Dietetics EPA2 Establish and implement evidenced based nutrition goals, aims and care plan

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

Identifies and prioritises patients who would be at high nutritional risk

Interprets measured anthropometry and critically analyses accuracy of measurements

Selects most accurate anthropometry for use in establishing nutrition care plan

Implements appropriate nutrition care plan to manage abnormalities (i.e low electrolyte feeds / semi elemental feed)

Advocates for abnormal biochemistry in relation to nutrition care plans within the MDT

Implements appropriate nutrition care plan based on organ failure / organ support requirements. Considerations made but not limited to:

• ventilation status and mode of ventilation;
• propofol dose;
• cardiovascular support;
• Renal function (Renal replacement therapy, fluid balance goals and urine output);
• Blood glucose control

Identifies patients at risk of refeeding and implements appropriate nutrition care plan in critical care setting

Requests appropriate management of refeeding with the MDT (i.e. prescription of Pabrinex, electrolyte monitoring frequency, electrolyte replacements)

Able to recognise relevant medications and describe how they impact the GI tract

• Intravenous (IV) fluids;
• Electrolytes (IV and enteral);
• Laxatives (including mode of action);
• Prokinetics;
• Proton pump inhibitors (PPIs);

Awareness of:

• Local Gastric Residual Values (GRVs) protocol ;
• Local bowel protocols;
• The use of faecal management systems to protect wounds.

Implements appropriate nutrition care plan for patients at risk of absorption and / or motility problems

Implements appropriate nutrition care plan for patients on medication with drug-nutrient interactions

Considers discussion with pharmacy / medical team regarding change to IV medication where indicated (i.e. poor absorption / tolerance, inability to meet nutritional targets in reduced feeding times)

Advocates for suggested management of:

• High gastric residual values (GRVs / aspirates);
• Diarrhoea / constipation;
• High stoma output;
• Fasting for procedures (if local guidance available).

Able to calculate energy, protein and micronutrient requirements for specific patient groups including but not limited to:

• Ventilated and self-ventilating patients
• Obese
• Renal failure (on and off filter regimens)
• Pressure areas
• Disease specific requirements (based on local patient population, i.e. Liver, Surgical, Trauma, ARDS, COVID, ECMO)

Considers metabolic phase of critical illness when calculating nutritional requirements

Able to identify and recommend appropriate feeding route(s) (PO / EN / PN)

Able to identify and recommend enteral feeding tube (gastric, post-pyloric)

Able to identify and recommend appropriate use of nasal bridles and mittens

Identifies and communicates with relevant MDT members when long-term feeding tubes are indicated

Identifies and communicates with relevant MDT members when there are concerns over swallow safety

Identifies and communicates with relevant MDT members when parenteral nutrition is required

Able to select an appropriate nutritional products and devise appropriate feeding regimen (oral and enteral)

Able to devise appropriate nutritional diagnosis for critically unwell patient

Able to demonstrate clinical reasoning skills

Able to formulate aims and goals of nutrition intervention considering all clinical parameters

Able to develop appropriate nutrition care plan based on aims and goals

Communicates dietetic care plan with MDT