Fiona Lucey, a Senior Dietitian in Critical Care, tells us about how her role at Naas General Hospital has changed during the COVID-19 pandemic. This article was published in the Leinster Leader and Kildare Now on 14th June 2020.
A Day in the Life of Frontline Worker
By Fiona Lucey, Senior Dietitian in Critical Care, Naas General Hospital
As the weeks have gone on we have adapted and tried to get used to our new “normal” at work, in the same way that the public have adapted to their new “normal” too. It’s not easy whether you are working on the front line or are at home, but we are all in this together and there are brighter days ahead!
My name is Fiona and I am a Senior Dietitian in Naas General Hospital, working in the Intensive Care Unit and Coronary Care Unit. People are often surprised to hear that dietitians work in the ICU, but we are an important part of the critical care team caring for the sickest patients. When patients are ventilated they can’t eat or drink, and need a feeding tube to receive the nutrition their body needs to help them overcome their illness and recover. I work with a number of other healthcare professionals in the ICU including nurses, doctors, respiratory physiotherapists, pharmacists, speech and language therapists and healthcare assistants.
I am able to get up a little later than usual as there is no traffic on the roads now (silver lining!). I get ready for work, give the kids their breakfast and try set some school work for the day to keep my eldest busy while my husband works from home. Working from home and minding the kids has been challenging for my husband like many other families I’m sure, so for a period I altered my working hours to try be at home more during the day time mid-week, which involved working at the weekends or starting work at 7.00am and working a combination of long and short days.
I arrive into work at about 8.00am. I start with our daily general symptom check including a temperature check. In order to be able to maintain physical distancing in our office we have had to split our department into two locations, which has made communication more challenging, and lunch breaks less social! When I get in to the office I check my emails and catch up on admin work. I also check the hospital system to see have there been any new admissions to ICU overnight to help me plan my day. I’ll usually liaise with others in my department about patients who need to be seen that day too.
Next I start checking bloods for the patients I will review in ICU. Once that’s done I have my coffee break about 10.30am, to make sure I have something to eat and drink before I head into ICU.
In order to preserve stock and limit unnecessary use of PPE, I try to see all my patients in the ICU in one visit to the department. Before the pandemic I could come and go to the ICU throughout the day breaking up the workload. This is challenging as I can be in there a long time and the PPE can become quite uncomfortable, so it’s important to make sure you have had something to eat and drink before going in! I also have to ensure that I have all the resources that I need with me, to prevent the need for leaving the unit and using another set of PPE.
Usually in ICU patients are fed by a tube that goes into their nose and down into the stomach or small bowel. Sometimes if a patient’s gut is not functioning properly they may be fed intravenously instead, and nutrients are infused directly into the bloodstream. We will often make recommendations on the most appropriate route of feeding.
When patients are critically unwell, their nutritional needs may change on a daily basis. My role entails assessing a patient’s nutritional requirements taking into account a range of different factors such as the stage of their illness, existing health conditions, on-going treatments, blood work, medications etc. We devise a feeding plan that takes all of this into account, and select the most appropriate feed and rate of infusion. We then monitor how well patients are tolerating feeding, and adapt the nutrition care plan quickly if a patient’s condition changes.
Clinically patients with COVID-19 have been somewhat more challenging to manage in terms of their nutritional care, due to many of the symptoms they experience or the side effects of different medications. This has required a lot of reading and upskilling in a short amount of time, based on the experiences in other countries further ahead on the curve had of feeding these patients. Many of the patients with COVID-19 are proned as part of their treatment (placed lying on their front) which is not something we have done before in our ICU, and it can present challenges in terms of how well patients tolerate their feed.
In terms of the main hospital wards outside of ICU, during the pandemic our dietitians and other health and social care professionals have also been assisting in feeding patients with COVID-19 at mealtimes due to staff shortages, which would be outside our usual role.
Once I am finished in ICU I take a break for lunch, which is much needed after a few hours in PPE. We try to fit in a quick walk around the hospital grounds when the weather is nice to get some fresh air and break up the day.
In the afternoon I usually have patients to see in the Coronary Care Unit or the wards. These patients are usually eating and may not require as intensive input as in ICU but their nutrition is just as important as malnutrition can be very common when people are unwell.
As mentioned above, this pandemic has presented challenges to how we do our job and has required a lot of upskilling in a short amount of time. So in the afternoon I try to dedicate some time to further learning and development in relation to nutrition in COVID-19. In a way we were lucky to be able to learn from the experiences other countries further ahead on the curve had of feeding these patients. There is also an email group of dietitians working in ICU which has been an invaluable source of information and knowledge. Part of my role has also including upskilling others in my department in the area of critical care and COVID-19 specific feeding issues, as we expanded our ICU bed capacity, so I have spent time developing relevant resources for the department.
The best part of my job is when you get to see patients come out the other side after being so sick in ICU. It’s great to see patients discharged to the wards, wean off their feeding tube and get back to enjoying their food again. There have been difficult days during the pandemic but when you see this it makes it all worthwhile.
I get home from work at about 5.00pm, and head straight for the shower before coming in contact with any of my family. Once I’m at home I try to switch off from everything pandemic related and enjoy some family time. We have dinner together and go out for a walk or cycle. After the kids go to bed I often go for a run to clear my head or watch something on Netflix. I’ll often have a Zoom chat to catch up with family and friends.
The early days of the pandemic were probably the most scary as we were facing into the unknown and seeing how bad things were in other countries. I am lucky to be part of a great department and Hospital, we have all looked after each other and been a big support to each other in this challenging time. As the weeks have gone on we have adapted and tried to get used to our new “normal” at work, in the same way that the public have adapted to their new “normal” too. It’s not easy whether you are working on the front line or are at home, but we are all in this together and there are brighter days ahead!