Dietetics

The following describes the skills required for a novice dietitian to be able to work competently and confidently in critical care. Workforce planning should ensure that the below are included in the training and development of staff to ensure we have the necessary skills and knowledge amongst dietitians to provide safe and high-quality patient care.

Attainment of the Shared AHP Competencies, Dietetics Core Competencies and EPA sign off will ensure the clinical caseload is managed by a sufficiently skilled therapist who can work independently.  

It is recommended that critical care dietitians (especially those working in isolation) consider membership to intensive care societies such as the BDA critical care specialist group.

Prior to commencing the Dietetic Core Competencies, it is expected that a dietitian understands the key principles of the following guidelines and protocols:

  • ESPEN (2018): Guideline on clinical nutrition in the intensive care unit
  • ASPEN/SSCM (2022) Guidelines for the provision of nutrition support therapy in the adult critically ill patient
  • ESICM (2017): Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines
  • GPICS (version 3)
  • Local Critical Care Guidelines / Protocols

Some of the domains within this document can be better understood by engaging with those outside your profession (ie asking a bedside nurse to explain the lines and wires, learning from the medical team regarding shift handovers, discussing with the nurse in charge which MDT meetings are most relevant for your role and contribution). See Appendix 2 for suggested MDT shadowing experiences which will aid the completion of both shared and dietetic domains of the C3Framework.

EPA quick access

Dietetics Entrustable Professional Activities (EPAs)

Dietetics EPA 1 : Assessing critically ill patients requiring enteral nutrition support
Specifications and Limitations

This EPA includes collection, analysis and interpretation of relevant information to establish nutritional risk and inform decision making in future steps.

Context: Adult patients in the critical care setting requiring oral or enteral nutrition

Limitations: Does not include assessment of patients requiring parenteral nutrition

Required knowledge and skills

  1. C3Framework Shared AHP Competencies

  2. C3Framework Dietetics Domains:

    • Assessing Nutritional Risk
    • Biochemistry
    • Effects of Critical Illness on Nutritional Interventions
    • Metabolic Response
    • Refeeding Syndrome
    • Gastrointestinal Function
    • Estimating Targets
    • Nutritional Routes
    • Nutritional Products
Assessment to measure progress
  • Anonymised patient records of patient assessments
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care dietitian after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Dietetics EPA 2 : Establish and implement evidenced based nutrition goals, aims and care plan
Specifications and Limitations

This EPA includes: - Identification and prioritisation of nutritional problems and aetiology using information gathered through EPA 1. - The use of clinical reasoning skills and knowledge of the evidence base to create nutrition goals, aims and plan for the patient.

Context: Adult patients in the critical care setting requiring oral or enteral nutrition. It is recommended that EPA 1 is completed before EPA 2.

Limitations: Does not include assessment of patients requiring parenteral nutrition

Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. C3Framework Dietetics Domains:
    • Assessing Nutritional Risk
    • Biochemistry
    • Effects of Critical Illness on Nutritional Interventions
    • Refeeding Syndrome
    • Gastrointestinal Function
    • Estimating Targets
    • Nutritional Routes
    • Nutritional Products
    • Nutritional Diagnosis
    • Dietetic Care Plan
Assessment to measure progress
  • Anonymised patient records of patient assessments
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care dietitian after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.

Dietetics EPA 3 : Monitoring, modification and ongoing care of critically ill patients
Specifications and Limitations

This EPA involves measuring progress towards previously set nutrition goals, aims and care plan. Including identification of barriers and modification of care plan to ensure dietetic intervention goals can be met.

Context: Adult patients in the critical care setting requiring oral or enteral nutrition. EPA 1 and 2 must be completed prior to undertaking EPA 3.

Limitations: Does not include assessment of patients requiring parenteral nutrition

Required knowledge and skills
  1. C3Framework Shared AHP Competencies
  2. C3Framework Dietetics Domains:
    • Outcomes
    • Dietetic Care Plan
    • Discharge Planning
    • Handover
    • Outreach Follow up Clinics
Assessment to measure progress
  • Anonymised patient records of patient assessments
  • Supervision documentation
  • Reflective reports
Basis for formal entrustment decisions

An entrustment decision should be made by an experienced critical care dietitian after observing this EPA completed on more than one patient.

Use the EPA Completion Template (PDF, 88KB) for this.