Quality statement 7: Nutritional monitoring after discharge from the bariatric surgery service

Quality statement

People discharged from bariatric surgery service follow-up are offered monitoring of nutritional status at least once a year as part of a shared-care model of management.

Rationale

After bariatric surgery, unidentified nutritional deficiencies can occur and cause long-term harm (such as Wernicke's encephalopathy, peripheral neuropathy, anaemia, osteoporosis or night blindness) or death. It is therefore important for people who have had bariatric surgery to have lifelong nutritional monitoring and appropriate nutritional supplementation, as part of a shared-care model of management. The management plan should involve collaboration between named tier 3 specialists and primary care as well as locally agreed monitoring arrangements and responsibilities.

Quality measures

Structure

a) Evidence of local arrangements and written clinical protocols to ensure that people are offered at least annual monitoring of nutritional status and appropriate supplementation after discharge from bariatric surgery service follow-up as part of a shared-care model of management.

Data source: Local data collection.

b) Evidence of a locally agreed shared-care model of management for people who are discharged from bariatric surgery service follow-up, developed by tier 3 specialists and primary care.

Data source: Local data collection.

Process

Proportion of people discharged from bariatric surgery service follow-up who have at least annual monitoring of nutritional status and appropriate supplementation as part of a shared-care model of management.

Numerator – the number in the denominator who have had their nutritional status monitored within the past year as part of a shared-care model of management.

Denominator – the number of people discharged from bariatric surgery service follow-up more than 1 year ago.

Data source: Local data collection.

Outcome

Nutritional status after discharge from bariatric surgery service follow-up.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (primary, community-based, and secondary care services) ensure that people who are discharged from bariatric surgery service follow-up are offered monitoring of nutritional status at least once a year as part of a shared-care model of management.

Healthcare professionals (primary care and tier 3 service staff) ensure that they monitor the nutritional status of people discharged from bariatric surgery service follow-up at least once a year and prescribe appropriate supplementation if needed, as part of a shared-care model of management.

Commissioners (clinical commissioning groups and NHS England) ensure that local shared-care models of disease management are agreed between primary care and tier 3 services for people who are discharged from bariatric surgery service follow-up, and that a named person or unit responsible for recalling people and performing ongoing checks is clearly specified. This is part of a shared-care model of management.

What the quality statement means for patients and carers

People who had an operation to help them lose weight (called bariatric surgery) and have finished their follow-up care are offered a check-up at least once a year to make sure they are getting the nutrients they need. The check-up is part of a care plan that has been agreed between the person, their GP and other healthcare professionals involved in their care.

Source guidance

Definitions of terms used in this quality statement

Monitoring of nutritional status

This involves identifying any nutritional deficiencies, including vitamins, minerals and trace elements, after bariatric surgery and providing appropriate nutritional supplements. Clinicians should liaise with the local bariatric unit about patient-specific nutritional deficiencies and necessary treatment.

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189) and expert opinion]

Shared-care model of management

A clear plan that outlines how a shared-care model of chronic disease management for lifelong annual follow-up after discharge from the bariatric surgery service will be implemented, including monitoring arrangements, common nutritional responsibilities and their treatment and responsibilities of the tier 3 specialist, the GP and the patient. The plan should involve collaboration between named tier 3 specialists and primary care.

[Adapted from Obesity: identification, assessment and management (NICE guideline CG189)]

Guidelines for the follow-up of patients undergoing bariatric surgery (O'Kane et al. 2016) provides further detail and potential models of shared-care protocols for postoperative management after bariatric surgery.