SKILLS & LEARNING
EXTENDED ROLES IN DIETETICS: A CASE STUDY Kaylee Allan RD ICU Dietitian, Southmead Hospital Bristol Kaylee works as a Critical Care Dietitian in Bristol and is undertaking a MClinRes part time with Plymouth University. Her interests are ICU, research and sports nutrition.
Extended roles in the NHS have shown to boost job satisfaction, improve the dietetic profile, enhance multidisciplinary team learning and most importantly, provide better patient care.1,1a This article takes a look at a recent case study that highlights the positive outcomes of extended roles in dietetics. Within dietetics, there are many clinical specialists with extended roles as part of their day-to-day responsibilities. Roles which were traditionally held by nursing or medical professionals are now held by dietitians working beyond their recognised scope of practice. In an effort to modernise the NHS, extended roles were introduced amongst Allied Health Professionals (AHPs), which have been shown to boost job satisfaction, improve the dietetic profile, enhance multidisciplinary team learning and most importantly, provide better patient care.1 There is a gap within the available literature which firmly concludes that extended roles enhance patient care. However, it is well reported that patient outcomes are likely to be
improved due to earlier interventions, where traditionally procedures were performed by medical staff.2 There is little known about the effectiveness of AHP training programmes and competency frameworks which underpin extended scope of practice. Nevertheless, there are many examples within dietetics of highly skilled extended roles, like feeding tube insertion and requesting condition specific blood tests and scans, all of which require training and an awareness of the liability associated with the job.3 This article explores a recent case study and the impact of two dietitians with different extended roles, and the benefit to the patient care. To protect patient confidentiality, details have been adjusted.
CASE STUDY A 50-year-old gentleman admitted to the intensive care unit (ICU) following a road traffic collision. Injuries included multiple broken ribs, fractured sternum and pneumothorax. Due to chest injuries and the difficulties maintaining his oxygen requirements, the patient was ventilated and sedated on day one. The patients’ ability to ventilate worsened due to respiratory failure, and the decision was made to prone (ventilate the patient, face down instead of supine). At this stage, the ICU dietitian was asked to review the patient and make a decision about the feeding options. Assessment Table 1: Initial assessment made by ICU dietitian Assessment Baseline (weight, height, BMI*) Admission details PMH+ Discussions with medical team *BMI (body mass index) +PMH (Past Medical History) **NG (nasogastric) ++ NJ (nasojejunal)
Findings BMI >30kg/m2 Respiratory failure, prone position, vomiting, no NG** feeding tube in situ. Gastric band placed eight years ago to aid weight loss. Failing to ventilate, oesophageal dilation on CT, gastric band in situ, vomiting, unable to pass an NG tube. Team would like an NJ tube placed at bedside to prevent vomiting whilst patient is in a prone position. Patient desaturates quickly when returned to supine position, making NJ++ insertion difficult.
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