1. LAGB Adjustments Extended Role Fiona Sim Bariatric Dietitian Aberdeen

2. Background Initial Pilot in 2004 for 20 gastric bands. Initial Pilot in 2004 for 20 gastric bands. NHS Grampian provided bariatric surgery to patients from NHS Highland, Western Isles, Orkney, and Shetland within local North of Scotland agreement as well as other health boards. NHS Grampian provided bariatric surgery to patients from NHS Highland, Western Isles, Orkney, and Shetland within local North of Scotland agreement as well as other health boards.

3. NHS GRAMPIAN

4. Problems……. Only radiological done Tuesday afternoons Only radiological done Tuesday afternoons O/ P appointments on Wednesday on different site! O/ P appointments on Wednesday on different site! Transport difficulties for distant patients Transport difficulties for distant patients Emergency deflations to wait for surgeon/ medical staff Emergency deflations to wait for surgeon/ medical staff

5. Problems…….. Request chits for adjustment could only be signed by medical staff Request chits for adjustment could only be signed by medical staff Time delay from request to adjustment could be several weeks Time delay from request to adjustment could be several weeks Patients would keep follow-up appointments with surgeon to request adjustment but not attend for dietetic review Patients would keep follow-up appointments with surgeon to request adjustment but not attend for dietetic review

6. How to provide better service? Train non medical staff to perform fills Train non medical staff to perform fills Provide adjustments at out-patient clinics Provide adjustments at out-patient clinics Provide a “local” adjustment service for outlying patients Provide a “local” adjustment service for outlying patients

7. How? Follow BDA protocol Follow BDA protocol Find surgical support Find surgical support Find suitable course Find suitable course Ensure adequate supervision to Ensure adequate supervision to Achieve and maintain competency Achieve and maintain competency

8. My Experience Find a mentor Find a mentor Find training course Find training course Get supervision Get supervision Show competency Show competency

9. Practical Tips! Practice touching patients Practice touching patients Hep B jab Hep B jab Warm hands/short fingernails Warm hands/short fingernails Although you may fail to adjust band you may identify a problem! Although you may fail to adjust band you may identify a problem!

10. Working towards…… Achieving competency Achieving competency Adjustments routinely done at O/P clinic Adjustments routinely done at O/P clinic Training other non medical staff Training other non medical staff Developing better overall service for patients Developing better overall service for patients Developing an extended role for dietitians Developing an extended role for dietitians

11. Advantages of extended role Enhanced patient treatment, opportunity to offer dietetic advice with adjustment Enhanced patient treatment, opportunity to offer dietetic advice with adjustment Flexible Flexible Improved outcomes Improved outcomes Time saving Time saving Cost saving Cost saving

12. And finally………… To achieve this extended role you will need to… Have a desire to learn this skill, be determined and willing to find solutions to the inevitable hurdles….. but if you succeed Have a desire to learn this skill, be determined and willing to find solutions to the inevitable hurdles….. but if you succeed You will have a skill that will enable you to provide a more efficient and enhanced service for patients. You will have a skill that will enable you to provide a more efficient and enhanced service for patients.

13. Questions ??????????? Fiona Sim Bariatric Dietitian Aberdeen Royal Infirmary fionae.sim@nhs.net