Other dietetic services
Home Enteral Feeding
All patients discharged with a PEG or PEJ from a hospital in Cornwall will be known to the Home Enteral Feeding Service and will be regularly reviewed.
Refer any patient who does not have regular contact ( at least every 6mths ) with the home enteral feeding team or who has symptoms potentially related to their feed e.g.
· unintentional weight loss
· unintentional weight gain
· nausea, vomiting, bloating
· persistent diarrhoea
For problems relating to the PEG tube or stoma contact the gastrostomy nurse on email@example.com
All patients who are on dialysis are known and reviewed by the Renal Dietitians. Other patients with CKD 4/5 are referred by the Renal Consultants/Renal Team. Refer to the Renal Dietician if you have any dietary concerns with a renal patient under your care:
· with CKD 4/5,
· patient is on dialysis
Most patients will already be known and referred to the dietitian via the Oncology Team and consultant but consider referral if:
· The patient is losing weight or is at risk of malnutrition
· Their swallow is effected by the disease or treatment
Good advice can be found on
Patients may already be known to the dietitian via gastroenterology consultant but consider referral if :
· The patient has newly diagnosed coeliac disease (and not already referred)
. The patient has symptoms of irritable bowel syndrome and
- there has been no improvement despite following first and second line advice for a minimum of 8 weeks at each stage
(First line – sign post to NHS UK website - https://www.nhs.uk/conditions/irritable-bowel-syndrome-ibs/further-help-and-support/?a=1,
Second line - direct to FODMAPS webinar - http://www.patientwebinars.co.uk)
- those who have found an identified FODMAP causing symptoms or have further concerns, advise patient self refers to the Dietitian by emailing firstname.lastname@example.org and asking for a referral form
- if the GP feels the above is not suitable for the patient then they can refer the patient in the usual way on ERS
- for further information about IBS please see the page under Gastroenterology.
· The patient has a difficult to manage allergic response to foods that potentially results in exclusion of main food groups, nutritional deficiencies and/or weight loss
· Decompensated liver disease with significant muscle loss.
· Fatty liver linked with obesity
Please refer to the dietitian working with the learning disability service using the referral form if:
· The patient has complex needs requiring input from a number of specialists within the learning disability service, eg Speech and language therapist, learning disability nurse .
· The patient will struggle to access main stream services due to challenges with communication , behaviour etc.
· The patients’ dietary needs are closely associated with their learning disability, eg limited food selection, weight loss associated with swallowing problems.
· The patient’s family and/or care team need additional support and advice that cannot be delivered via a routine clinic appointment.
Specialist dietitians can be accessed via the CAMHS and Adult Eating Disorders Services.
<18 years- refer to the CAMHS Eating Disorders Service - a specialist dietitian will conduct a dietetic assessment as part the Eating Disorders Assessment.
>18 years - refer to the ICMHT who after initial assessment will refer to the Adult Eating Disorders Service. Once the person has been assessed and meets service criteria specialist dietetics will be offered as part of their treatment.
Date reviewed 05.06.19
Next review due 05.06.20 (12 months after)
Sifter name Dr Rebecca Harling
Consultant name + any other contributors:
Lisa Ledger, Lead Dietician, North East Cornwall Dietetics Team, June 2019 – re IBS
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