This blog post is to simply share the content, JPEG and PDF of a poster that will be presented at the FNQ (Far North Queensland)/CHHHS (Cairns and Hinterland Hospital and Health Service) Research and Innovation Symposium on 16 September 2022.

EAT Target (Eating disorder planned Admission via Transit lounge)

Background and Rationale

It was observed there was a prolonged delay in commencing nasogastric feeds for some people who had a planned admissions via the Cairns Hospital Transit Lounge for nutritional resuscitation in relapse of an eating disorder.

Delayed nutritional resuscitation in eating disorders increases refeeding risk, decreases medical stability, may cause health deterioration, and delays safe hospital discharge.

Method

To address the concerns re delayed nutritional resuscitation, a nurse- and dietitian-led response was discussed, solutions were brainstormed by the presenters, and the “EAT Target” was proposed (EAT = Eating disorder planned Admission via Transit lounge).

Since that brainstorming session the EAT Target has been refined and drafted as a workplace instruction named “Initiation of nutrition for patients with Eating Disorders admitted via Transit Lounge.” This is expected to be implemented in August/September 2022.

Results (ie: content of new time-critical work instruction)

⏰ On admission to transit lounge obtain baseline observation including lying and standing BP and HR, 12 lead ECG, IV cannula, routine bloods and baseline height.

⏰ Liaise with medical team for admission. Aim for timely charting of medications including IV thiamine and PRN anxiolytics to assist with NG tube insertion if appropriate.

⏰ Insertion of Nasogastric tube (pending medical order) within 2 hours of presentation either at transit or in General Medical ward depending on bed availability.

⏰ Confirm position of NG tube as per clinical guidelines (ie: low risk patients can have placement confirmed by pH strip, and may not need to proceed to x-ray).

⏰ Liaise with Dietitian to document NG feeding regime within 2 hours of presentation. For after-hours presentations please follow Initiation of Nutrition for Patients with Eating Disorders (ADULT) General Medical and Mental Health Teams.

⏰ Liaise with Consultation Liaison Psychiatry Service CNC via ext 66175. Aim for nursing care plan, clarification regarding AIN special etc within 2 hours of presentation.

⏰ Commence NG feed within 3 hours of admission to Transit lounge (NB: ensure IV thiamine is administered prior to NG feed).

⏰ Offer resource plus if NG feed is delayed beyond the 3-hour mark.

⏰ Enter “orders” on ieMR for nursing care as per QuEDS guidelines: QID Lying and standing BP/ pulse, QID BGL & 2am BGL monitoring, Daily ECG, Weight – Monday and Thursday.

Evaluation

⏰ Quantitative
Pre- and post- comparison data re time taken for NGT insertion and commencement of feeding.

⏰ Qualitative
Feedback from inpatients with the lived experience of planned admission for nutritional restoration in eating disorder.

Key Message

⏰ Nutritional Resuscitation is Time Critical ⏰

Acknowledgements

Dozens of staff on the CHHHS multidisciplinary team collaborate to provide safe, timely care to people experiencing eating disorder relapse. The CHHHS values of compassion, accountability, integrity and respect are embedded in our practice together. It is a pleasure to work with you.

Mental Health and ATODS Nursing Director kindly funded this poster for the 2022 Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium. Thanks Gino. 🙂

Presenters

The presenters are a collaboration of medical nurses with an interest in caring for people with eating disorders, together with a specialist dietitian and two specialist mental health nurses.

⏰ Rekha Thomas, RN, BN, Grad Cert
Clinical Nurse, General Medical Unit, Cairns Hospital

⏰ Nicolle Hogan, RN, BN, Grad Cert
Nurse Unit Manager, General Medical Unit, Cairns Hospital

⏰ Emma Coleman, APD, NEDC
Dietitian, North Queensland Eating Disorder Service (NQuEDS) & Cairns Hospital

⏰ Jelena Botha, RN, BN, Grad Cert, MMHN
Clinical Nurse Consultant, Consultation Liaison Psychiatry Service, Cairns Hospital

⏰ Paul McNamara, RN, BN, MMHN, FACMHN
Clinical Nurse Consultant, Consultation Liaison Psychiatry Service, Cairns Hospital

Citation

Thomas, R., Hogan, N., Coleman, E., Botha, J. & McNamara P. (2022, September 16). EAT Target [Poster presentation]. 2022 Cairns and Hinterland Hospital and Health Service Research and Innovation Symposium, Cairns, Queensland, Australia. https://cairns.health.qld.libguides.com/chhhs-researchsymposium

End Notes

I’m home with time on my hands recovering from a minor procedure. That’s why there’s been a flurry of online activity. Don’t worry. I’ll be back at work soon, and will stop cluttering-up the internet then.

Observation: it’s MUCH easier to spruik about work-stuff when you’re not busy and tired doing work-stuff. 🙂

Technical note: the poster above (and this one from yesterday) was made using Apple Pages on an iMac from about 2017ish. The formatting was pretty easy, but took me quite a few hours. I don’t think I could earn a living out of it. I would have to drop my hourly rate to about 50 cents.

That’s it. Thanks for visiting. As always, feedback is welcome via the comments section below.

Paul McNamara, 24 August 2022

Short URL meta4RN.com/EAT