Covering the ITU patients forms part of my wider dietetic role so every day is different.

A multiprofessional approach is needed to ensure optimal nutritional care in the critical care patients. Once patients are referred to me after the ward rounds I will begin by fully assessing their nutritional needs considering factors such as their previous nutritional status, blood tests, surgical history, any planned procedures , gut function, medications , number of organ failures, comorbidities and allergies. This enables me to plan the most appropriate method of feeding for each individual patient which may be via a tube in their nose to their stomach or small bowel , directly into a vein or orally as normal food or special nutritional supplemented drinks. If the patients are awake and not sedated I try and chat to the patients and relatives to establish food likes, dislikes and allergies to help ensure these are met as far as possible.

The critical care patient has constantly changing nutritional requirements and these need to be regularly reviewed to optimise their nutrition but limit complications. Every patient will have individualised nutritional needs and, as the dietitian, I will help establish these, preventing nutritional deficits. As patients improve the amount and type of energy, protein and micronutrients will change as they move into the recovery phase and start rehab. Provision of nutritional support to critical care patients is complex and not all patients will benefit to the same degree.

Research suggests that over a third of patients admitted to hospital are malnourished so it is vital that they receive the most appropriate form of nutrition as soon as it is safe to do so and that this continues when they move to the ward so all the patients will receive ongoing dietetic care on the ward from one of members of the dietetic team.

On Tuesday and Friday mornings I participate in the Nutrition Support Team ward rounds reviewing all patients on parenteral nutrition (intravenous feeding) throughout the hospital and also assessing any patients requiring a multidisciplinary opinion to help make decisions regarding their complex feeding needs. These rounds take up most the day but if possible I also attend the ITU multidisciplinary meeting in the afternoon. I am also one of the Acute Dietetic Leads so I spend quite a lot of my time supporting the junior staff , teaching, writing guidelines or attending a variety of meetings.

Every day is hectic and brings different challenges but I certainly never get bored!