Forth Valley Wide Eating Disorders Service Protocol

Transcription

1 Forth Valley Wide Eating Disorders Service Protocol Date of First Issue 05/10/2011 Approved 05/10/2011 Current Issue Date 28/07/2016 Review Date 28/07/2018 Version 1.5 EQIA Yes 04/07/2014 Author / Contact Annette Gilmour / Dr Stephen Anderson Group Committee Adult Mental Health Care Group Final Approval This document can, on request, be made available in alternative formats th July 2016 Page 1 of 8

2 NHS Forth Valley Consultation and Change Record Contributing Authors: Annette Gilmour Dr Stephen Anderson Consultation Process: Distribution: Quality Improvement Web Pages Change Record Date Author Change Version 4/7/2014 SA Section 5. Changes to staffing and addition of information regarding treatment offered. Section 6. Addition of information regarding MARSIPAN 28/7/2016 SA Section 2. Changes to protocol statement. We now accept referrals for people with BMI >40 if they have an eating disorder th July 2016 Page 2 of 8

3 1. Introduction A need for a specialist eating disorder service was identified across NHS FV as these patients require specific treatments and support. This service is based at Livilands Resource Centre, Stirling Community Hospital and is a Forth Valley wide service for people between the ages of Younger patients would be seen by the Child and Adolescent Mental Health Services in NHSFV. People with a less severe Eating Disorder are usually managed within the General Psychiatric services and / or Mental Health Resource Centres provision. 2. Protocol Statement The team offer a Forth Valley wide out patient specialist Eating Disorder Service to patients suffering from: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder 3. Scope This protocol applies to all referrals to the NHS Forth Valley Eating Disorders Service. The service work towards the Healthcare Improvement Scotland recommendations for Management and Treatment of eating disorders. 4. Referral to Eating Disorders Service Referrals are only accepted via SCI gateway. Referrals are accepted from: GPs, other professionals within the Mental Health Services, Dietetics and our General Medical colleagues In order to prioritise referrals it is very important that we receive an up to date record of height weight and current BMI as well as blood tests, including U&E, LFT, FBC, Glucose and Creatinine Kinase in the SCI-Gateway referral th July 2016 Page 3 of 8

4 Referral to specialist services is indicated when the following clinical features are present. 1 Anorexia Nervosa continuing weight loss severe emaciation, eg BMI<16 marked vomiting or laxative abuse physical complications, eg hypotension when primary care interventions have failed when depression is marked and/or a risk of self harm co-morbid conditions such as pregnancy or diabetes Bulimia Nervosa symptoms severe and persistent duration longer than 6 months other dyscontrol behaviours, eg shoplifting, wrist cutting, overdoses when depression is marked when simple advice/diaries have failed rapid weight loss even if not yet satisfying criteria for anorexia nervosa Referral to specialist services is very strongly indicated when the following are present. Anorexia Nervosa BMI < 13.0 rate of weight loss continuing at >1 kg per week vomiting more frequently than once per day heavy laxative use prolongation of QTc interval or other significant ECG abnormality core temperature <34 c muscle weakness - unable to rise from a squat without use of arms for leverage pulse rate less than 40 per minute or systolic blood pressure (BP) less than 80 mm/hg major abnormality of biochemistry or haematology signs of significant cognitive impairment Bulimia nervosa persistent suicidal thinking persistent deliberate self-harm rapid weight loss although not yet satisfied criteria for anorexia nervosa major abnormality of biochemistry or haematology th July 2016 Page 4 of 8

5 5. Treatment Problems should be moderate to severe in nature. The multi-disciplinary team which consists of a Consultant Psychiatrist, a Senior Nurse Therapist, Advanced Nurse Practitioner and Senior Mental Health Dietitians, offer assessment and treatment mainly on an out patient basis. Although based at Stirling Community Hospital, the Service can offer treatment at home or in other clinical settings such as FVRH or GP clinics if clinically indicated. We can offer limited meal support and additional support in terms of shopping for food and cooking if this would be of benefit to the overall care plan. Treatment can be on an individual basis or in groups. Therapists work closely with the Dietitians, often developing joint packages of care. We are also able to access Mental Health Resource Centre assessment, Occupational Therapy assessment and provision of Art Therapy. The main aim is to treat and support people at home. 6. Inpatient Treatment NHS Forth Valley has access to beds in the specialist Regional Eating Disorder Unit at St John s Hospital, Livingston. This unit serves the populations of the NHS Forth Valley, Fife, Lothian and Borders Board areas. Multidisciplinary input is provided by nursing, psychiatry, psychology, dietetics, physicians, physiotherapy and social work. Admissions will generally be planned and for time-limited, specific pieces of work and referrals will only come from the Forth Valley Eating Disorder Service. There will be regular communication between the in-patient and out-patient teams to ensure smooth transitions of care. In some circumstances it may be necessary to admit patients with eating disorders more locally and we have access to one in-patient bed in Ward 3 in Forth Valley Royal Hospital. This is on a General Psychiatric ward and again the ED team would work closely with the in-patient staff to ensure continuity of care, particularly dietetic input. If patients with Anorexia Nervosa and a BMI of less than 15 are admitted to acute medical wards, the MARSIPAN guideline developed jointly by the Royal Colleges of Physicians and Psychiatrists should be implemented. This guideline recommends joint management of these patients by a physician with specialist knowledge of eating disorders and by eating disorder/liaison psychiatry. The guideline can be accessed here on the NHS Forth Valley Quality Improvement Page th July 2016 Page 5 of 6

6 7. Informal Enquiries Informal Enquiries to Team Secretary: Eating Disorders Service NHSFV Livilands Resource Centre Stirling Community Hospital Stirling FK8 2AU Publications in Alternative Formats NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print. To request another language for a patient, please contact For other formats contact , text , fax or - [email protected] th July 2016 Page 6 of 6