Dietitian
What does a dietitian do on the wards?
Dietitians works closely with the ward staff to make sure patients get enough nutrition to help their recovery. Dietitians provide advice and guidance on all types of nutrition, from tube feeding (either through a tube in the nose into the stomach (Nasogastric tube) or a tube straight into the stomach (gastrostomy tube), or directly into the bloodstream (Parenteral nutrition)) to eating normally. If eating isn’t quite back to normal or people are struggling to regain weight, the dietitian will provide support and advice.
Why might a patient need to be seen by a dietitian after being on ICU?
Patients in the ICU are likely to have got liquid food through a feeding tube (link to NGT), nutrition in ICU, PN). It is likely that the feeding tube will have been taken once patients start eating on ICU. However, some people continue to need it on the ward and the dietitian will work with them to decide on the right time to get the tube out.
It is common to experience some weight loss, especially loss of muscles after being on ICU. It is very important to make to eat the right kinds of food to help regain lost muscle. The dietitian will advise on high energy and protein food or drinks to help you recover. The dietitian will also monitor your weight to make sure we are not losing any more weight.
Some people patients may struggle with eating after being on ICU. The most common issues include poor appetite, food not quite tasting as it should (with either a salty or metallic taste), feeling full quickly and feeling very tired. Others have told us that changes in their normal sleep pattern and feeling low after having been very ill can have an impact on eating. The dietitian can offer advice and support on all these issues.
When should the patient expect to see the dietitian?
Not everyone who leaves ICU will need to be seen by the dietitian. The ICU dietitian will decide if more input is needed on the ward. If this is the case people should be seen within a few days of moving to the ward. A referral can be made by the doctor or nurse to the dietitian on the ward if needed.
What is involved in the various nutritional assessments?
Weight history: the dietitian will have a chat about the patient’s normal weight, the weight they are now and will work together to set goals.
Food charts: the dietitian may ask the nurses to keep a chart of everything that is eaten and drunk, so they can work out if you are getting enough for recovery.
Calorie and protein calculations: The dietitian will work out how many calories and protein are needed every day and will compare this with what’s being eaten, as recorded on the food chart. They will also ask the patient and family for updates.
Review of blood tests: The dietitian may also look over recent blood tests you may have had to see if there are any dietary changes that may be necessary
What kind of help can patients get after they go home?
If the dietitian feels more support at home is needed, they will arrange for follow up with a local dietitian. This could be at the GP practice, home, local hospital or the hospital where the patient was treated, depending on local arrangements. Be aware it can take up 12 weeks to be seen. If the nutritional supplements (the high calorie and protein drinks) need to be continued on leaving hospital, the dietitian will provide a supply to take home, and then a prescription from the GP is needed. The dietitian will notify your GP. Patients who go home with any sort of tube feeding will be referred to a community dietitian and will be seen within 5 working days of hospital discharge.
What if patients need more help after they get home?
If weight loss continues and / or eating problems, make an appointment with your GP. They will assess if you need to be referred to a dietitian.