19 May 2020
Good nutrition is absolutely central to any recovery or rehabilitation. Policy makers, healthcare leaders and dietetic leaders need to take action to ensure that everyone leaving hospital after suffering COVID-19, has access to suitable nutrition, with expert guidance from a dietitian.
As patients with COVID-19 are at high risk of malnutrition, all should be screened for malnutrition prior to discharge. Their nutritional risk should be included in discharge documentation, along with a handover of the nutritional care plan, suggested monitoring, and involvement of community dietetic colleagues and other relevant members of the multi-disciplinary team (MDT) in the community settling. Not having this in place will lead to prolonged rehabilitation which will stretch primary and secondary care services further.
The BDA believes the following action is required:
- Every COVID-19 inpatient, regardless of Body Mass Index (BMI), should undergo nutritional screening taking into account weight loss, with particular attention to signs of muscle wasting. This should be recorded on discharge documentation, and a clear plan put in place to provide nutrition support where needed. It is essential that patients with overweight or obesity are screened for malnutrition. Unintentional weight loss and muscle wastage in all patients can lead to malnutrition. Dietetic teams should ensure clear communication between acute and community services as part of discharge processes, to include the nutritional needs and consideration of how nutritional care plans will work within the community setting.
- Dietitians must be familiar with their local COVID-19 therapy pathways and have discussions with therapy leads and healthcare professionals involved to ensure nutrition and dietetics is embedded as part of a robust MDT pathway for rehab. Similarly, those leading therapy pathways should contact local dietetic services to ensure nutrition is embedded within them. Health services must ensure sufficient and if necessary additional resources and funding are directed to dietetic services in outreach care as well as services in the community.
- Health services in the community must seek out and engage with their local dietetic services where required, ensuring those in their care have access to necessary dietary expertise.
- The BDA, ESPEN and others have produced clinical guidance which should form the basis of all healthcare services rehab pathways, ensuring nutrition is considered at each stage of the patient’s recovery journey (see further information section below for links to these guidance documents).
- Community dietetic teams must be provided with appropriate PPE to undertake their work (read BDA statement on PPE). Trusts and health boards should utilise digital technology to provide relevant nutritional information and support to patients in light of infection control risk (read BDA rapid implementation of digital tools).
- Support for community nutritional rehabilitation needs to be in place for the long term, in particular as there is likely to be much greater demand from non-COVID patients in the near future due to the impact of shielding and reduced uptake of existing NHS services. Government must provide the resources necessary to achieve this.
- All dietetic departments should collect consistent data on COVID-19 nutrition outcomes (see further information below).