BAPEN | Resources | Education general advice and help

The following information has been produced in response to many individual requests for help.

We hope you will find it useful. If you would like to make any comments about it please send them to:

Ruth Newton
Chairman: Education and Training Committee
BAPEN
Sovereign Conference
Secure Hold Business Centre
Studley Road
Redditch
Worestershire B98 7LG

Extra Information for Clinicians wanting to develop a
Nutrition Support Team

Extra Information for the newly appointed Nutrition Nurse Specialist

Extra Information for the newly appointed Nutrition Support Dietitian

Extra Information for Pharmacists wanting to develop a
Nutrition Support Team

EXTRA INFORMATION FOR CLINICIANS WANTING TO DEVELOP A NUTRITION SUPPORT TEAM

1. LOCAL NETWORKING

Open up broad discussion with senior members of the Trust in preparation for setting up a Trust Nutrition Steering Committee (if one does not exist already)

2. ACTIVITIES

Successful nutritional support depends upon a team approach. Find out what interest already exists among senior nurses, dietitians and pharmacists. You (even with your junior staff!) cannot do it alone.
Start meeting regularly and form some rudimentary guidelines - but do not spend too long at this stage.
Start functioning at patient level as soon as you can. Do ward rounds together and involve your junior staff.
Use an audit approach and keep records of your activity. This will
- help to improve your practice
- help to make your case for additional resources

3. DEVELOPMENTS

A planned approach will be helpful

When you have a successful approach, offer it to other teams in the hospital - initially on a word of mouth basis.
If it is a good system and truly helps others to provide a better service for their patients, it will catch on - especially if it reduces hassle for them (see below).
Try to offer a catheter insertion service.
Work together to develop any detailed practical protocol that may be needed. Consider a wider consultation process before trying to get them adopted as Trust Policy. This will, almost certainly, involve making a case for a nutrition nurse specialist.
Consider developing a system for more general nutritional screening of patients in hospital - and audit it.
Consider developing a PEG feeding service in conjunction with Endoscopy and Speech and Language Therapy Services.
This will involve careful planning and co-operation with community services.
Consider setting up a multi professional service for following up patients requiring artificial nutritional support.
Produce regular (? annual) reports for your Directorate and/or the Trust Board.

4. RESOURCES

Become a member of both BAPEN (British Association for Parenteral and Enteral Nutrition) and ESPEN (European Society of Parenteral an Enteral Nutrition) by joining the Clinical Nutrition and Metabolism Group of the Nutrition Society.

Bring your team to the course which is organised by BAPEN and run in Grasmere as described by Howard J P et al (J. Roy. Soc. Med. 1997 90 675-8)

EXTRA INFORMATION FOR THE NEWLY APPOINTED NUTRITION NURSE SPECIALIST

1. LOCAL NETWORKING

Arrange to meet the following:

stoma nurse(s)
endoscopy nurse(s)
control of infection nurse
community staff as appropriate

2. ACTIVITIES

Find out about the basic standards of nutritional care - for all patients who are able to eat.
Observe procedures which will be relevant to your planned practice
- insertion of fine bore tubes, naso-jejunal tubes, PEG’s, mid-lines, PICCS, central lines
Familiarise yourself with
- the nursing care of patients who have had the above procedures
- discharge preparation and arrangements for patients on home enteral feeding
- ward activities at mealtimes

3. RESOURCES

Make arrangements to visit
- a district general hospital with an active nutrition support team. (The NNNG will be able to suggest useful contacts)
- a tertiary referral centre appropriate to your patients
Become a member of BAPEN by joining the National Nurses Nutrition Group - for peer support
Talk to nutrition company representatives. Compare the products currently used in your hospital with those that are currently available. It is important to do this constructively and critically. Ask companies to provide relevant research/review papers.

EXTRA INFORMATION FOR THE NEWLY APPOINTED NUTRITION SUPPORT DIETITIAN

1. BACKGROUND READING

The PEN (Parenteral and Enteral Nutrition) Group of the BDA has produced the following

Adult Enteral and Parenteral Nutrition Guidelines for Dietitians in Training
These have been devised to help dietitians to consolidate their knowledge of nutritional support. To use these effectively, it may be necessary to find a local mentor. (The PEN Group will be able to help with this if necessary).
PEN Group Standards for Nutritional Support

2. ACTIVITIES

Endeavour to keep up-to-date by reading the relevant literature and attending relevant study days.
Register for the BDA Diploma in Advanced Dietetic Practice. This will encourage dietitians to attend study days, undertake research and audit and evaluate their practice taking the most up-to-date information into account.

3. RESOURCES

Become a member of BAPEN (British Association for Parenteral and Enteral Nutrition) by joining the PEN Group of the BDA. This will provide peer support and ensure that dietitians are aware of activities occurring in the field of artificial nutritional support.
Attend the PEN Group Clinical Update. This course is run for qualified dietitians to enhance their knowledge and practice in the areas of nutritional assessment, artificial nutritional support and nutritional monitoring. The course is validated by the BDA for 120 learning hours.

EXTRA INFORMATION FOR PHARMACISTS WANTING TO DEVELOP A NUTRITION SUPPORT TEAM

1. LOCAL NETWORK

Meet with the Chief Pharmacist and discuss the clinical and technical aspects of nutritional support, liaise with the clinical services and technical services pharmacists about its provision. Contact the key leaders of nutritional support in your hospital (in particular consultants with a nutritional interest) the nutritional support dietitian and the TPN/IV therapy lead nurse. Gain an impression of their practices and policies relating to their practice.

2. ACTIVITIES & DEVELOPMENTS

Gain a complete and thorough understanding of the nutritional products supplied by the pharmacy department, including stability and compatibility issues.
Study and become aware of all standard operating procedures relating to preparation of parenteral nutrition admixtures
Attend ward rounds with consultants involved in nutritional support.
Persuade clinical pharmacists to gain a degree of "ownership" for their patients on nutritional support and, importantly, become a pivot point for advice.
Review the composition of parenteral nutrition regimens supplied by the pharmacy to ensure they are appropriate, complete and cost effective.
Produce guidelines for colleagues who will encounter nutritional support
Liaise with purchaser over Home PN (if any) in locality.
Organise departmental study sessions to increase awareness of risk factors.
Produce advice for drug/nutrient interactions e.g. Phenytoin and enteral nutrition products.
Consider audit, types of feed, regimen details, response times, wastage rates, appropriateness of feeds etc.

3. RESOURCES

Become a member of BPNG (British Pharmaceutical Nutrition Group), this will entitle you to automatic membership of BAPEN (British Association for Parenteral and Enteral Nutrition) and also reduce subscription membership of ESPEN (European Society of Parenteral and Enteral Nutrition)
Liaise with your multidisciplinary colleagues and consider attendance on Nutrition Team course organised by BAPEN.
Attend the educational symposium organised annually by BPNG for pharmacists.
Obtain copies of BPNG audit, stability and Network News documents. Obtain a copy of the interactive pharmaceutical nutrition CAD package from BPNG (planned launch late ’99).