G149 The management of eating disorders on children’s wards: trials, tribulations and training

Abstract

Aims This series of studies considers the challenges faced when caring for young people with eating disorders on children’s wards, suggesting approaches to improving quality of care. Methods This report brings together information from four sources, all referencing the standards defined by Junior MARSIPAN: Audit of 12 admissions to Hospital A, assessing quality of medical care Audit of 4 simultaneous admissions to Hospital B, considering pragmatic aspects of care Review of a particularly challenging case admitted to Hospital A Deanery-wide trainee survey (22 responses, ST4–8) Results At least half of young people displayed high risk clinical parameters, but assessment was frequently incomplete. Postural observations were rarely recorded.%BMI was only documented in 17%. Hydration status was considered in 8%. However, most patients had an ECG, and monitoring for refeeding syndrome was adequate. All four young people displayed multiple high risk medical features. Despite all experiencing symptoms for over 9 months, each was known to CAMHS for less than 2 months. Limited confidence in managing these patients was acknowledged amongst both medical and nursing staff. Particular challenges included adequate supervision, lack of specialist dietetic advice, and communication between paediatric and CAMHS teams. This case involved a teenage girl admitted for nasogastric refeeding. Compliance was limited from the outset. Despite sedation, full time specialist nursing support and frequent restraint, feeds could not be safely administered and her condition deteriorated significantly. A specialist bed only became available after a 13 day admission. Despite three-quarters having encountered at least one young person with an eating disorder in the last 2 years, only one in five had received any formal training. 82% were unaware of Junior MARSIPAN. Red flag features were not consistently recognised. However, all could give a basic description of refeeding syndrome. Challenges experienced included adequate nursing supervision, and multidisciplinary team working. Conclusions Together these reviews highlight the need for improved education amongst paediatricians, including signposting to Junior MARSIPAN. The challenges of effective multi-disciplinary working are described in all. Improved education within schools and primary care is also suggested, facilitating earlier recognition and referral.