CLINICAL

Work as an integral member of the Trust multidisciplinary Nutrition Team.  This involves attending daily ward rounds, case conferences, weekly multidisciplinary team meetings and regular liaison with a range of disciplines across all specialities regarding specific issues of patient care e.g. discussion with consultants or senior registrars  regarding the appropriateness of referral for TPN, patient biochemistry, route of feeding, complications etc

Provide a high quality and comprehensive nutrition and dietetic service to TPN patients on the Gastroenterology and Lower Gastrointestinal surgery ward and to all specialities across the Trust requiring the specialist TPN service

To assess the nutritional status of individual patients based on anthropometric measurements as well as biochemical markers, diet history and other validated methods of nutritional assessment as appropriate.

Obtain and analyse relevant information from different sources in order to make a comprehensive assessment of the patients condition, prognosis and treatment plans so that a decision on the most appropriate dietetic treatment to support this can be made in the short and long term.

Calculate nutritional requirements using specific assessment tools and calculations. To remain up to date with the literature and ensure that this is an evidence based process and clinically relevant to the TPN patient group.

Advise on appropriate artificial feeding routes (enteral  or parenteral) for patients across all disciplines experiencing difficulties with feeding or meeting their nutritional requirements  as a result of surgery or complex gastrointestinal disease

To formulate individualised patient care plans and parenteral nutrition prescriptions, taking into consideration factors which may affect requirements or help/hinder provision of nutrition support such as: prescribed drugs, biochemical derangements, metabolic complications, access issues etc.

Request specific biochemical tests and respond to this by suggesting to medical colleagues to replete and monitor levels until within normal ranges.

Evaluate the effectiveness of nutritional goals and modify plans as necessary based on ongoing analysis and assessment of information available and changing patient needs and medical condition.

To be involved in the discharge planning of patients receiving nutrition support via enteral or parenteral route in order to facilitate continuity of care of patients following transfer to out of area acute hospitals and the community setting.

To be actively involved with the initiation and development of evidence based trust-wide guidelines, for example TPN guidelines, feeding protocols and other resources including diet sheets in liaison with dietetic colleagues, senior nurses and clinicians e.g. intensive care nutrition support guidelines, re-feeding guidelines (guidelines for re-feeding malnourished patients safely), diet sheets for short bowel syndrome, low oxalate diet, low fibre diet etc.

Where necessary, to provide a specialist dietetic outpatient service to patients with chronic progressive gastrointestinal conditions e.g. scleroderma, intestinal failure, short bowel syndrome, dysmotility disorder.  To address and monitor their changing nutritional needs over the course of their disease in liaison with other members of the multidisciplinary team.

To communicate effectively with patients, carers and other health professionals. Skills of motivation, explanation and gaining consent will be used in a wide variety of and sometimes sensitive situations. The ability to communicate complex information at an appropriate level to allow understanding is important. Barriers to communication may be evident e.g. loss of hearing, receptive and expressive problems with the formulation and understanding of language, difficulties with speaking, altered perception. The use of communication aids such as letter/picture boards, light-writers may be necessary.

Act as a resource for colleagues within OUH on nutritional issues related to TPN, HPN and intestinal failure.

To assist in delivering a dietetic service to any clinical area when required, for example by covering other dietitians work load, etc.

To be an active member of the trust MDT nutrition team and dietetic TPN team including attending team meetings and delivering relevant outcomes generated from these meetings

PROFESSIONAL

Be accountable for standards of conduct, performance, professional Ethics and standards of proficiency as set out in the Health Care Professions Council and the British Dietetic Association's Professional Standards for Dietitians.

To take responsibility for own continuing professional development (CPD) and providing evidence for this by maintaining a CPD portfolio in line with HCPC standards and maintaining HCPC registration. CPD involves critical evaluation of scientific papers, attending professional development meetings, working as a reflective practitioner and attending relevant internal/external courses.

Participate in annual appraisal, identifying own development and training needs and setting personal development objectives with line manager.

To participate in departmental audits and initiate audit within own work area in order to monitor and evaluate whether local/ national standards are being met and make recommendations for change. To be involved with the planning of departmental clinical effectiveness and audit strategies.

Actively participate in the dietetic student training program, facilitating the development of skills and knowledge, being involved in the assessment process and acting as a mentor to students.

To mentor, supervise and enable Dietitians on the Band 5 rotation working in this speciality

To provide specialist advice, teaching and training to all members of the medical, surgical and multidisciplinary team, regarding the nutritional management of patients, particularly those on TPN.