Title: Checking fat soluble vitamin levels in patients with Pancreatic Exocrine Insufficiency (PEI) in the community
As a dietitian, I have spent over 20 years working with adults and children with Pancreatic Exocrine Insufficiency (PEI). Through this I have developed a specialist interest in the need to check fat soluble vitamin blood levels and monitor bone health in people with PEI as these patients are less able to digest and absorb food properly, especially fat soluble vitamins such as A D and E. Lack of these vitamins can lead to significant health issues, including night blindness and loss of peripheral vision, depression, muscle weakness heart disease, osteoporosis and some cancers. This is costly to the NHS and of course to the patients and various literature and guidelines make it clear that regular monitoring is good practice.
Despite this however, patients with PEI in the community, or attending acute units in Cambridgeshire, did not routinely have their fat soluble vitamin levels checked. I investigated and established a viable system for blood to be taken from patients with PEI. Following this I developed a range of patient literature and a system which ensured all patients with PEI (except those with terminal pancreatic cancer) have their fat soluble vitamin levels discussed with them on referral to the community dietitian.
I designed a training pack for other Gastroenterology Dietitians explaining why and how to check fat soluble vitamin levels and how low levels could be addressed.
I developed two standard letters to enable communication of tests and results between dietitian and GP and to suggest a plan for GP action following the results.
We have collected eight sets of data to date which have shown that 50% of patients have either Vitamin D deficiency or suboptimal serum levels. These patients were commenced on vitamin D supplementation and referred for consideration of a DEXA (bone density) scan.
Addressing this situation should have reduced the risk of developing costly health issues and in addition the patients themselves reported that they felt they were receiving an enhanced and thorough service. We hope to continue to offer this service and to standardise this care across the county.
Despite many years of hard work in the NHS I have never had formal recognition like this and so I was not only shocked but also proud, honoured and very pleased to receive the award.
Winning this award will not only give me recognition from my colleagues but also help to raise the profile of my profession, department and Trust. It will enhance my career, by encouraging me to continue to strive for change that will enhance patient care.Kim Jones