Links with Hospital Nutrition and NST to adapt hospital policy to directorate use and to develop directorate nutrition policy
- Specialist requirements
- Training and education
- Governance and audit
Diagram showing areas of responsibilities for Directorates
Patient’s primary medical team
Must play a co-ordinating role between nutritional and other medical and surgical treatments and ensure that their patients receive excellent nutritional screening, assessment and care.
- Acknowledges the importance of the involvement of all doctors/surgeons in nutritional care as, for example, emphasised by the Royal College of Physicians and PMETB.
- Develops, fosters and encourages an awareness of the benefits of appropriate nutritional management and treatment, before during and after hospital admission, whether surgical or medical.
- Considers the patients’ mental and physical ability to eat, the integrity of gastrointestinal function including motility, digestion and absorption, the metabolism and excretory function in the context of a diagnosis.
- Prescribes treatment, taking into consideration drug nutrient interactions, surgical needs etc
- Takes note of and applies nutritional screening, and assesses and monitors nutrition employing clinical, biochemistry/haematology/microbiology information. Includes documentation of nutrition-related issues in records.
- Decides in liaison with NST, nurses, dietitians etc on the optimal approach to each patient’s nutritional needs and ensures informed consent.
- Liaises with patient and patient’s relatives: provides major source of information to patient and relatives in respect of all aspects of treatment, including nutrition.
- Leads on ethical decisions in conjunction with NST and ward nurses, taking into consideration family/carer views including interpretation of advance directives.
- Includes nutritional aspects of care in plans for discharge and out-patient follow up
- Includes nutrition when liaising with primary healthcare professionals.
Are the crucial “final common pathway” of nearly all patient-centred, ward-based care. For Nutrition they should adhere to standards set by Hospital Nutrition Steering Committee which may be adapted locally by Specialist Unit governance. They work in close co-operation with the patient’s principal medical team and the nutrition support team. Together with them they:
- Maintain an ongoing policy towards the nutritional support of patients which has continuity in the context of staff turnover.
- Employ routine nutritional screening including assessment of nutritional risk and the ability of the patient to eat.
- Maximise use of available facilities and options to achieve enjoyable, psychosocially beneficial, nutritionally effective meals and food intake.
- Take responsibility for individual patient’s food intake and co-ordinate a protected mealtimes policy at ward level.
- Help with food choices
- Help with feeding as appropriate
- Monitor/keep records of food intake when necessary
- Are alert to unsafe feeding
- Provide food, and in conjunction with dietitians, supply artificial nutritional supplements
- Provide expert safe delivery and monitoring of artificial nutritional support.
- Deliver enteral and parenteral nutrition skillfully, closely following hospital protocols and guidance
- Monitor enteral and parenteral nutrition – fluid balance, blood/urine glucose, diabetic charts, microbiology
- Prevent (cross) infection.
- Liaise with patient and patient’s relatives
- Employ timely discharge planning and liaise with the community.
Other specialist teams
A major challenge in organising excellent nutrition support is to bring groups together in a common cause to provide the highest quality nutritional care for the patient. It is a major challenge for a clinical team to organise in such a way that it works efficiently with other teams with subtly differing agendas.
Each specialist area in a large hospital may have its own governance, structure and nutrition protocols but these must be in line with overall hospital or institutional policy.
Nutrition Support services link importantly to :
- Radiology (central line insertion, Radiologically Inserted Gastrostomy insertion)
- Endoscopy (Feeding tubes, Percutaneous Endoscopic Gastrostomy, Percutaneous Endoscopic Jejunostomy insertions) will be crucial to practice organisation.
- Speech And Language Therapy will be crucial allies in the care of patients with (potentially) unsafe swallow.
- Nurse led catheter insertion services may link directly or indirectly with nutrition nurse specialists. Liaison over policy development will be vital.
- Infection control team and microbiology: particularly relevant to parenteral nutrition – there needs to be tight coherence in policies.
- Biochemistry services
- Home enteral or parenteral feeding services