I have worked as a dietitian in critical care for over 25 years, with the last 18 years in the Intensive care unit at the Royal Infirmary of Edinburgh. My vision, as the Lothian dietetic lead for critical care, is to provide the highest standard of nutritional care through an engaging, educated and research driven critical care dietetic team.
So, what does this look like in practice?
Firstly, we provide a highly visible and responsive dietetic service to critical care with participation in ward rounds, handovers, multidisciplinary meetings and case conferences. We proactively screen all critical care patients to ensure active involvement in initiating timely nutritional support and the provision of individualised nutritional care – one size does not fit all.
Secondly, we deliver quality nutritional care reflecting current evidence base. This involves having an awareness of how much nutritional support should be delivered during the different phases of critical illness, how much nutritional support is actually delivered and what measurable impact nutritional support has on patient outcomes.
This has definitely proven to be a challenge during the pandemic as we initially had limited data on the clinical features and subsequent medical treatment, and a complete lack of COVID-19 specific recommendations for nutrition therapy. We worked hard to adapt our practice as new knowledge and research gave us a better understanding of how to provide nutritional care for COVID ICU patients.
Thirdly, we have a research driven agenda to answer some of the nutritional unknowns in critical care.
I wanted to know what happened to nutritional intakes in ICU survivors and this led me to undertake a PhD looking at the factors that influenced nutritional recovery in patients after critical illness. I was subsequently awarded an NRS fellowship to continue my work in this area and I now work as a clinical academic dietitian.
Finally, we engage in the teaching and training of medical and nursing staff, other members of the multidisciplinary team and our dietetic colleagues. With so many different health professionals involved in the provision of nutritional care to critically ill patients during and after ICU stay, it should part of our role as critical care dietitians to ensure the wider team is aware of the nutritional issues faced by such a complex patient population.
You can always learn something new!
I can honestly say despite 25 years of working as a critical care dietitian I am still learning: the implications for nutrition as a result of an obscure medical condition; how to adapt dietetic practice in the midst of a pandemic; and how technology can improve care having just launched “Tailored talks” in NHS Lothian, a digital platform that provides personalized information, support, and advice to COVID-19 survivors and their carers/families.
Dr Judith Merriweather is Critical Care Dietitian, Clinical Lead for Critical Care Recovery Service with NHS Lothian. She is also a NRS Clinician and University of Edinburgh Honorary Fellow.
Follow Judith on Twitter @JudithMerriwea2