Acute dieticians

Who to refer:

Adult inpatient with MUST score 2 or above.

MUST screening tool.

Indications for dietetic referral regardless of MUST score:

Gastrointestinal Conditions:

• Decompensated liver patients.
• Upper gastrointestinal conditions including newly diagnosed oesophageal cancer, oesophageal stent insertions, oesophageal strictures, achalasia, stomach cancer
• Lower Gastrointestinal conditions – malabsorption, newly diagnosed coeliac disease, inflammatory bowel diseases (active crohns and ulcerative colitis)
• Complicated bowel surgery that is poor to recover e.g. erratic or non-moving bowels, nausea and vomiting.
• Pancreatic conditions e.g. severe pancreatitis or pancreatic cancer
• Diverticulitis

Artificial Feeding:

• Requiring enteral feeding (NG, NJ, PEG, jejunostomy)
• Requiring parenteral nutrition (TPN)
• Eating disorders- if admitted for artificial feeding support

Electrolyte Abnormalities:

• Persistent hyperkalaemia K+>5.5mmol/l on an upward trend, despite first line medical management.

Other Indications:

• Wound Healing for pressure ulcers or slow healing wounds
• Dysphagia requiring advice on altered consistency
• Oral Nutrition support in Palliative care if appropriate
• Bariatric patients.

Based on referral information inpatients are triaged appropriately:

High Risk

• Parenteral Nutrition
• Enteral Nutrition if tube in situ and starter regimen commenced
• Enteral tube feed discharge
• New PEG
• Polymeric diet
• Hyperkalaemia (K+>6.0) following medical management
• Oesophageal stent
• Eating disorders- if admitted for enteral feeding or medical stabilisation
• Decompensated liver disease, Hepatitis
• Upper GI conditions including new oesophageal Cancer, stomach Cancer, Achalasia
• Complicated bowel surgery that is slow to recover
• Pancreatic conditions e.g. severe pancreatitis or pancreatic cancer
• Poor wound healing/pressure sore (Grade >3)
• MUST OF 3 or above
• Newly diagnosed Type 1 diabetes- liaise with Diabetes dietitian

Medium Risk:

• MUST of 2
• Renal disease requiring low potassium, low phosphate diet
• Irritable Bowel Disease (IBD)

Low Risk:

• MUST of 1 + Poor intake for 3 days
• Diabetes – newly diagnosed type 2 or poor control- liaise with Diabetes dietitian
• Any patient requiring bariatric equipment
• Newly diagnosed Coeliac Disease
• Diverticulitis
• Irritable Bowel Syndrome (IBS)

It is our aim to assess patients within 1-5 working days on the basis of staffing capacity and prioritisation criteria. For those who are discharged before seen will be followed up as outpatient.

Who not to refer:

• Weight monitoring and dietetic referral should only be undertaken if there is an expected benefit. Patients receiving end of life care should be encouraged with preferred foods and fluids.
• MUST score less than 2, please monitor patients’ dietary intake and repeat MUST screening weekly.

How to refer:

Referrals are accepted by all health care professionals and can be made via

Telephone: 01896 826 450 or

Email: Acute.Dietitians@borders.scot.nhs.uk

Has a MUST assessment been done for this patient?

Outline of nutritional concerns?

Local resources:

NHS Borders weight management services

NHS Borders Children and Young Peoples Dietitian

Other organisations:

• The food train is a nationwide organisation supporting older adults living at home to eat well and age well.
• Beat is the UK's leading Eating Disorder Charity providing support and specialist resources to those living with disordered eating.
• NHS Borders health and wellbeing support.

Useful quick links:

• Malnutrition pathway
• BDA Food Facts
• Food and Nutrition - healthy living | NHS Inform
• Keeping active| NHS Inform
• Coeliac UK
• Crohns and Colitis UK
• Motor Neuron Disease Association 
• Macmillan
• Dementia UK
• Stroke Association

Acute.Dietitians@borders.scot.nhs.uk

01896 826 450