Experiences of the Dietetic Department at Newham Hospital during the Covid-19 pandemic
Diana Markham, clinical lead dietitian at Newham Hospital, shares her experiences of working in the Dietetic Department during the Covid-19 pandemic.
As the Covid-19 pandemic started to unfold early in the year, all departments within our hospitals had to react swiftly to changes in practice and new ways of working. The Nutrition and Dietetic departments were no exception to this, and stepped up to the mark brilliantly.
The Newham Hospital (NUH) Dietetic department is the smallest within Barts Health and our clinical workload is around 55% outpatient work and 45% inpatients. It became apparent early on that we needed to close down the majority of our outpatient services and retrain the community based dietitians to cover inpatient work as well as upskill the acute team, so that everyone could cover basic ICU caseloads. We were also able to assist other sites by sharing staff with them.
CPD was undertaken to ensure the team was upskilled, enabling staff to manage ICU and Covid-19 caseload. It was also essential that staff were trained in areas outside of the usual remit, as they were required to cover for colleagues. Alas, other CPD events that had been planned were cancelled.
Weekend working was introduced during the peak of the epidemic, to ensure that all patients were assessed and reviewed very promptly.
The specialist enteral feeds required by this group of patients, is in high demand nationally resulting in shortages. Whilst NUH had sufficient stocks , other sites within the trust did not and our Dietetic colleagues faced challenges to redesign enteral feeding regimes in order to meet their patients requirements. We worked collaboratively to assist the other sites to help with specialist feeds and equipment. Our ordering of feed stocks and equipment had to be thorough and rigorous.
Policies, protocols and standard operating procedures (SOPs), covering various areas were developed with colleagues across the other sites, and produced at pace.
Some of the positives from the experience:
- Increasing the skill mix and competencies of the department so that we are in a good position to respond should another surge or pandemic occur
- Enhanced support and team working within the department and with our colleagues
- New guidance documents produced which will be embedded in normal practice
- Using virtual means to contact outpatients in order to continue providing dietetic care
- At NUH, a Dietetic service will be maintained now on bank holidays ensuring there will always be a 5 day per week service throughout the year
Some of the challenges facing us now:
- Continuing to adapt to the new ‘normal’ with having Covid +ve as Covid –ve patients within our caseloads and the impact this has on the daily routine
- Ensuring that the newly acquired skills remain in place within the team
- Rebuilding the out patient services in a different format with far fewer face to face contacts and more virtual consultation. These include a video once it has all been established. Clearing the backlog of cancelled appointments is going to take us a while
- For the foreseeable future, far more meetings and discussions will remain virtual ones
To mark Dietitians week 2020, the team have put together a Nutrition misinformation document to help highlight the importance of the profession.