Emma Jenkins, Paediatric Dietitian
Cwm Taf University Health Board
This Bevan Exemplar project has enabled a pre-existing tool to be used by other healthcare staff, in the absence of a dietitian, to calculate adult nutritional requirements.
Paediatric dietitians in Cwm Taf University Health Board (UHB) use an Excel tool (that was developed in-house) to calculate nutritional requirements and devise tube feeding plans.
The tool was initially devised to improve accuracy and to reduce time spent calculating individual nutritional requirements and feeding plans, for tube-fed patients.
Dietitians are skilled in this process and can produce individual personalised feeding plans. However, these calculations can be time-consuming, impractical to complete at patients’ bedsides or in outpatient settings, and therefore additional appointments are often needed to discuss proposed feeding plans, once requirements are calculated. This method does not facilitate co-production, doesn’t utilise resources effectively and can lead to inappropriate variation.
7 day dietetic cover is not available in Cwm Taf UHB. If tube feeding plans are required, when dietitians are unavailable, generic emergency feeding plans are used. These plans are not individualised, and therefore don’t allow healthcare staff to provide only nutrition that is needed, no more or less.
This project aimed to test whether the existing Excel tool could be:
Amended for calculation of adult nutritional requirements.
Used by other healthcare staff, in the extended absence of a dietitian, to achieve individualised, target feeding plans, in a more prudent way.
Challenges included limited use in community settings as the tool is stored on internal IT systems. A mobile device is being sought to enable an initial trial in community settings and improve the efficiency of community dietetic care. Other challenges included potential changes in the way that nutritional requirements are calculated. Therefore planned updates to the tool have been halted, but when these changes are incorporated, the tool can be used to ensure accurate calculations with reduced variation while a new practice is established.
The tool does not consider the risk of refeeding syndrome – a serious condition that can be overlooked when initiating tube feeding. An update is being added to highlight patients at risk, further reducing human error and improving safety of patient care.
Using the Excel tool enables dietitians to calculate nutritional requirements accurately and devise a tube feeding plan in minutes. This allows for improved co-production with patients and carers; with feeding plans easily being discussed, modified and agreed at the point of assessment.
Introduction of the tool for use by other healthcare staff could reduce the time taken to fully meet nutritional requirements, with potential to reduce the length of patient stays.
Reducing time spent calculating requirements and feeding plans allows dietitians to direct their resources more efficiently, to those with the greatest health need. This equates to potential savings of around £2500 per annum for paediatric caseloads alone.
The Excel tool will be updated, to reflect the needs of those using it, by incorporating:
The changes in the way nutritional requirements are calculated.
A prompt system to highlight the potential of refeeding syndrome.
The nutritional content of powdered feeds that are made at non-standard concentrations.
This updated tool will be trialed with dietitians and other healthcare staff working in a range of settings.
Alternative methods of sharing and storing the tool will be researched in order to make the tool more portable and accessible, particularly to those staff working in community settings.
“Truly valuable experience that changes mind-sets, creates networks and opportunities, and ultimately provokes innovative thinking to challenge and improve!” Emma Jenkins, Paediatric Dietitian “It’s great – I’ll be using it!” Dietetic staff member
Part of cohort Bevan Exemplar Projects 2017-18