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It is important to identify and treat patients who are malnourished or at risk of becoming malnourished as soon as possible.
The PCT supports a ‘Food first’ policy and patients are provided with practical advice on ways to make meals and snacks more nutritious by increasing the protein and energy in their diets.
ONS are a medical intervention and should only be provided to patients who are classed as malnourished or at risk of malnutrition, where dietary intervention (such as food fortification, altered meal patterns, pureeing of food, assistance with feeding) has not promoted an improvement in nutritional status. They are a food supplement, not a food substitute, and so should not be used as a meal replacement or a sole source of nutrition (unless recommended by a dietitian).
A screening tool known as the Malnutrition Universal Screen Tool (MUST) is used to assess patients’ nutritional status and ONS should only be initiated by non dietitians in line with MUST score, in conjunction with a holistic view of the patient. NB Some patients under the care of acute services such as oncology or renal patients may require ONS outside of the MUST guidance.
The PCT policy is set out in the following document to ensure ONS are only used where appropriate. Patient information leaflets on practical ways to provide nutrition under the ‘Food First’ scheme are embedded in the policy document.
Reference: NICE CG 32 Feb 2006 Nutrition Support in adults | 
