Within 24-48 hours of admission services: The clinical Dietitians provide inpatient services to all patients requiring nutritional intervention.
When evaluating the impact of achievements it is necessary to look at the change in the patient profile of this institution. Since the opening of the New Oncology Centre, there has been a definite shift in the inpatient profile in the pediatric and adult population towards care for oncology patients, in many instances palliative in nature. This change can even be observed in the Intensive Care Unit (ICU) settings where more critically ill cancer patients are seen by the clinical Dietitian in the ICU settings. Providing optimal nutritional care for cancer patients is impacting on the available resources of this institution such as in the issuance of Nutrition Take Home Supplements (Formula) which most often used for cancer patients.
Care of the cancer patient in this institution is therefore one of the areas where the input of the department through the clinical Dietitian has led to a noticeable improvement in quality of life of often terminally ill patients. Through the efforts of the clinical Dietitian in this area, medical and nursing staff now recognizes the importance of nutrition. The Dietitian’s unique skills and training allow him/her to relate to the patient’s psyche and by using food preferences and food tolerances, he/she helps patients to achieve better quality of life. The clinical Dietitian is now a valued member of the multidisciplinary care team of cancer patients, whatever the treatment modality might be.
The same can be said for pediatric cancer patients. Nutritional support of children with cancer has shifted focus from total parental nutrition – which meant hospitalization – to very
successful Nasogastric feeding as well as oral nutrition support. This allows the patient more time out of hospital and a better quality of life. At the same time nutrition support helps the patient to continue growing and developing throughout the period of treatment. All pediatric cancer patients are screened upon first admission and other micronutrient deficiencies are frequently diagnosed and corrected.
- Diabetic and Endocrine Patients:
Pediatric and adult diabetics treated at this institution are another group that has benefited from the continued input of a clinical Dietitian as part of a multidisciplinary management team. As the diet is one of the cornerstones in the management of diabetes, the clinical Dietitian plays an important and very valued role in the management of these patients. The success of this approach can be seen in the very infrequent admissions of uncontrolled pediatric and adult diabetics and bears witness to the commitment of all the team members.
- Renal and Haemodialysis Patients:
Another area where measurable and considerable improvement in patient care has been achieved is in the care of renal patients and especially patients on hemodialysis. The Clinical Dietitian has been assigned to the Renal Unit and together with other team members has established excellent standards of care of this subgroup of patients. Evidence based nutrition is now practiced where monthly blood analyses are documented and followed to identify specific trends and changes and to monitor nutritional status. Nutrition care is then tailored made to the needs of a specific patient. Through regular plotting of values and monthly statistics, standards of care are obtained. Through these it has been observed those adequacies of dialysis as well as the nutritional status of patients of this unit have improved markedly.
The impact of this department through its clinical Dietitian has also gone beyond this. The Clinical Dietitian is responsible to do the nutrition education pamphlets and dialysis guidelines. As a consequence of this all these materials is now become available to the department and will be of great benefit to patients of this institution.
Additional enteral feeding pumps have been recommended and gained by the Nutrition Department. These pumps have resulted in improved patient tolerance of enteral feeding regimens and reduced nursing time.
- Multidisciplinary Meetings:
All multidisciplinary meetings for each ward are attended by a Dietitian, communicating with the health care team about patient care and progress and also to achieve a timely referral of appropriate patients.
Specialised diets were formulated in conjunction with all patients with specific disease such as patients admitted with gestational diabetes are on corresponding dietary regimens. This allows for faster blood glucose stabilisation by the medical team and therefore a hastier discharge from hospital.