Sip Feeds and Guidelines
Jon Durand
Medicines Management
NHS Hampshire
What are we trying to achieve?
 Weight gain
 Patient survival
 Better health/healing
 Better nutrition?
 Good patient experience?
What type of patient might be using sip
feeds?
 Elderly
 Undernourished
 Terminally ill
 Drug addicts
 Care home patients
 Anybody
What are the pressures on clinicians to
prescribe sip feeds?
 Patient requests
 Patient’s relative requests
 Care home requests
 Poor catering facilities
 Caring GP/Nurse requests/prescribers
 Guidelines
How appropriately are sip feeds used?
Scenario – elderly patient in care home is given a sip
feed for lunch. What happens next?
 Patient drinks whole carton happily
 Patient is left alone/forgotten about
 Cannot use straw
 Doesn’t like sip feed – texture/taste
 Sip feed gets taken away before patient can finish it
 Patient cannot communicate their needs
What do we need to do?
 Regular reviews of all patients
 Monitor patients
 Prescribe appropriately
 Use appropriately
 Follow guidelines – see next slides
Who are sip feeds for?
 Patients with a MUST score ≥ 2 or BMI ≤ 18.5.
 N.B. Patients with a BMI > 18.5 can still be
malnourished.
 This could include patients with dysphagia or
malabsorption.
 Patients who do not meet the criteria, but may be at
risk might need sip feeds or some nutritional support
from OTC products such as Complan and Build-Up.
 (MUST Tool available at www.bapen.org.uk).
What do I give?
Treatment should be two bottles a day in addition to usual food
intake for 30 days, or less if you wish to review earlier.
Certain patients who rely on sip feeds as their sole source of
nutrition will need advice from a dietitian and more than two
bottles a day.
To aid patient choice, endorse “mixed flavours”. Some
manufacturers offer starter packs to assist with taste choice.
Prescribe acutely, do not put on repeat.
Review before prescribing again. Consider giving food
fortification advice and appropriate diet/recipe sheets.
What are my options at review?

Check weight and compliance.

Continue for another month unchanged if necessary.

Adjust quantity to suit patient requirements.

Give dietary advice and or leaflets if available.

Consider changing to OTC foods as a meal replacer such as
Build-Up and Complan (non-prescribable, but available OTC).

Refer to a Registered Dietitian if you feel it is necessary.

Reassure patients that they have “permission” to eat foods
that they might perceive to be unhealthy. E.g. full fat dairy
foods.

If no longer required, stop prescribing. (Target weight
achieved, improved MUST score)
How do I stop prescribing?
 Re-screen and reassess.
 If patient no longer malnourished and no longer at
risk, sip feeds should not be required.
 In order to maintain improved nutritional status,
consider possible options as above plus care plans
and motivational assistance from a Registered
Dietitian.
Guidelines for Review of Patients on Long
Term Sip Feeds
A Review should include the following:
1. A re-assessment of patient’s current weight and comparison to
expected weight. An assessment of nutritional requirements
2. An assessment of current intake alongside patient’s social and
physical circumstances.
3. An estimate of which nutrients may be in short supply.
4. An individualised action plan.
5. A mechanism to ensure that the patient is reweighed at monthly
intervals.
Who do I ask for advice?
 Registered Dietitians (RDs) are the only qualified health
professionals that assess, diagnose and treat diet and nutritional
problems at an individual and wider public health level.
 Dietary resources and advice leaflets are available from Dietetic
Departments and/or Registered Dietitians.
 Community Nurses who have received full MUST training are also
able to undertake such an assessment and understand when to
refer on to a dietitian.
Commonly Prescribed Sip Feeds and Alternatives
Fruit Juice
Style
Pudding
Style
Fresubin Energy (300kcal in 200ml)
Fresubin 2Kcal (400kcal in 200ml)
Fresubin Energy Fibre (300kcal in
200ml)
Fresubin 2Kcal Fibre (400kcal in
200ml)
Provide Xtra
(300kcal in
200ml)
Fresubin
Crème (225
kcal in 125g)
Fortisip Bottle (300 kcal in 200ml)
Fortisip Compact (300 kcal in 125ml)
Fortisip Multifibre (300 kcal in 200ml)
Fortijuice
(300 kcal in
200ml)
Forticreme
Complete
(200 kcal in
125g)
Ensure Plus (305 kcal in 220ml)
Ensure Plus Fibre (305 kcal in
220ml)
Ensure Plus
Juice (305
kcal in
220ml)
Resource Energy (300kcal in 200ml)
Resource Energy 2.0 Fibre (400kcal
in 200ml)
Resource
Fruit
(254kcal in
200ml)
Manufacturer
Milk Shake Style
Fresenius Kabi
Nutricia
Abbot
Nestlé
Complan
Complan Shakes, various flavours
(251 kcal in water, 387kcal with
200ml milk)
Resource
Dessert
Energy
(200kcal in
125g)
Powdered Products
Build - up (263kcal
per sachet with
200ml of FULL FAT
milk) – NB OTC
only.
Complan (382kcal
per sachet with
200ml of FULL FAT
milk) – NB OTC
only.
Remember
 Prescribe Acutely
 Reassess and or Refer Before Repeating
 Review Frequently
Thank you!