Older patients recovering from Covid-19 at Ysbyty Cwm Cynon are benefiting from an innovative nutrition pathway as part of their rehabilitation and treatment.
Patients on Ward 1, YCC’s Coronavirus ward, are being given an extra 500kcal per day in nutritional supplements to support poor appetite, muscle wastage, fatigue and taste changes caused by the illness. The initiative came from close and rapid teamwork between specialist dietitian Natalie Potter, nurse practitioner Rita Phillips and ward sister Janine Burton, with great teamwork from colleagues to put it into practice.
Natalie, who has worked with the health board for 16 years, said: “The idea came from plans we had in place to support patients in our field hospitals. Having worked across many specialities in my career, including acute and intensive care services for 10 years, I knew how metabolically challenged these patients were likely to be.
“Covid-19 presents its own specific nutritional challenges to patients, such as lack of taste and smell, and we wanted to put in place a pathway to ensure they received the nutrition needed for the best chance of recovery. Thankfully, we haven’t needed our field hospitals but the Covid ward here in Ysbyty Cwm Cynon is, in essence, our field hospital.
“I spoke to our nurse practitioner Rita Phillips and ward Sister Janine Burton, who told me how patients were struggling to eat, as well as suffering from extreme fatigue and poor appetite, with many of them needing practical help feeding. A number of our ward nurses have had Covid-19 and could personally identify with the loss of taste and fatigue, even three or four weeks afterwards.
“Patients here in particular are elderly and extremely frail, and are most likely to be nutritionally compromised before contracting Covid-19, so a dietetics frailty pathway was adapted which involves all patients receiving a stat dose of an additional 500kcal per day in the form of oral nutritional supplements.”
Ordinarily, patients would receive the supplements only if deemed high-risk via a nutritional screening tool and advised by a dietitian. “This intervention was achieved in the space of one afternoon, with all staff from nursing, medical and dietetics teams immediately enthusiastic and on board,” added Natalie.
“The result has been that all patients have improved nutritional and fluid intakes, and we have been able to see in practice how this pathway works and make changes to ensure its success. It’s had a knock-on effect of increasing overall fluid intake, with patients having between 1,000ml and 2,000ml per day. For an older person, this is significant and can contribute to a reduction in UTIs, falls and confusion linked with being dehydrated.
“All of our staff are so committed and enthusiastic about this intervention. It has meant a lot of extra work for everyone involved, from additional prescribing to drug rounds, paperwork and dietetic referrals, while our dietetic technical instructor Andrew personally has had to deliver 40 supplements per day to the ward! But we have seen results and there is a real human aspect to this.”
One patient has progressed from being bedbound to being able to use an exercise bike in his room, while an elderly lady was discharged home after gaining weight. “Patients are recovering and rehabilitating and, although we can’t prove it is solely down to the extra nutrition, we know it’s playing a role,” said Natalie.
“I’m really pleased and proud of this intervention and how we very quickly pulled together to make this happen. I feel we are truly nutritionally rehabilitating our most vulnerable cohort of patients with Covid-19. At the height of this pandemic, the outlook for this patient group was extremely bleak, but we are now seeing them recover and that’s heart-warming and incredibly positive for all the staff caring for them.”
Due to the trial’s success, the pathway is now being reviewed with regards to implementing it at other sites across the health board.