Dietetics EPA1 Assessing critically ill patients requiring enteral nutrition support

Able to demonstrate knowledge of general infection control prevention and control including hand hygiene, aprons, masks and aseptic non-touch technique

Has completed Basic Life Support Training as per local trust policy

Describes how they would summon help in an emergency and locate crash bells

Describes how to call a medical emergency call via switch

Describes own role and expected contribution in medical emergency eg. Basic Life Support, providing assistance to MDT as able

Demonstrates positive patient identification and awareness of allergies

Demonstrates how to monitor vital signs (Temp, HR, SpO2, RR, blood pressure, MAP)

Interprets observations in an ICU setting, considering trends and normal ranges for all (Temp, HR, SpO2, RR, blood pressure)

Able to troubleshoot difficulties with taking vital signs eg. poor trace on pulse oximeter, missing ECG leads, positional sensitivity of arterial line

Awareness of who to escalate concerns to in relation to patient safety with recognition of different levels of urgency and reporting to different staff members dependent on situation

Can describe the bed numbering, storage location of safety equipment, location of offices and other key areas within the critical care unit

Can describe the shift patterns and handover process of other MDT members

Able to identify key MDT members by their role, including critical care nurses, nurse in charge, consultant on call

Demonstrates how to locate the local protocols and guidelines relevant to own role

Has an awareness of key ICU meetings relevant to role e.g. MDT meetings, handovers, safety briefings, teaching sessions.

Can identify standard ICU bedspace equipment and location of equipment necessary for role

Describe barriers to communication in ICU including those associated with PPE, illness and ICU interventions.

Awareness of communication aids with patients to overcome communication barriers i.e. PPE + oral intubation

Describe the support services available to help liaise with family including family support nurses, PALS, psychology services as appropriate.

Describe barriers to communication with family and methods to improve this

Knows importance of confidentiality and consent to share information with friends and family

Awareness of peer support and psychological support

Demonstrates how to access and document in patient records using local IT systems

Demonstrates how to view results and imaging on local IT systems

Awareness of Falls prevention and who to escalate to if concerned regarding falls risks

Compliant with Manual Handling training as per local trust policy.

Demonstrate working in an MDT by building and maintaining relationships with other professions

Aware of the roles and responsibilities of other members of the MDT

Clarifies, accepts and executes tasks delegated by the team leader

Explains the importance of highlighting safety issues / concerns to a member of your team in a prompt manner

Uses appropriate level of assertiveness for the clinical situation

Demonstrates a logical and systematic handover using local format

Outline how to escalate and to whom if there are patient / safety concerns

Identify and respond to patient / staff safety issues appropriately

Demonstrate ways to open up airway using simple manoeuvres (inc. repositioning, head tilt chin lift, jaw thrust)

Demonstrates how to deliver manual ventilation using two person bag-valve-mask (BVM) technique

Recognise and escalate airway compromise in a tracheostomised patient

Demonstrates how to perform and document oral hygiene

Knows the types of oxygen delivery system and their limitations (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Demonstrates how to deliver oxygen urgently (including reservoir mask, simple face mask, venturi system and nasal cannulae)

Describe how to escalate or de-escalate oxygen therapy in a step wise manner eg. nasal cannulae to face mask.

Recognise different lines and their location relevant to local population (eg arterial lines, central line, vas-cath)

Identify enteral feeding tube in situ, whether it is connected to feed and whether the feed pump is running

Knows to discuss plans with nursing staff prior to moving or reposition a patient with NG feed running

Aware of events which can displace feeding tubes and to escalate accordingly

Describes how to check enteral feeding length and escalates if tube length has changed

Describe how to recognise dysphagia and an escalation plan including referral to SLT

Demonstrates how to assist patients with eating and drinking

Have an awareness of modified diets or thickened fluids in line with SLT recommendations

Demonstrate how to categorise neurological status using the AVPU scoring

Describe factors that may cause or contribute to delirium

Describes how to recognise delirium

Demonstrates how to complete a CAM-ICU score

Demonstrates an understanding of non-pharmacological management of delirium

Demonstrates knowledge of the Mental Capacity Act, when capacity assessment is indicated, how to assess capacity and when specialist communication support is required eg. referral to SLT

Demonstrates how to use pain faces or a similar visual analog scale

Demonstrates an understanding on the impact of pain on patient presentation eg. agitation

Demonstrates an understanding of the impact of pain medication on patient presentation eg. sedative effect

Demonstrates an understanding of RASS (or alternative sedation) scoring system

Able to access and read using ICU drug charts

Demonstrates an awareness of common ICU sedative medications

Demonstrates a basic knowledge of common ICU medications and their role e.g. sedatives, vasopressors, inotropes

Describes the different nutritional screening tools which are validated for use in the critically ill

Describes the limitations of using screening tools in the critically ill

Describes nutritional screening method used in local hospital

Able to suggest appropriate methods to gain anthropometry for patients

Able to perform basic anthropometric measurements (i.e. MUAC, Ulna, Estimated weight and heights, handgrip strength)

Identifies the advantages and disadvantages of anthropometric measurements

Has knowledge of equipment available at local hospital

Able to recognise abnormal biochemistry and describe the following:

• Causes (medical and nutritional)
• Implications
• Different electrolyte targets in the critically unwell

Able to interpret abnormal biochemistry

Aware of how critical illness affects the major organs

Aware of the principles of organ support

Aware of how organ failure / organ support can impact nutritional status

Aware of how sedatives / paralysis and impact on gut function

Aware of how lipid based sedatives and calorie content

Aware of how vasopressors / inotropes and increased risk of gut ischaemia

Aware of how renal replacement therapy and fluid balance goals

Able to describe the metabolic phases of critical illness

Has an awareness of:

• Blood glucose targets in the critically ill;
• Why these blood glucose targets are recommended;
• Local guidelines on blood glucose management.

Able to describe refeeding in the critical care setting

Able to describe the structure of the gut and identify where key nutrients are absorbed

Demonstrates an understanding of how surgery / insults to the gut may affect the absorption of nutrients

Able to describe how gastrointestinal function is assessed

Has an awareness of gold standard methods of calculating nutritional requirements

Has an awareness of predictive equations available for estimating nutritional requirements

Has an awareness of limitations of methods used to calculate nutritional requirements

Has an awareness of metabolic phases and impact on calculations of nutritional requirements

Describes barriers to oral intake

Describes enteral feeding routes including indications and contraindications

Describes what feeding tubes / insertion methods are available locally

Describes local policy for confirming location of enteral feeding tubes

Describes indications and implications of oro-gastric feeding

Describes appropriate use of restraints (i.e. nasal bridles and mittens)

Describes long-term feeding tube indication and local referral process

Describes indication for parenteral nutrition and local escalation process

Has awareness of the increased risk of dysphagia in the critically ill

Has awareness of the local dysphagia screening protocol

Has awareness of the patients who require immediate speech and language therapy (SLT) input rather than nurse led screening

Able to list enteral feeding products available in trust and indications of use

Has awareness of local ‘out of hours’ protocols