Laura Houston, Community Prescribing Support Dietitian, NHS Greater Glasgow and Clyde
Redeployment from community in to acute dietetics at the start of the COVID-19 pandemic in March, was a daunting prospect. My first thoughts were of what the hospital setting would look like, of my own safety, and worry that I would be putting my family at increased risk of exposure.
Dietitians in the hospital assess patients’ nutritional risk and work face to face to create a tailored management plan. The medical team which I was now a part of, cover a high dependency unit and general wards, many of which were being used to treat patients with COVID-19 infection. The first few weeks of COVID’s emergence in hospitals saw dietitians step up, creating outstanding resources to up skill people like myself, who were coming back to work in acute settings. Webinars from renowned dietitians and the British Dietetic Association specialist groups gave me confidence in my ability to support patients in the COVID environment.
Returning to the hospital setting, I found a supportive dietetic department, a team adapting national resources to local settings, and working collaboratively with ward staff. Working differently was challenging at first; you quickly realise how fundamental communication is to dietetic intervention. For example, it is difficult to motivate a patient to change their behaviour over the phone, or to show compassion from behind a mask at a distance of two metres. In order to negotiate the best patient centred care, we had to make our relationships with the wider ward MDT even more robust.
Dietetic support with Medical High dependency unit (MHDU)
As the demand for intensive care unit (ITU) beds increased, we were finding the COVID positive population in MHDU on the rise also. With patients stepping down from ITU to MHDU and patients entering MHDU from home and ward settings, there was a rapid turnover of patients which made monitoring hard. Challenges associated with mobilising this patient group also meant that the usual ward protocols such as weighing and nutritional screening (the basis for much of our dietetic referrals), were becoming more difficult. We know already that patients in critical care settings experience challenges in achieving adequate nutrition, and with COVID-19 symptoms often including respiratory distress, changes in taste and smell, and gastrointestinal upset, this poses further barriers to eating and drinking. For example, patients on non-invasive ventilation (NIV) have to wear a mask for long-periods, leaving little room for oral intake. Good nutrition is fundamental to recovery, influencing functional and psychological outcomes, with failure to meet nutritional needs negatively impacting on muscle mass, strength and function. Working with ward staff to ensure a route for feeding, whether through nourishing supplement drinks or nasogastric (NG) feeding, was essential.
So, with limited access, and increased time and resource pressures on the wards, alongside our understanding that this patient population are at high risk of malnutrition, the team problem-solved creating ways to identify these patients early on in their COVID-19 journey. We took the decision to develop nutrition support protocols to ensure early initiation of first line interventions. We also liaised with wards daily at suitable, pre-agreed times in a form of remote screening to identify any patients at nutritional risk, in order to provide a dietetic intervention tailored to each patient.
Whilst the hospital environment has been testing at times, we rolled with it as a team and I was able to make a meaningful contribution to the COVID-19 response. I’m proud that the dietetic profession came together, responding quickly to create a platform for discussion, to share resources and support one another.
Find Laura on Twitter: @vegtibbles