Adult Dietetic Service
The adult dietetic team provide a service to both inpatients and outpatients with a range of medical conditions. These specialist dietetic services include:
The specialist dietitian supports peoples nutrition in a variety of clinical conditions from cancer to major trauma within critical care. The work is mainly with patients who have a feeding tube as these patients may be on equipment to aid with breathing and are unable to swallow. They provide support and dietary advice to those weaning off a tube feed to eating and drinking by mouth. The dietitian works with patients and relatives alongside a multi-disciplinary team involving nurses, doctors, speech therapists and physiotherapists. The dietitian is also involved with training and development of other staff on the intensive care unit and in student training.
The specialist dietitians work with patients who have a variety of conditions including inflammatory bowel disease (IBD) i.e, Crohn’s disease and ulcerative colitis, liver disease, pancreatitis and irritable bowel syndrome (IBS). They cover both gastroenterology wards at RPH and CDH and work closely within the multidisciplinary teams for both inpatients and outpatients.
Many patients with these conditions require nutritional support from the dietitian. This includes the usage of nutritional supplement drinks which provide additional calories, protein and vitamins and minerals. At times these patients require feeding via a tube or dietary changes to relieve symptoms such a low residue (low fibre diet).
There are weekly clinics across both hospital sites for advice regarding Coeliac disease and IBS. We have three trained dietitians in the Low FODMAP diet for the management of IBS. We also have a monthly decompensated liver clinic and further clinics with patients with IBD and other bowel conditions.
We are currently looking into setting up group sessions for both Coeliac disease and the low FODMAP diet.
Upper Gastrointestinal (GI)
The specialist dietitians support patients who have undergone surgery and treatment for conditions of the oesophagus, stomach and duodenum, some of whom have cancer. They cover the Upper GI surgical ward at RPH and also support the oncology ward.
They provide dietary advice for patients who have undergone surgeries to include cardio-oesophagectomies and gastrectomies and continue to provide support to these patients as outpatients. These patients are seen by dietetics pre-operatively to try and optimize them for surgery as part of the prehabilitation service (includes input from specialist nurses and physiotherapy).
The specialist dietitians care for patients with brain and spinal injury, as well as neurological conditions such as Motor Neurone Disease, Parkinson’s, Huntington’s and Myasthenia Gravis in both the acute and rehab setting.
They are active members of the Multi-Disciplinary Team (MDT) on the acute neurosurgical and neurology wards and the neuro-rehabilitation unit. As part of their role they attend MDT ward rounds, goal setting meetings and outpatient clinic appointments. This patient group often require intense dietetic input with ever changing plans, transitioning from tube feeding, to the reintroduction of oral intake and vice versa.
The use of oral nutritional supplements and modification of diets is also common within this patient group and they are involved in specialist research bodies, developing dietetic practice within these areas. At present they are involved in improving the vitamin D status of long term patients through audit and screening. We have also co-written the Nutritional standards of Practice for people with Huntington’s disease, as part of the European Huntington’s Disease Network standards of care and Quality of life group.
As part of the specialist Motor Neurone disease (MND) team at Royal Preston Hospital we are participating in both national and international research projects as well as contributing to the MND working group, developing dietetic competencies, safe staffing levels and screening tools within this patient group.
As a large neurology centre we often see rare conditions and have recently published an article in the national, Clinical Nutrition, magazine providing guidance to dietitians working with the uncommon disorder, Wilsons disease.
Head and Neck Oncology
Head and neck cancers and any planned treatments are likely to affect your ability to eat and drink.
This can lead to problems with wound healing, vulnerability to infections, prolonged recovery, delayed length of stay in hospital and a detrimental impact on quality of life.
Treatment side effects can include, swallowing difficulties, altered oral secretions, nausea, taste changes, pain and reduced appetite. All of which can mean that eating is so challenging, support in the form of tube feeding may be required.
The specialist dietitians support people undergoing treatment for head and neck cancers. They will assess your nutritional requirements and support you with an individually tailored plan to optimise your nutritional intake, taking in to account your treatment plan and anticipated side effects.
The colorectal dietitians can provide dietetic advice to patients who have additional nutritional needs when undergoing colorectal surgery or medical treatment for colorectal cancer. They work closely with the surgeons, oncologists and colorectal nurses to provide a multi-disciplinary approach to care. They are able to see patients on the ward and also in the outpatient setting including seeing patients in the Rosemere Cancer Centre, and in the dietetic clinics.
An individual can be at risk of malnutrition following a stroke. This may be due to various factors e.g. reduced dietary intake due to cognitive impairment, difficulty swallowing, problems with movement, etc. Malnutrition can have a negative impact on a person’s recovery. The specialist dietitian provides dietary advice to those identified as being at risk of malnutrition and/or require modified textured diets. This may be in the form of oral nutrition support e.g. nourishing snacks and drinks, oral nutritional supplements, etc. and/or artificial nutrition. To ensure the best patient care they work closely with other members of the multi-disciplinary team e.g. Speech and Language Therapists, Nurses, Doctors, etc. It is also their responsibility to educate other members of the MDT on how to identify those at risk of malnutrition to ensure those who need it get the appropriate dietetic care.