONS: OR • The patient successfully achieves the targets set by the Dietitian as per the ONS monitoring form (Appendix 4).
6.6 The pharmacy will refer the patient back to the dietitian if: • The patient’s nutritional status declines to markers as specified on the ONS Monitoring Transfer Form: OR • If the patient is still prescribed ONS after 12 months of community pharmacy monitoring (in this instance, ONS prescribing by the pharmacy should continue until further notice is received from the Dietitian).
6.7 The Pharmacy Contractor will utilise the “Local Services” tab on the UCF to obtain payment for the cost of the supplements provided.
6.8 Details of the patient will be securely shared (electronically) with the patient’s GP practice via a locally agreed process. Standard forms e.g. letter to GP re ONS discontinuation or letter to GP re ONS discontinuation will be used.
6.9 Completed claim form(s) will be returned to the Community Pharmacy Development Team (CPDT) on: - Initial sign up; - Registration of each patient entering the service; - The provision of monitoring for any patient once discharged from active direct dietetic review.
6.10 Patients re-presenting to the community pharmacy after having been discharged from the service will be assessed using the MUST tool and if appropriate will be referred to their GP or Dietitian Dietician for further review.
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Sources: Service Level Agreement