PENG Webinars 2022

September 2022

Parenteral Nutrition: A discussion of complex intestinal failure cases

Available for members only, login to access the video here

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June 2022

Inspiring your next conference abstract and funding applications

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March 2022

Blended Diet in Clinical Practice

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PENG Webinars 2021

September 2021

Outcome Toolkit Update

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June 2021

Estimating Requirements: Two Years On

Available for members only, login to access the video here

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April 2021

PENG Award Winners Webinar.

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February 2021

The first PENG webinar of 2021 was held on Tuesday February 9th from 6-7.30pm on the topic of 'Water usage in enteral feeding: Results of PENG survey' and can be viewed below.

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October 2020 webinar and questions & answers raised during the webinar:

This webinar focused on prescribing and you can listen from the two speakers below and see the questions that were raised and how the speakers addressed them.

Dr Alison Culkin ‘Supplementary Prescribing’

Tanya Rumney ‘Supplementary Prescribing – insights and opportunities’

Questions asked throughout the October 2020 webinar

1. If the inpatient is not physically able to sign the Clinical Management plan (CMP) can you verbally discuss it or use an electronic signature as this is a problem for us getting the CMP signed when the patient needs to start parenteral nutrition (PN).

Alison: Patients do not need to consent, they need to agree. I think this is an important distinction. Their verbal agreement needs to be documented in the medical notes as part of your entry.

2. Do you have any advice for dietitians that are very keen to undertake supplementary prescribing that work in areas such as critical care where it would be difficult to implement prescriptions in critical practice?

Tanya: Most important thing is to discuss with your manager to see if there is a need. We are fortunate to have four non medical prescribing (NMP) dietitians where I work but only one is acute based, the rest are community focused. We had to demonstrate that there was a need for it – i.e. you could remove the doctor (mostly) out of the pathway by doing this. We therefore do not have secondary care diabetes / renal dietitians as prescribers as they work with consultants who can do the prescribing. However in gastro and primary care, supplementary prescribing (SP) allows transformation of clinical pathways so that it can be managed by the clinical person with the right skills to deliver it – i.e. the dietitian.

Alison: I think critical care is a tricky area as I am aware of a Dietitian who qualified and then was unable to prescribe because she was unable to get the patients agreement. It would be great to know what ICU RDs are doing to get over this hurdle.

3. How do you apply for the course?

Here is a link where you can find all the information you need https://www.hcpc-uk.org/education/approved-programmes/

4. For community dietitians, covering all GP practices, would the Independent prescriber (IP) be the patients actual GP or overall GP?

Tanya: Community dietitians are always going to struggle because they are too far removed (usually) from the GP. You will not get an overall GP happy to be the IP for patients who are not registered to them. GPs on the whole do not understand the clinical management plan (CMP) – so this is only likely to work in areas where you have a close working relationship with the GP so you can demonstrate how it works and they can see the benefit of this to them.

5. Have you used your prescribing to manage dehydration and constipation? Have your ideas of how to manage those been different from the doctors?

Tanya: Main difference is you do the food / fluid bit first and then medication whereas doctors might do the medication bit first!

Alison: Yes, I use my prescribing to manage hydration as part of the PN prescription and other IV fluids and electrolytes plus oral rehydration solutions. This is a perfect area for prescribing. Not yet used for constipation although I don’t see why you couldn’t. I have experienced differences in prescribing IV fluids as this is an area where doctors in training may not be as experienced as an experienced Dietitian.

6. Is CMP needed to deprescribe?

Alison: Yes as if you do not have one in place then you should not be managing prescription only medications which would include deprescribing.

7. How do people deal with doctors rotating weekly when they have signed CMP? Our doctors do one week and rotate to another consultant.

Alison: You will need a separate CMP for each consultant. I mainly work with 2 consultant Gastroenterologists and have the same CMP signed by each of them. When they rotate I use the one with their signature on.

8. Is the course limited to only gastro / renal /diabetes specialist dietitians or can it be undertaken by other specialists RDs?

Tanya: See answer to 2 – there needs to be a clear recognised need for prescribing. It is not a nice to do – it needs to be really clear how it is going to improve the patient journey and experience. If this is not clear before you apply for the course then you will really struggle to put this in to practice afterwards.

9. With the CMP is this for every medication or every new patient?

Both: Every patient.

10. Do you think patients mind that an RD is prescribing, not a doctor?

Tanya: No, they usually find it weird that you can’t prescribe. Patients rarely understand the legalities of medication

Alison: Not in my experience. Patients want the best person with the right skills.

11. Can you recommend a suitable course?

Alison: I attended Southbank University and was very impressed with the course but am sure they are all very similar as have to be approved by the HCPC.

See answer to question 3.

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