23 Mar 2020
The COVID-19 pandemic has led to unprecedented expansion of and challenge to our critical care services. Undoubtedly, this will require significant planning and re-structuring of dietetic services to ensure that we are able to provide a safe and effective service during this time.
This guidance has been developed by members from the Critical Care Dietitians Specialist Group (CCSG) of the British Dietetic Association taking into account current recommendations for planning and local experiences to date. In the absence of evidence-based guidance in this area, we have drawn upon the experiences and knowledge obtained from those already working with critically ill patients with COVID-19, including our international colleagues. Click the tabs along the top of the page for more information.
It goes without saying that it is incredibly important that we look after ourselves and each other during this uncertain time and that the health and wellbeing of staff members is of paramount importance. Continue to look after each other, communicate and share practice with others.
This document is up to date as of Friday 3 April and we will update in line with new information that arises, so please check back regularly for updates. Please contact us if you have any information to share that might be useful for others.
Most trusts and health boards across the UK are making provisions for the expansion of ICU beds. This will place significant pressure on all MDT members, including dietitians.
CCSG strongly recommends that planning for increasing ICU dietetic capacity occurs urgently in line with dietetic managers and critical care planning strategies.
We recommend the following:
- Estimate the number of additional dietitians that may be needed to cover the planned increase in ICU beds. Using the Guidelines for the Provision of Intensive Care Services (GPICS) can help with this.
- Identify dietitians in the department who have previous adult critical care experience (Level 2 and / or 3)
- Identify dietitians who have significant experience with enteral and parenteral feeding.
- Identify dietitians with none of the above experience, but who will be freed up from outpatient services and are willing to help.
- Start upskilling proposed ICU dietitians immediately (click here for resources and links to assist with planning and teaching) and arrange for computer access to ICU specific systems as appropriate.
- Agree local criteria for how patients will be prioritised for dietetic input and agree proposed timelines for follow up. This will be dependent on local agreements and capacity.
- Many critical care patients will be nursed in non-critical care areas e.g. recovery, theatres. Ensure early communication with nursing staff in charge of non-critical care areas (e.g. recovery or theatres) where ICU patients will be cared for to ensure they are aware of unit feeding protocols and the requirements for ordering of feed, ancillaries etc.
Additionally, consider the following:
- Phasing the introduction of dietitians into ICU as per the increase in bed numbers, but this does not negate the need for training to commence as a matter of urgency.
- Triaging the sickest patients to the most experienced dietitians (e.g. the less experienced dietitians would be well placed to cover high dependency / non-COVID-19 patients to free up the most experienced dietitians for the sickest patients).