Elizabeth Washington 2017 - Winner
Profiling the winner of the Elizabeth Washington Award 2017
Mary has also answered a few questions on camera - take a look to find out more about the work and why she believes research is so important.
Why did you choose to enter for the Elizabeth Washington Award?
I was proud of the work that other healthcare professionals, patient representatives and I had done in developing guidelines and educating others in the long term follow-up of patients who have weight loss surgery. I felt that our work met the criteria for the Elizabeth Washington award and this could be a further opportunity to publicise dietetic led work.
What is your current role and organisation?
I am a consultant dietitian specialising in adult obesity at Leeds Teaching Hospitals NHS Trust. I work with patients who have severe and complex obesity and support patients in both the medical and surgical obesity pathways.
Can you provide further information on your work?
Weight loss surgery is a treatment option for people with severe and complex obesity. It helps people to lose weight and improves weight related health problems (such as diabetes and sleep apnoea). The weight loss surgery affects dietary intake and absorption of some nutrients so it is extremely important that patients have access to long term follow-up. This was highlighted and recommended by the National Institute for Health and Care Excellence. In the NHS, weight loss surgery centres are often only commissioned to provide two years follow-up after which patients must be discharged back to the care of their GP. As GPs and other primary care staff receive little training in this area, it leaves patients vulnerable.
I was asked by NHS England Obesity Clinical Reference Group to lead a subgroup and develop guidelines on the follow-up of patients undergoing bariatric surgery. As the subgroup lead, I invited a surgeon, 2 physicians, 2 GPs, a nurse, a public health doctor and 4 patient representatives to join the group. All individuals were experienced in bariatric surgery or had demonstrated an interest in this area and felt passionately that long term follow-up of patients undergoing bariatric surgery should be improved.
Over the next year, we researched and critiqued the literature and developed the guidelines. All healthcare professionals and patient representatives contributed. As we had no budget, there were no face to face meetings and all correspondence was by email. The “Guidelines for the follow-up of patients undergoing bariatric surgery” and supporting appendices were published in Clinical Obesity in June 2016 (Clinical Obesity 2016; 6: 210–224). These are the first to outline the operational requirements and pathways for long-term care of patients who undergo weight loss surgery. They have a large educational component and aid healthcare professionals to deliver long term follow-up. For instance, areas covered include:
- Advice is given about when anti-hypertensive and diabetes related medications should be stopped or the dose modified
- The importance of lifelong nutritional monitoring using the British Obesity and Metabolic Surgery Society (BOMSS) nutritional guidelines is emphasized.
- Dumping syndrome and post-prandial hypoglycaemia are defined and their management is discussed.
- Advice is given on timing of pregnancy and management of pregnant bariatric surgery patients.
Within the guidelines, four different models of shared care are proposed and in each of these, the dietitian plays a key role as an annual dietetic assessment is required. The shared care models take account of the fact that local expertise and access to specialist centres is variable. In the supporting appendices, GPs are given advice about when they must refer back to specialist centres.
In June 2016, I presented a poster summarising the guidelines at the Obesity Summit in Gothenburg. At that same meeting, Dr Dicker, an international speaker on the European Association for the Study of Obesity teaching course was speaking on “Post bariatric surgery follow up”. I was both stunned and thrilled to see that he had made our paper the main focus of his lecture. He presented and discussed many of our recommendations. I spoke to him afterwards as I had only managed to get to get a poster presentation accepted. He said that he had picked our guidelines as he thought follow-up was a very important area that often was neglected.
The importance of follow-up and shared care was recognised in NICE Quality Standards 127 Obesity. Quality statement 7 states “People discharged from bariatric surgery service follow-up are offered monitoring of nutritional status at least once a year as part of a shared-care model of management”. Our paper is acknowledged in the standards and healthcare professionals are directed to our guidelines for further detail and potential models of shared-care protocols for postoperative management after bariatric surgery.
The GPs ran a workshop at the Association of Obesity conference in September 2016. The physician and I presented at the BOMSS annual conference. We are continuing to seek education opportunities.
What does winning this award mean for your work?
Winning the award is a great honour and fantastic recognition of the work that the team and I have done. It gives a further opportunity to publicise and promote this important area. I hope it will help to raise the dietetic profile and demonstrate that dietitians have the knowledge and expertise to contribute and take the lead in national work.
How will your work progress next?
The International Federation for the Surgery of Obesity and Metabolic Diseases (IFSO) is holding its annual conference in London, 29th August to 2nd September. We have organised a postgraduate pre-congress day for all healthcare professionals in primary and secondary care, including doctors, nurses, dietitians and psychologists, involved in the management of patients with severe and complex obesity. The objective is to meet the educational needs of healthcare professionals within primary and secondary care involved in the management of patients who have bariatric surgery. Sessions have been organised to be delivered jointly to all delegates along with parallel sessions to meet the specific needs of general practitioners, dietitians, psychologists and specialist nurses. Members of our working group, including one of the patient representatives are delivering sessions. In addition, I am an invited speaker in the main conference and will be covering this work.
Commissioning of weight loss surgery has now transferred from NHS England to clinical commissioning groups. Whilst the intention is that clinical commissioning groups will seek to improve long term follow up of patients and adopt a shared model of care, this becomes more challenging to implement. Further training and education of health care staff and engagement of clinical commissioning groups in the long term management of patients is needed.
We will continue to seek opportunities to engage and educate others in this area. As a working group, we remain in contact and further initiatives are being undertaken.
Why is evidence based practice so important?
We have a responsibility to our patients to ensure that we are helping to improve their physical and mental wellbeing and quality to life. As new research and evidence becomes available, it is important to use that alongside our clinical expertise and judgement to deliver the best clinical service we can to individual patients.
It is a difficult time for academic and clinical experts to ensure the advice to the public is evidence based – what you think dietitians and other scientific professionals can do to counter this?
We are the experts in dietetics and nutrition and have the knowledge and skills to translate research findings and consider the implications. We should not be shy at sharing our views. We have to be vocal and speak out. Multidisciplinary team meetings can be a supportive environment to share views and have a healthy debate about issues. We also have many allies who trust our judgement so it is important to join forces with others and work together. The British Dietetic Association is already proactive in making sure that dietitians are approached for advice but as dietitians, we all have a responsibility to be proactive locally. Social media can be an excellent tool for the promotion of positive messages to the public. We need to take advantage of all avenues and make sure our voice is heard.
What advice or tips would you give to dietitians to highlight the importance of being involved in research?
Keep up to date with current evidence. In addition to scientific journals, many professional societies and journals are on Twitter. Follow your areas of interest. Participate in relevant debates and TweetChats. This helps to widen your professional network and consider others’ viewpoints.
Start with audits and question your current practice. Involve patients and find out what is important to them. Disseminate your audit findings.
Speak with your multi-professional colleagues and teams about gaps in knowledge and evidence. Discuss your ideas and act on constructive feedback. If you are specialising in an area of dietetics, consider becoming a member of the multi-professional society, not just the BDA specialist group.
Consider studying for a Masters or Doctorate. There are many ways of achieving this so find one that suits your personal circumstances – and expect it to be hard work.
Publicise and share your findings locally, nationally and internationally either at conferences or publications and preferably both.
What are your future career aspirations?
The guidelines group is continuing to seek opportunities to roll out the clinical guidelines and share with clinical commissioners and educate healthcare professionals and commissioners. I am working on the update of the British Obesity and Metabolic Surgery Society (BOMSS) nutritional guidelines. I have been invited onto IFSO’s Integrated Health Committee and to be chair elect. I am looking forward to being more involved in IFSO and raising the dietetic profile internationally.
What does the future hold for dietetics?
I believe the dietetic profession and the Allied Health Professions are gaining a stronger voice and recognition of the holistic approach and value they give to patient care. Participating in research and gaining higher degrees helps dietitians to further develop skills. There are always challenges to higher grades of staff however we must ensure that we retain our professional heads of service and work toward developing more consultant and clinical specialist posts. BDA trade union representatives play an important role in working with senior management for the benefit of staff. The use of the internet and social media gives networking opportunities that were not available previously. As a profession, dietetics has developed in the 36 years I have been a dietitian and I am confident this will continue.
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