Blog by Carleen Barry – Band 5 rotational Dietitian covering Gastroenterology/Medical
As a newly qualified band 5 Dietitian I often carry a diverse caseload of patients.
I currently cover the band 5 Gastroenterology/Medical rotation at the Trust and I work alongside two part-time band 6 specialist gastroenterology Dietitians and between us we cover a specialised gastroenterology ward. In addition to this I also cover four medical wards including two medical assessment units.
My day-to-day is far from predictable and can all change from one simple phone call at 8:30am. Therefore, I thought I would share with you a regular Thursday of mine.
My days start at 8:30am in the office catching up on emails, checking our online referral system, and liaising with the rest of the Dietitians for a team huddle.
Artificially fed patient
My first patient of the day is a patient well known to our community Dietitian’s team whom requires artificial feeding via a tube into the stomach called a Percutaneous Endoscopic placed Gastrostomy (PEG). This patient had been admitted to Derriford for an organised PEG replacement due to complications. So, my role is to work with the broader multidisciplinary team to communicate and organise loose ends. This ensures the wider community team are up-to-date and as prepared as they can be for when the patient is discharged back into the community. Whilst this patient is on the wards I liaise with the multidisciplinary team to ensure particular post procedure checks are carried out and all supplies of feed, syringes, and after care tools are organised. The complexity of this particular patient is heightened due to a severe learning disability. This means all of my information comes from the patient’s parent, and their ability to understand the patient needs. A smooth admission and discharge is reliant on us all working together meticulously.
Complex Eating Disorder patient
Next up was a patient whom had not been under my care as such but had been seen by both the band 6 gastro Dietitians. It was a non-working day for both of them and this highly complex patient was pending discharge upon dietetic review. To prevent delaying discharge I arrived on the ward and spoke with the medical staff and the patient. Together we came to an agreement for the discharge plan and how this particular patient could be further supported in the community. Although eating disorders is a specialist area, we are able to provide the best possible care as a multidisciplinary team. Effective communication and active listening skills are central to successful patient treatment and discharges.
Re-feeding Syndrome patient
A patient on one of the Medical Assessment Units was referred for dietetic input after presenting with alcohol withdrawal and minimal nutritional intake. Both of these presenting conditions are just two of several factors which could put a patient at risk of re-feeding syndrome. Unless you work as a Dietitian or is someone who works within the clinical setting, it is unlikely you would have heard of this syndrome. Re-feeding syndrome is a serious but potentially preventable syndrome as long as it is identified early enough. A registered Dietitian like me will assess the patient and implement the trust protocol to ensure the risk is minimised. Not all patients who are referred to a Dietitian are at risk of re-feeding syndrome. However, we do rely on trained members of staff to use a specially designed tool to identify those patients at risk of malnutrition. Then I or another member of the dietetics team can carry out a fall nutritional assessment.
As with any patient it was vital I worked as part of the multidisciplinary team to highlight this patient as a risk. These includes working with the Doctors to prescribe essential vitamins, check biochemistry daily and treat promptly if any are out of range. I communicate effectively with the nursing staff to ensure they know the precautions they need to take in preventing an increased risk, and document my full assessment in the medical notes. I worked closely with this patient over the next coming days to gradually reintroduce nutrition until they were meeting their nutritional requirements and were no longer at risk of re-feeding syndrome.
Ulcerative Colitis Patient
My last patient of the day was diagnosed with Ulcerative Colitis, a form of irritable bowel disease, 6 months prior to this admission. They presented to the emergency department after disease symptoms had resulted in a minimal nutritional intake and weight loss. Although I am not a specialist gastroenterology Dietitian I can still play an important part in treating this patient whilst they are admitted to the ward. This patient group can also be at risk of re-feeding syndrome, along with being malnourished, dehydrated and in a great deal of discomfort. I carried out a full nutritional assessment and discussed this with the patient to gain an understanding of their own knowledge of their disease. This particular patient had not had any input from a Dietitian before this admission and was very keen to further their understanding of how best to manage their symptoms and prevent further weight loss. I started them on oral nutritional supplements to support their limited nutritional intake. These are specialist drinks which can provide vital calories, protein, vitamins and minerals, when individuals cannot obtain enough from their diet alone. Again, I also worked alongside the multidisciplinary team to provide prescriptions of much needed vitamins and minerals. Whilst they are an inpatient my aim would be to prevent any further weight loss and support them as best as I can. Once they have been discharged they are often invited to an out-patient appointment to see the specialist gastroenterology Dietitian.
As we are registered professionals our patients can expect to be treated with only the most up-to-date evidenced based care. We are proud to be in a position of responsibility, where we hold extensive knowledge that allows us to put our patients first.