Intestinal Failure Unit - Salford Royal

Salford Royal Intestinal Failure Unit (IFU) is a National Reference Centre for the treatment of complex intestinal failure.  Parenteral support is a means of providing adequate nutrition and hydration via the blood stream to people with intestinal failure.

This can occur for a variety of reasons, including Crohn’s disease or following surgery. The team is multidisciplinary in nature and is proud to have an international reputation as a centre of excellence.

Due to referrals nationwide and the specialty of the unit, you may have to wait for a while until a bed becomes available. The referral list is reviewed on a regular basis. It is possible you could be assessed in our outpatient clinic.

Your stay

In order for our specialist team to treat you, it is possible that your stay may last for several weeks and in some cases months. When you arrive various tests and investigations will be booked for you. As your health improves you will be encouraged to take time off the unit and spend time at home for a few hours, or overnight.

Our facilities

We appreciate that you maybe far from home and we will endeavour to make your stay with us as
comfortable as possible. With this in mind we offer:

  • Free TV and radio
  • Free laundry and ironing facilities
  • A patient’s kitchen with fridge and drink making facilities
  • Dedicated telephone lines for incoming calls to patients
  • Close to the unit within the hospital there are several cafes, a bistro, gift shop, boutique, pharmacy, hairdressers, newsagent, religious requirements, patient advice and liaison service and
  • cash points.

Intestinal Failure Surgical Team Surgery often plays a key role in the treatment of patients with intestinal failure. A team of five consultant surgeons at Salford work closely with the multi-disciplinary IFU team in patient assessment and the development of treatment plans. They all regularly perform the long and complex operations required to reconstruct bowel and abdominal wall often working together. What we do The surgeons participate in ward rounds and clinics as well as operating in theatre and are experienced in the complex management of patients with intestinal failure. Teamwork on the IFU is a critical part of our patient management as patients often have a prolonged build up and optimisation before surgery. Working with and understanding the critical contributions of colleagues in nursing, stoma-therapy, psychology, pharmacy, nutrition and gastroenterology underpins successful surgery alongside operative experience and surgical technique.

Please provide a referral letter and complete all sections of the referral form, as incomplete or eligible forms cannot be processed and will therefore be returned for completion.

This form needs to be completed even if a formal referral letter has been sent already.

If you require further information please contact the administration office by phone on 0161 206 5116 or 206 5364 or email directly using the intestinalfailure@nca.nhs.uk email address.

Intestinal Failure Clinical Health Psychology Team 

The Clinical Health Psychology team is based on the Intestinal Failure Unit (IFU) and is an integral part of the multi-disciplinary service. The team comprises qualified Clinical Psychologists, all of whom specialise in the assessment and treatment of psychological difficulties commonly associated with Intestinal Failure.

Our overall aim is to support patients, families and medical teams to achieve the best quality of life for the patient, and optimise psychological well-being whilst living with Intestinal Failure.  

The team provides support across the patient care pathway. This includes meeting patients during their stay on the IFU, through to out-patient support and also during crucial points in treatment (e.g. when making decisions about surgery and/or pre and post-surgery).

What we do

Living with Intestinal Failure can affect how people feel and cope with many aspects of daily life. The Psychology team therefore offers a variety of evidence based psychological therapies.  

The services we provide include:

  • Specialist psychological assessment and intervention to address commonly reported difficulties in relation to living with Intestinal Failure. Common difficulties include anxiety, low mood, stress, acceptance and adjustment, body image, changes in relationships due to changes in physical health, and trauma related distress.
  • Joint work with the multi-disciplinary team. For example, the psychology team attend medical ward rounds, and often see patients alongside other team members (dietitians, nurses and surgeons) to help maximise quality of life.
  • Please speak to any healthcare professional based within the Intestinal Failure Service for more information about how to access the psychology service.

Intestinal Failure Nutrition and Dietetic Team

The Nutrition and Dietetic team are based on the Intestinal Failure Unit (IFU) and are an integral part of the multi-disciplinary service, every patient undergoes a detailed nutritional assessment and has a bespoke treatment plan agreed. The team comprises of 3 dietitians, all of whom specialise in the assessment and treatment of Intestinal Failure and Home Parenteral Nutrition.

Our overall aim is to support patients, families and the multi- professional teams to optimise patients nutritional status and therefore achieve the best quality of life for the patient.

The team provides support across the patient care pathway from admission and in the outpatient setting. This includes regularly reviewing patients progress during their stay on the IFU, through to out-patient support.  

What we do

Assess the nutritional status of patients on admission using anthropmetric measurements, functional measures, bio-electrical impedance and regularly throughout their patient stay on the unit.

Wherever clinically possible educate the patient on what they can eat and drink safely. All our patients are actively encouraged to continue with oral diet unless this is not in their best interests. This may be using techniques such as cognitive behavioural therapy or digital solutions to help patients understand the role of diet in their treatment.

Liaise with the multi-professional team to devise the optimal treatment plan, be it a combination of parenteral nutrition / oral diet and /or tube feeding to facilitate a safe discharge into the community.

We have an active role in education and training the multi-professional team on all aspects of nutrition support.

All members of the team are research active in order to contribute to the evidence base and ensure our patients receive the optimal treatments available in relation to artificial nutrition support and dietary interventions.


Clinical Biochemistry

The Clinical Biochemistry laboratory plays a key role in the multi-disciplinary service provided by the Intestinal Failure Unit (IFU), offering a wide range of blood, urine and faecal tests to assist with diagnosis, monitoring and treatment of patients.

These include:

  • monitoring of electrolytes in blood and urine to help support fluid management of patients
  • specialist analysis of vitamins and trace elements to allow optimisation of nutritional support
  • specialist diagnostic testing including faecal calprotectin analysis for the investigation of inflammatory bowel disease (IBD)
  • therapeutic drug monitoring both in-house and with referral laboratories to optimise treatment strategies

State-registered Clinical Scientists also regularly attend multi-disciplinary team meetings in the IFU to support patient management and act as a key point of contact with the laboratory, helping to review and interpret test results and advising on testing strategies


Intestinal Failure Clinical Pharmacy Team

The Intestinal Failure Pharmacy team is based on the Intestinal Failure Unit (IFU) and is an integral part of the multi-disciplinary service. The team comprises of specialist pharmacists, pharmacy technicians and assistant technical officers. The team also works in partnership with the aseptic compounding unit for the provision of parenteral nutrition for inpatients.

Our overall aim is to support patients and the medical and nursing staff to optimise pharmacological treatments, empowering patients to best manage their condition. We support both inpatients and outpatient with pharmaceutical advice, as well as advising other healthcare professional where required both from SRFT IFU but also referring hospitals and within primary care.

What we do

We provide a highly specialised pharmaceutical service to both our inpatient and outpatients including

  • Integral part of the MDT, reviewing medications regularly and optimising their use. Reducing the risk of medicines related harm and aiming to empower patients to best manage their medications through education and support. 
  • Supply of medication during inpatient stay and discharge, as well as ongoing supply of specialist Hospital only medication not available within primary care.
  • Management of parenteral nutrition within the MDT, liaising with our aseptic unit and homecare companies to ensure safe provision. Working with patients to provide safe and effective plans for parenteral nutrition for holidays both in the UK and abroad
  • Answering of medicines information queriers from a range of sources, including healthcare professionals (internal, external hospitals and primary care) but also from patients themselves.
     

Intestinal Failure Surgical Team

Surgery often plays a key role in the treatment of patients with intestinal failure. A team of five consultant surgeons at Salford work closely with the multi-disciplinary IFU team in patient assessment and the development of treatment plans. They all regularly perform the long and complex operations required to reconstruct bowel and abdominal wall often working together.

What we do

The surgeons participate in ward rounds and clinics as well as operating in theatre and are experienced in the complex management of patients with intestinal failure. Teamwork on the IFU is a critical part of our patient management as patients often have a prolonged build up and optimisation before surgery. Working with and understanding the critical contributions of colleagues in nursing, stoma-therapy, psychology, pharmacy, nutrition and gastroenterology underpins successful surgery alongside operative experience and surgical technique.


Intestinal Failure Nursing Team

Intestinal Failure (IF) is a highly specialised area and nursing is pivotal in the management of patients with IF.  The nursing team manage 21 inpatients beds on the Intestinal Failure Unit (IFU) and are part of the wider multi-disciplinary team (MDT). 

Each member of the nursing team has an extensive in-depth knowledge on the treatment of patients with IF.  This includes managing the prevention of catheter related blood stream incidents (CRBSI’s), fistuloclysis, complex abdominal wound & stoma care and ensuring patients are supported on the unit throughout their journey.  There are many factors which may contribute to IF problems such as psychological issues, poor body image or catheter complications for this complex cohort of patients and this list is by no means exhaustive.

The IF nursing team have a strong work ethic with an internal motivation to succeed and the IF lead nurse is committed to supporting and developing others.  This includes continuous professional development and collaborating across the network of healthcare providers (including commercial companies). The lead nurse is also a member of the national HPN Stakeholders committee and displays visibility, teaching and regularly presents at international & national IF study days and conferences.  

The senior IF nursing team also plays an active role in educating and sharing best practice and is encouraged to regularly network and collaborate at various nutrition conferences such as the National Nurses Nutrition Nursing Group (NNNG), British Intestinal Failure Alliance (BIFA) and European Society for Clinical Nutrition and Metabolism (ESPEN).


IF Outreach Service

The IF Outreach service plays a crucial role on the IFU and this service is continually developing.  Currently the IF Outreach team consists of 2 Clinical Nurse Specialists caring for patients that are in beds outside of the IFU, sometimes within another NHS hospital or in the community.  These patients are looked after in relation to bloodwork, management of central venous catheters, catheter care complications, home parenteral nutrition (HPN) and general day to day IF requirements.

The IF Outreach service regularly care for more than 3 patients per day on wards outside the IFU, alongside a daily nurse led clinic where patients may attend for a variety of IF / HPN related issues. The reason for day attendees can be a wide range of issues such as central venous catheter (CVC) management / HPN complications - catheter occlusion, sluggish catheter, exit site infection or catheter repair.  In addition, there could be a pyrexia, complex stoma/ wound issue, or a distal feeding tube issue that cannot be managed in community.  Furthermore, it could be advice around a high output stoma or dietary advice. It is all of these issues that require expertise from an IF clinical nurse specialist in conjunction with the MDT which consequently reduces hospital admissions and reduces pressure on the accident and emergency departments.

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