REAL FOODS LIQUID,NUTRITIONAL SUPPLEMENT
Clinical Criteria Summary
Exclusion Criteria
- Consult to VA Registered Dietitian Nutritionist (RDN) is not completed
- Does not meet criteria for tube feeding or oral nutrition supplementation
- Commercial Blenderized Tube Feeding (CBTF) is not recommended by VA RDN
Inclusion Criteria
- Veteran has a food-related allergy that excludes the trial of other standard non-blenderized formulas (including but not limited to dairy, soy, corn, nuts, or gluten)
- Standard formulary options have been attempted and were not tolerated; formulas attempted and tolerance symptoms are documented in RDN progress notes
- Specific disease states as documented by the RDN prevent the use of standard formula
Dosage and Administration
- Dosing to be determined by RDN nutrition assessment and recommendation
- Dosing must be documented in request and/or RDN assessment
- Approved National NFS Dietary Supplement contract products:
- Compleat Standard 1.4 Vanilla for tube feeding or oral nutrition supplementation (Plant-based-vegan, high calorie, nutritionally complete; free of dairy, soy, nuts, wheat, corn; 250 ml, 350 calories, 18 g protein per carton)
- Kate Farms Peptide for tube feeding (Organic Plant-based Peptide, vegan; for impaired GI function or malabsorption and intolerance to other formulas; free of dairy, nuts, corn, wheat, soy; 325 ml, 500 calories, 24 g protein per carton)
- Compleat Organic Blends for tube feeding or oral consumption (Made with organic whole foods plus vitamins and minerals; plant-based/vegan or chicken blend varieties made without common allergens; 300 ml, 380 calories, 19 g protein per pouch)
Monitoring
- Requires routine follow-up by RDN annually or more often as needed
- RDN documentation must include justification for CBTF, monitoring for formula tolerance and appropriateness, and progress toward meeting defined therapeutic goals
- Reassessment by an RDN is required prior to prescription renewals
Renewal and Discontinuation Considerations
- When veteran no longer meets criteria for CBTF, RDN will discontinue or recommend that CBTF prescription be discontinued as appropriate
- Reassessment by RDN is required for renewal of CBTF prescription