Cairns Hospital Grand Rounds on Friday 9 September coincided with 2022’s Body Image and Eating Disorders Awareness Week (#BIEDAW). Understandably, it was planned that the session should focus on eating disorders.
Dr Janet Bayley, Consultant Psychiatrist with NQuEDS* was to present, but was unexpectedly unavailable. Janet passed the baton to Dr Sharmila Prakash, Consultant Psychiatrist with Cairns Hospital’s Consultation Liaison Psychiatry Service. Unfortunately, Sharmila also became unexpectedly unavailable. That’s where – Steven Bradbury style – I slid-in to be on the Cairns Hospital Grand Rounds program.
There were two other presenters on the theme of eating disorders at Grand Rounds. Consultant Nephrologist and Physician Dr Bibin George presented very interesting early data from an audit of Cairns Hospital eating disorder medical admissions. Psychiatric Registrar/Dual Advanced Trainee Dr Manjuka Raj presented early results from her research examing core competencies of staff involved in a new eating disorder service. There is a fair chance that each of these research projects will progress to publication in future – keep an eye out for them.
My presentation was not about hard data or research. It was an overview of the role that a Consultation Liaison Psychiatry Service has when a person is admitted to hospital as a medical patient because of problems associated with an eating disorder. For those interested the session was videoed:
A few dozen people go to Cairns Hospital Grand Rounds either in person or via Zoom. The meta4RN blog extends that reach. If you were not at Cairns Hospital Grand Rounds yesterday, and have an interest in the care of people admitted as medical inpatients because of an eating disorder, perhaps the video is worth a look.
Also, just in case I (or you) want to revisit or recycle any of the info in the presentation, here is the link to the Prezi.
Cairns Hospital Grand Rounds 9 September 2022
NQuEDS*
NQuEDS = North Queensland Eating Disorder Service. More info about NQuEDS here and here. Enquiries about referral should be directed to 1300 64 2255 (1300 MH CALL).
End Notes
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As always, feedback is welcome via the comments section below.
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 Symposiumon 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
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.
Q: Is this the shortest blog post in the history of humans?
A: No. Please read on for elaboration, geeky stuff and a disclaimer (look for the red asterisk* below).
Elaboration
Recently I was chatting with someone who experiences an eating disorder and was asked whether there were any apps specific to their circumstances. I was a bit busy at work, and only had time to to check-out Australia’s digital mental health hub Head To Health, and found nothing specific to eating disorders there. A few things pop-up on a google search, but when you’re a health professional you need to be careful about prescribing digital technologies. As articulated in editorials, letters, journal articles and blogs, health professionals have a responsibility to do no harm, and provide credible, evidence-based information if giving advice re apps, websites or other digital technologies.
Geeky Stuff
Fairburn and Rothwell (2015, p. 1038) took a systematic approach to clinical appraisal of eating disorder apps, and concluded, “The enthusiasm for apps outstrips the evidence supporting their use.” Ouch.
But that was way back in 2015, some people are still giving eating-disorder-specific app development a go, and digital therapeutics evolve quickly, so I thought it was worth doing a search of credible sources anyway.
After searching Head To Health, later (in my own time boss) I had a look at the Queensland Eating Disorder Service (QuEDS) resource page, the Butterfly Foundation website, and the Eating Disorders Victoria site and couldn’t find recommendations for apps. I then signed-up for ORCHA (“the world’s leading health app evaluation and advisor organisation“) and did a search there – that yielded poor results. Searching ORCHA for “eating disorder” was too broad and yielded a list of food/diet-related apps. Searching ORCHA for “anorexia nervosa” yielded two apps that had a green rating – one was a NHS/UK-only app, and when I clicked the other one on the App Store the top review spoke about their weight-loss. It might be a good app, but I’m afraid to share it here. That sort of thing would probably be laughed-off with an eye roll by someone who is living with an eating disorder and is in a good head space, but could really throw a spanner in the works for someone who isn’t in a good head space. The mortality rate of eating disorders is a worry, so primum non nocere.
Then I stumbled into the Centre for Eating and Dieting Disorder (CEDD) website and found a resource called “Navigating Your Way to Health” and, lo and behold, found this on page 33:
Using apps can be a handy way of helping you in your journey to recovery. We’ve listed some FREE apps here that might be useful. The following apps have been designed to help people with eating disorders to empower you to be in control of your recovery. > Rise Up + Recover > Recovery Record – RR > recoveryBox > MindShift
Disclaimer*
Although it was listed in the resource above, I left the recoveryBox app off my list at the top of the page because as at 09/08/20 (today) their website isn’t working. The app is still available on the App Store, but as the website is out of action, I’m guessing the app isn’t being updated any more. “Navigating Your Way To Health” was published in 2016 and, as noted above, digital therapeutics evolve quickly. It seems they devolve quickly too.
I’m pretty confident this is credible information as of right now, but who knows what reviews are underway or what apps are in development? Not me. For all I know there will be a fantastic Australian app co-produced by consumers/survivors, clinicians and academics tomorrow. I hope so. Just in case, check in on CEDD if you’re reading this after 09/08/20.
As noted in my recent blog post regarding the stepped care model (“One. Step. Beyond.” meta4RN.com/step) the concept of “one size fits all” doesn’t apply in mental health recovery. On the same theme, apps can be a useful addition to other strategies and useful for maintenance/relapse prevention. They should not be relied on alone if someone is experiencing significant symptoms of poor health.
I won’t pretend for a moment to have any special insight into what is a useful app for people who are experiencing an eating disorder, and don’t really have the time, skill-set or funding to undertake an independent review. I do trust the credibility of CEDD though, and if they say these apps are OK, who am I to say otherwise?
As originally noted in September 2012 (see number 13 here: meta4RN.com/about), the views and opinions I express here or on related social media portals do not represent the views of my employer. That really should be taken for granted, but anyway…
One last thing in this section: I don’t have any financial/other ties to any of the organisations or apps named above.
References
Daya, I., Hamilton, B. and Roper, C. (2020), Authentic engagement: A conceptual model for welcoming diverse and challenging consumer and survivor views in mental health research, policy, and practice. International Journal of Mental Health Nursing, 29(2): 299-31.
doi: 10.1111/inm.12653
Fairburn, C.G. and Rothwell, E.R. (2015) Apps and eating disorders: A systematic clinical appraisal. International Journal of Eating Disorders, 48: 1038-1046.
doi: 10.1002/eat.22398
Ferguson, C., Hickman, L., Wright, R., Davidson, P. & Jackson, D. (2018) Preparing nurses to be prescribers of digital therapeutics, Contemporary Nurse, 54(4-5): 345-349.
doi: 10.1080/10376178.2018.1486943
Hunter Institute of Mental Health and the Centre for Eating and Dieting Disorders (2016). Navigating Your Way to Health: A brief guide to approaching the challenges, treatments and pathways to recovery from an eating disorder. NSW Ministry of Health.
via cedd.org.au/begin-recovery
Neumayr, C, Voderholzer, U, Tregarthen, J, Schlegl, S. (2019) Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist‐guided smartphone app. International Journal of Eating Disorders, 52: 1191– 1201
doi: 10.1002/eat.23152
Søgaard Neilsen, A. & Wilson, R.L. (2019) Combining e‐mental health intervention development with human computer interaction (HCI) design to enhance technology‐facilitated recovery for people with depression and/or anxiety conditions: An integrative literature review. International Journal of Mental Health Nursing, 28(1): 22-39.
doi: 10.1111/inm.12527
Wilson, R.L. (2018) The right way for nurses to prescribe, administer and critique digital therapies, Contemporary Nurse, 54(4-5): 543-545.
doi: 10.1080/10376178.2018.1507679
End
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