clinical focus
The ins and outs of a dietitian’ s day
A vital part of the overall care of the aged is providing the correct food and drink. Enter the Accredited Practising Dietitian.
By Claire Hewat
Optimal care of patients in aged care settings requires a cohesive and collaborative multidisciplinary team. Medical, nursing and allied health staff all play unique and essential roles in patient care.
Accredited Practising Dietitians( APDs) are recognised professionals with the qualifications and skills to provide expert nutrition and dietary advice. Nutrition greatly affects clinical outcomes and quality of life for aged care patients.
APDs have sound university training accredited by the Dietitians Association of Australia( DAA), undertake ongoing professional development and comply with the DAA guidelines for best practice. They are committed to the DAA Code of Professional Conduct and Statement of Ethical Practice, and to providing quality service.
APD is the only national credential recognised by the Australian government, Medicare, the Department of Veterans’ Affairs and most private health funds as the quality standard for nutrition and dietetics services. It is a recognised trademark protected by law. Three areas commonly seen in aged care, in which APDs have a key role, are disability, mental health and nutrition support.
In all areas of practice, APDs are committed to providing person-centred, evidence-based information, and working with cultural belief systems( religious-, nationality- or disabilityspecific). They undertake nutritional screening, assessment and monitoring, and estimate individual nutritional requirements to formulate a suitable, realistic diet-nutrition care plan. As part of the process, they consider diet quality; diagnoses( mental and physical health, co-morbidities and disabilities); family history of chronic disease; current treatments, medications, drug-nutrient interactions and side effects; biochemical and physiological markers; other lifestyle related factors; use of any complementary or alternative treatments; food security; availability of social support; and living conditions. APDs participate in clinical grand rounds or case conferences and liaise with carers and medical teams regarding nutrition therapy.
APDs provide advice and education to everyone involved in the care of a patient, including the client, carers, family and other health care staff. They adjust the level of information provided to ensure it is at an appropriate level, especially for clients where an intellectual disability-cognitive impairment is present. Individual or group education may be provided and health promotion campaigns undertaken.
When nutrition support is required, APDs educate about the regimen and / or administration of nutrition support and / or care of their tube line and tube site. APDs recommend an appropriate feeding formula, route of administration and regimen. They can also contribute to discharge planning and post-discharge care where applicable( for example, Home Enteral Nutrition service).
APDs working at a higher level may undertake tasks that influence management of nutrition support, disability or mental health more broadly. Consultation and collaboration with community agencies, government bodies or the media may be their responsibility. They can develop and actively participate in implementation of policies and best nutrition practice and undertake research that informs both. Working with foodservice on menu planning and staff training is an integral part of maximising patient satisfaction and outcomes. Design of resources for patients, carers and staff may also be undertaken.
APDs working in nutrition support can set and monitor clinical standards and benchmarks for services.
If their competency has been formally demonstrated, APDs may insert and care for enteral feeding tubes / devices and tube sites. They may also play a larger role in the planning and coordination of dietetic services in the area of nutrition support, whether for inpatients or at home after discharge. Best possible management for people with disabilities is enabled by being aware of specialistsupport services available in the local area.
As discussed, APDs are an integral part of a multidisciplinary team. They work closely with other medical and allied health staff and refer on when appropriate, such as for mental health diagnoses or risk assessment, assessment of functional( for example, cooking) or physical capacity, swallowing ability.
APDs work closely with speech pathologists who assess the person’ s ability to safely chew and swallow. Dietitians utilise the speech pathologist’ s recommendations regarding food texture and fluid consistency to ensure the person consumes a nutritionally adequate diet. Other allied health professionals, including occupational therapists and physiotherapists, also contribute to person-centred eating and drinking plans.
APDs do not routinely assist people at meal times. But dietitians can design / develop an informed supported eating and drinking plan. When supporting people with a disability with eating and drinking, it is important to consider the whole person, not just their swallowing disorders. ■
Claire Hewat is DAA chief executive and is an Advanced APD.
Visit the What Dietitians Do section of the DAA website at www. daa. asn. au where you can locate an APD near you.
26 agedcareinsite. com. au