Warwickshire Dietetic Service Referral Criteria

Transcription

1 Warwickshire Dietetic Service Referral Criteria Author: Anne Davidson Dietetic Service Manager Developed June 2008 Reviewed August 2010/June 2011 Rewritten - May 2012(Countywide)

2 Referrals are accepted from the healthcare professionals indicated below: GPs, Consultants, Dentists and Community Doctors Practice Nurses, District Nurses, Midwives, Ward nurses, Specialist Nurses, Community Children s Nurses, Occupational Health Nurses, Registered Nurses in Care Homes AHP s Health Visitor and School Nurses Information required on all referrals Patient s full name, address, date of birth, NHS / PID number, contact details of relevant carers Name, profession and contact details of person referring Name of patient s GP Name of consultant if relevant Present medical condition and relevant past medical history Relevant anthropometric measurements weight, height, BMI, weight history, waist circumference, mid upper arm circumference (MUAC), Malnutrition Risk Category (e.g. MUST Category) Relevant biochemistry e.g. FBG, HbA1c, cholesterol, U s & E s, FBC Current medication Any dietary interventions already tried Any communication difficulties or if interpreter is needed Other relevant professionals involved and their contact details Any known risks e.g. history of violence or aggression (patient or other family members), mental health problems, risks associated with domiciliary visit location If an ambulance is required for out-patient appointment attendance Please ensure the patient has agreed to the referral and is aware the referral has been made. See referral form in Appendix 1 Clinic Locations Weekly Clinics Monthly clinics Warwick Hospital Stratford Hospital Orchard House, Leamington Spa George Eliot Hospital Orchard Centre, Rugby Abbey Medical Centre Kenilworth Bidford Health Centre Alcester Health Centre Hastings House, Wellesbourne Southam Clinic Shipston Medical Centre Atherstone Surgery Coleshill Clinic Polesworth Health Centre Kingsbury Health Centre Camp Hill Clinic Bedworth Health Centre (2 per month) 2

3 In-Patient Referrals (Adults) Adults with the following conditions would benefit from a referral to the dietitian Timescale Medical Condition / Nutritional Intervention required Aim to provide initial advice on Parenteral feeds the same working day of referral New enteral feeds (Nasogastric, Gastrostomy, Jejunal) Aim to provide advice within one Known patients on enteral feed transferred from another hospital working day from receipt of or the community referral Aim to provide advice within two working days from receipt of referral (unless additional information is made available to indicate the patient requires to be seen sooner) Aim to provide advice within 4 working days from receipt of referral May be offered and out-patient appointment if assessed to be a chronic/long term problem not affecting current episode of care. May be offered and out-patient appointment / written information Renal impairment with raised potassium, phosphate or requiring fluid or salt restriction Liver Disease with acute exacerbation of symptoms Pancreatic Disease with acute exacerbation of symptoms Inflammatory Bowel Disease with acute symptoms Gastrointestinal resections resulting in high output stoma s Malnutrition (MUST = High Risk Category) Dysphagia (if not requiring NG as per category 1) Pressure Ulcers Grade 3 or 4 Newly diagnosed with Coeliac Disease Newly diagnosed with Type I Diabetes Type II diabetes converting onto Insulin Nutritional Deficiencies Gallstones if under weight and symptomatic on consumption of high fat foods Irritable Bowel Syndrome Diverticular Disease Constipation Newly diagnosed with Type II diabetes (GP should refer for DESMOND education session) Impaired fasting glycaemia or impaired glucose tolerance Poorly controlled Diabetes - thought to be diet related Obesity - BMI 30 or BMI risk factors or waist circumference: > 102cm (40 ), > 88cm (35 ), Asian > 90cm (36 ) > 20% risk of CVD in the next 10 years / MI or cardiac surgery in last 4 months Food allergies or intolerance Emphasis should be for new diagnoses requiring dietary management, particularly where dietetic advice is needed to make appropriate provision for nutrition in hospital and where advice is needed to enable the patient / carer, to manage their dietary requirements following discharge. Patients who are established / stable / knowledgeable on a dietary treatment need not be referred routinely. The categories and time scales listed above are provided as a guideline. During periods of leave (planned and unplanned) the above standards may not be achievable. In-Patient referrals phone through to: Warwick Hospital and Ellen Badger Hospital ext 4258 RLSRH ext 3015 Stratford Hospital ext 5298 George Eliot Hospital ext 5098 for (for Parenteral Nutrition bleep 0020) 3

4 In-Patient Referrals (Paediatrics) Infants, children or adolescents with the following conditions would benefit from a referral to the dietitian Timescale Aim to be seen within one working day from receipt of referral Aim to provide advice within two working days from receipt of referral (unless additional information is made available to indicate the patient requires to be seen sooner) Aim to provide advice within 4 working days from receipt of referral May be offered an out-patient appointment if assessed to be a chronic / long term problem not affecting current episode of care. May be offered and out-patient appointment / written information Medical Condition / Nutritional Intervention required New Enteral feed Newly diagnosed with Type I Diabetes Newly diagnosed with Coeliac Disease New referrals for Nutritional support Infants on Special Care Baby Unit Suspected new food intolerance / food allergy in under 1 year olds Enteral feeds transferred from other hospitals Faltering growth in under 1 year olds Dysphagia IBD with acute symptoms Nutritional deficiencies in under 1 year olds e.g. iron or calcium deficiency Newly diagnosed type 2 diabetes Faltering growth / low Body Mass Index (BMI) in over 1 year olds Constipation Existing food intolerance/ allergies Nutritional deficiencies in over 1 year olds e.g. iron or calcium deficiency Obesity confirmed with weight, height and BMI. Referrals for patients classified as over weight on BMI will not be accepted Emphasis should be for new diagnoses requiring dietary management, particularly where dietetic advice is needed to make appropriate provision for nutrition in hospital and where advice and support is needed to enable the patient / carer / guardian to manage their dietary requirements following discharge. Patients who are established / stable / knowledgeable on a dietary treatment need not be referred routinely. The categories and time scales listed above are provided as a guideline. During periods of leave (planned and unplanned) the above standards may not be achievable. In-Patient referrals phone through to: Warwick Hospital ext 4258 or Fax George Eliot Hospital ext 5098 or Fax to

5 Out-Patient and Community Referrals (Adults) Adults with the following conditions would benefit from a referral to the dietitian Priority Medical Condition / Nutritional Intervention required Criteria for referral Urgent (1) Patients requiring enteral feeding in their own homes / residential homes Contacted / seen within 1 week Urgent (2) Contacted / seen within 2 week Urgent (3) Contacted / seen within 2-4 weeks Routine Aim to see within 18 weeks Patients requiring enteral feeding in nursing homes Diabetes Newly diagnosed with Type 1 diabetes with Random sugar 11.1mmol + symptoms Fasting glucose 7.0 Diabetes Type 2 converting onto insulin Gestational diabetes *Underweight / at risk of malnutrition / MUST = High Risk Category within the last 3-6 months. Dysphagia N.B. refer to SLT for assessment of swallowing ability Coeliac disease Renal Disease Liver Disease Pancreatic Disease Confirmed Inflammatory Bowel Disease with active disease Oncology Cardio Protective Obesity Diabetes BMI of < 18.5kg/m 2 or unintentional weight loss greater than 10% within the last 3-6 months. BMI of <20kg/m 2 and unintentional weight loss greater than 5% Significant deterioration in swallowing ability Low BMI / weight loss as above New confirmed diagnosis If wheat intolerant do not refer until Coeliac screen has been carried out Hyperkalaemia / hyperphosphataemia / fluid restriction / requiring advice regarding salt intake (If not under the care of the specialist renal dietitians at UHCW) Confirmed diagnosis of liver disease with MUST = High Risk Category Confirmed diagnosis with MUST = High Risk Altered bowel habits thought to be associated with diet MUST = High Risk Category For elemental of peptide diet to induce remission As per risk of malnutrition* or dysphagia criteria 20% risk of CVD in next 10 years MI or Cardiac Surgery in last 4 months Diagnosed Metabolic Syndrome BMI 30 BMI risk factors or waist circumference: > 102cm (40 ) > 88cm (35 ) Asian > 90cm (36 ) Complications or poor control thought to be related to diet Impaired Fasting Glycaemia (IFG) Impaired glucose tolerance (IGT) N.B. Newly diagnosed with Type 2 diabetes Refer to Desmond Group Education Sessions 6.1mmol fasting glucose Fasting plasma glucose > 6.1 mmol/l but < 7.0 mmol/l). Diabetes UK recommends that all those with IFG should have an OGTT to exclude the diagnosis of diabetes, and are actively managed with lifestyle advice Fasting plasma glucose < 7.0 mmol / and OGTT two hour value > 7.8mmol/l but < 11.1 mmol/l). 5

6 Inappropriate referral Referrals not accepted Food Intolerance / allergies IBS / Functional bowel disorder no active disease Diverticular Disease Nutritional Deficiencies e.g. iron or calcium deficiency Underweight / at risk of malnutrition Pressure Ulcers Osteoporosis Liver Disease Pancreatic Disease Confirmed inflammatory bowel disease Coeliac disease Elimination of major food groups for clinical benefit Nutritional risk from an unbalanced diet If urticaria or angiodema suspected due to IgE mediated allergies, refer to dermatologist / paediatrician Confirmed diagnosis If has functional bowel symptoms, has patient been investigated for organic pathology, coeliac disease? Please list symptoms (diarrhoea, constipation etc). Restricted eating patterns resulting in suspected nutritional deficiencies (whole food groups missing / less than 20 foods / clinically underweight) MUST score of 1 and nutritional status has deteriorated despite following first line dietary BMI of kg/m 2 or unintentional weight loss of 5-10% within the last 3-6 months Grade 3 or 4 where there are concerns regarding the nutritional adequacy of the patient s diet Where nutritional deficiencies are suspected NASH (Nonalcoholic steatohepatitis) Chronic condition where there are concerns regarding the nutritional adequacy of the patient s diet During remission if nutritional deficiencies or inadequate diet are suspected For annual review or if nutritional deficiencies are suspected Unhealthy lifestyle / general dietary advice with none of the above conditions Eating disorders Refer to Mental Health Team Catchment Consultant NB patients with disordered eating may not benefit from dietetic advice until the psychological issues related to the disorder have been identified and treated. We recommend a referral to the mental health team initially 6

7 Out-Patient and Community Referrals (Paediatrics) Infants, children or adolescents with the following conditions would benefit from a referral to the dietitian Priority Medical Condition / Nutritional Intervention required Urgent Newly diagnosed with type 1 diabetes Aim to see within 2-4 Known type 1 diabetes changing insulin regimen to basal bolus / insulin weeks pump Newly diagnosed with type 2 diabetes Faltering growth <1 year of age Deteriorating swallowing difficulties Newly diagnosed with Coeliac disease Suspected food allergy / intolerance < 1 year of age Newly diagnosed food allergy Newly diagnosed with I.B.D. Known enterally fed children with new problems Children discharged from hospital on enteral feeds (if dietetic care is Routine Aim to see within 18 weeks transferred locally) Faltering growth > 1 year of age Obesity confirmed with weight, height and BMI. Referrals for patients classified as over weight on BMI will not be accepted Existing Coeliac disease Existing or suspected food intolerance > 1 year of age Known food allergy for assessment / review Known type 1 diabetes (compliance / lifestyle advice) Existing I.B.D. Dietary assessment (e.g. restricted eaters) Nutritional deficiencies, e.g. Fe deficiency anaemia Existing swallowing problems Restricted eating patterns (whole food groups missing / less than 20 foods / 2 centiles below ideal weight / height) due to mental health or learning disabilities e.g. attention deficit disorder, hyperactive disorder, autistic spectrum disorders or food sensory disorders Children with special needs resulting in nutritional problems Constipation N.B. For referrals likely to require the prescription of nutritional supplements of baby milks a copy of the referral should be sent to the GP +/- consultant 7

8 NHS Number: Surname: First Name: Address: Postcode: Ward/Hospital: Interpreter required: Yes No Additional information required for referrals re children Are there any known risk factors associated with working with this family? Are any of the following relevant to the child:- Subject to a Child Protection Plan Looked After A Child in Need Subject to a CAF Dietetic Referral Form Title: Mr / Mrs / Ms / Miss / Mast / Other, please state Male Female D.O.B: Day time phone number: Ambulance required (OP only): Yes No If yes reason:. GP: Consultant: Language (if not English): Additional information required for outpatient or community referrals (adults and children) Is the patient/client/carer/parent/guardian aware of the reason for referral and diagnosis: Yes No Other health professionals involved:.. Any risks associated with this client:.. House bound - requires home visit : Yes No Wheelchair user: Yes No Current Weight : Previous weight(s): Date(s): Other anthropometric measurement(s): Height: BMI: MUST score*: *Not required for paediatric referrals Diagnosis and relevant medical history: Reason for Referral / Dietary advice suggested / Dietary advice or changes already put in place: Relevant medication and tests: Other information e.g. Expected date of discharge / Relevant discharge planning info (in-patients only) / Contact details for carers: Referrer s name (print): Signature: Job role: Date of referral Contact details: Please note if insufficient information is provided above the referral will be returned Send to Dietetic Department at: Warwick Hospital, Lakin Road, Warwick CV34 5BW or Fax to George Eliot Hospital, College Street, Nuneaton, CV10 7DJ or Fax to

9 For office use only: Accept: Yes No If No action taken:. Routine / Urgent (1) / Urgent (2) / Urgent (3): In-patient / outpatient / home visit / other: Out-patient clinic code / grouping: Reason for referral / Diagnosis code: Authorising Dietitian: Date: 9