The Lower Valley PCN care coordinator team identified issues with the dietician referral process from local care homes, particularly the lack of detailed information on the existing Support and Independence Team SIT) Referral Form. This often resulted in delays to dietetic assessments and challenges in managing residents prescribed nutritional supplements.
Care Coordinator Wendy Ibberson led on improving the referral process, working in collaboration with Lisa Green, Calderdale and Huddersfield Foundation Trust (CHFT) Dietitian, to redesign the referral form for the PCN Care Homes to use. The revised version captured all relevant clinical and dietary information and continues to align with CHFT’s guidelines on nutritional supplement prescribing and first-line dietary advice.
The Lower Valley PCN care coordinator team identified issues with the dietician referral process from local care homes, particularly the lack of detailed information on the existing Support and Independence Team SIT) Referral Form. This often resulted in delays to dietetic assessments and challenges in managing residents prescribed nutritional supplements.
A pilot was launched at Bridge House Care Home, focusing on residents currently prescribed supplements. Weekly weight monitoring was introduced, with results shared with the PCN pharmacy team for review. Once the new referral process proved effective, it was rolled out to other care homes within the PCN.
Outcomes
- Referrals became more appropriate, enabling faster, more effective dietetic input.
- Care homes became more confident in completing referrals and now submit them directly through Gateway to Care, reducing workload for the PCN teams
- The pilot strengthened collaboration between care homes, the PCN pharmacy team, the PCN Care Coordinators, and CHFT dietitians, supporting safer supplement prescribing and better nutritional outcomes.
Wendy’s work was instrumental in improving nutritional care pathways across care homes. By leading the pilot and co-developing a more robust referral process, she helped shape the new CHFT dietician referral form, creating a more efficient and clinically effective system for residents’ nutritional care.
