Online applications for Forticreme, Fortijuce or Scandishake

HIQA have stated the following:

A nutritional treatment plan is developed which takes account of the resident's preferences and recommendations from the relevant health professionals.

• Under HIQA guidance (National Standards for Residential Care Settings for Older People in Ireland 2016), nutrition care plans must take into consideration your resident’s preference for a particular oral nutritional supplement as well as the recommendations of relevant healthcare professionals, e.g. Dietitian/Speech & Language Therapist.

The criteria below each heading should provide sufficient rationale to ensure approval of an online application.

If your resident has Dysphagia:

• Click “dysphagia” tick box.
• Are they on a thickener? State this in the comment box.
• Forticreme recommended by X (e.g. Dietitian, Speech & Language Therapist) as most clinically appropriate. Potential clinical risk if switched to liquid oral nutritional supplement. No suitable alternative on List A.

If your resident is non-compliant with liquid oral nutritional supplements:

• Liquid oral nutritional supplements trialled but not tolerated by resident therefore pudding style recommended by X (e.g. Dietitian). No suitable alternative on List A.
• As per HIQA guidance: “A nutritional treatment plan is developed which takes account of the resident's preferences and recommendations from the relevant health professionals”.
• Potential clinical risk if patient is switched to List A product given history of noncompliance with liquid oral nutritional supplements.

If your resident is on Forticreme in addition to a liquid oral nutritional supplement:

• X (e.g. Dietitian) recommended Forticreme in addition to liquid oral nutritional supplements to meet nutritional requirements. Unable to tolerate/comply with additional liquid oral nutritional supplements.
• As per HIQA guidance: “A nutritional treatment plan is developed which takes account of the resident's preferences and recommendations from the relevant health professionals”.

If your resident is on Forticreme due to a fluid restriction:

• Resident is on XXXml daily fluid restriction. Based on recent fluid record charts will exceed same if switched from Forticreme to liquid oral nutritional supplement. No suitable alternative on List A.

If your resident is non-compliant with milk-based liquid oral nutritional supplements:

• Milk-based oral nutritional supplements trialled but not tolerated by resident therefore juice style supplement recommended by X (e.g. Dietitian). No suitable alternative on List A.
• As per HIQA guidance: “A nutritional treatment plan is developed which takes account of the resident's preferences and recommendations from the relevant health professionals”.

Medical Indication:

• Provide medical indication, e.g. fat/lactose intolerance, electrolyte restriction/renal impairment or fluid retention (Fortijuce is lower in protein & electrolytes, including sodium).

If Scandishake is being taken as a milkshake/drink:

• Recommended by X (e.g. Dietitian) as resident requires high energy oral nutritional supplement (~590 calories per serving). No suitable equivalent on List A.

If your resident is on Scandishake and won’t take any other oral nutritional supplement:

• Trialled on all other List A supplements – non-compliant with same. Will only take Scandishake.
• As per HIQA guidance: “A nutritional treatment plan is developed which takes account of the resident's preferences and recommendations from the relevant health professionals”.

If Scandishake is being used to fortify foods/drink:

• Scandishake powder is used to fortify meals/drinks. As Scandishake is more energy dense that other List A powders switching to an alternative powder would lead to a calorie deficit and subsequently impact nutritional status.