Issue 147 a Day in the life of...

A DAY IN THE LIFE OF , , ,

A COMMUNITY NUTRITION SUPPORT DIETITIAN Having reflected on her diary in order to write this article, Laura can honestly say that no two weeks as a Community Nutrition Support Dietitian are the same. It’s a busy and varied role that is challenging and satisfying at the same time.

Monday starts with catching up on emails, including one from an integrated care team (ICT) manager enquiring about the best weighing scales to purchase, and another from a care home manager asking about step 2 of ‘MUST’, which so many homes struggle with; I make a note to cover this at our next care home forum. I manage to book in a couple of home visits and then head off after lunch to run a training session for integrated care colleagues, including nurses and support workers, focusing mainly around the nutritional needs of older people, such as screening for malnutrition and interventions to treat it. Educating healthcare teams and care homes is vitally important, as they are the ‘eyes and ears’ on the ground, often the first to spot potential nutritional issues. They all seem really motivated about putting their new knowledge into practice.

HOME VISITS

The next day is a much more clinical affair. I visit a young man with cerebral palsy who lost a lot of weight after developing volvulus (twisted bowel) and eventually required surgery.

He’s doing really well, so I provide him and his live-in carers with lots of ‘food-first’ advice and tweak his supplement prescription to hopefully encourage some weight gain. A nursing home is next on the list, where I visit a 91-year-old lady who has advanced dementia and is immobile, unable to communicate verbally and needing one-to-one assistance with all aspects of care. She is not eating and drinking very well anymore and has lost over

10kg in the past year. Her family are there and want to know if she is going to get better. These conversations are always tough, as the irreversible nature of dementia means that improvement is unlikely; however, the family takes comfort from knowing that we can still focus on her quality of life by spending time with her and ensuring that she is comfortable and pain free.

The afternoon is busy with telephone reviews. Not everyone picks up, so I leave messages and hope I can catch up with them soon. I find out that a patient who has Huntingdon’s disease and who I’ve been seeing at home for nearly a year, has been in hospital after a fall that resulted in a head injury and who now needs residential care. I get in touch with the home to hand over some history and arrange to review the patient in a few weeks once she is settled.

On the flip side, a daughter looking after her mum at home with vascular dementia cannot thank me enough, as she has noticed a huge improvement with her mum’s cognition, mobility and bowels after implementing foodfirst advice and getting her supplement prescription sorted. This lady wasn’t well at all when I visited, so I’m chuffed to hear the impact on her quality of life, with her weight stabilising, is a bonus.

Laura Sexton RD Community Nutrition Support Dietitian, Frimley Health NHS Foundation Trust Laura has worked predominately in the community since qualifying in 2011. Her current role combines clinical nutrition support alongside prescribing support for two CCGs. She is also the meetings organiser for the BDA’s Older People Specialist Group.

REFERENCES Please visit the Subscriber zone at NHDmag.com

MDT MEETINGS

Wednesday begins in the hospital dietetic department where I finish yesterday’s letters and pick up new referrals. I meet with our students on their C placement who are doing some retrospective data collection for me to look at community www.NHDmag.com August/September 2019 - Issue 147

45

CAREER patient referral demographics and outcomes. They have learnt a lot about the nature of community dietetics just from trawling through my notes and they give me some useful ideas for future data collection. After lunch, I attend an ICT MDT meeting, where a variety of different health and social care professionals discuss the management of complex patients living in the community. There are no referrals for me this week, but I catch up with members of the team who are also involved with some of my patients. Being able to have these face-to-face conversations in the community is so refreshing, as we usually rely so much on telephone calls and emails.

My last visit of the day is with a community matron to a patient with vascular dementia who is living alone. This will be followed up by a best interests meeting next week when we will discuss his future living arrangements. The patient seems stable, but it is difficult to assess how much he is eating from carer notes, and there’s a half finished meal (presumably lunch) left by his chair.

In the medicines management team meeting the next morning, I update everyone on progress with IDDSI in the community, which has raised some significant challenges, particularly around the quality of thickener prescribing. We also discuss vitamin D and vitamin B prescribing in primary care and review some new guidance documents for GPs. The pharmacists are appreciative of my ‘outsider’ knowledge and experience and I, again, reflect on how satisfying it is to work collaboratively with different professions.

Q&A SESSION

I head off to speak at a local mental health service group for people with young onset dementia and their carers. A formal presentation didn’t feel appropriate, so I opt for a relaxed Q&A session which goes down better than expected, as they are all keen to talk and support each other. We cover many of the nutritional challenges associated with dementia, such as changes in taste, behaviour, memory and physical ability, and I realise how powerful it is to hear personal experiences first-hand, rather than just reading the theory in a textbook.

Throughout the day I have received several voicemails, so I spend the rest of the afternoon calling people back and am able to complete a few more telephone reviews.

On Friday morning, I join a teleconference with our CCG Quality in Care Homes team to discuss the upcoming care home forum. I have a regular slot where I talk about anything and everything that care homes might find useful, but as the next forum is about pressure ulcers, I’m also asked to do something on nutrition and wound healing. I see it as a useful opportunity for me to look at the latest guidance and refresh my knowledge, so, hopefully, I can squeeze in some preparation time next week.

The rest of the day is office-based, but there are plenty of telephone reviews to finish, new referrals to triage and visits to book in, plus all the inevitable admin that follows!

dieteticJOBS.co.uk • Quarter page to full page • Premier & Universal placement listings • NHD website, NH-eNews and Network Health Digest placements To place an ad or discuss your requirements:

01342 824 073 46

www.NHDmag.com August/September 2019 - Issue 147