Munirah Sulaiman

 1. Between 13 July 2022 and 5 August 2022, you failed to produce a safe and clinically justified dietetic care plan for Service User A, in that:

a) On 20 July 2022, you did not document the food record charts;

b) On 20 July 2022, you did not document a description of volumes or portion sizes of the meals that Service User A was tolerating;

c) On 20 July 2022, you did not document any clinical justification for your decision to feed Service User A to 80% of estimated nutritional requirements;

d) On 20 July 2022, you prescribed Service User A, two Fortisip Compact supplements to be taken three times a day without clinical justification;

e) On 21 July 2022, you did not document the reason why Service User A had requested to change their regime from bolus feeding to pump feeding;

f) On 21 July 2022, you did not proceed with pump feeding, which would have been the safer option for Service User A;

g) On 22 July 2022, prior to increasing Service User A’s bolus feed, you did not document Service User A’s oral intake tolerance or bowel movements;

h) On 21 July 2022 and 22 July 2022, prior to increasing Service User A’s bolus feed, you did not document whether Service User A was suffering from any gastrointestinal symptoms from starting the bolus regime;

i) On 25 July 2022, you documented in Service User A’s clinical notes that there was a likely “ileus”, however when questioned about this on 16 August 2022 by Heather Trudgill, you were unable to explain what an “ileus” was;

j) On 25 July 2022, you did not recognise that Service User A’s bloatedness and discomfort could be linked to the feeding regime / volume of feed prescribed;

k) On 27 July 2022, you did not document Service User A’s oral intake or current medications when undertaking a review of their dietetic care plan;

l) On 28 July 2022, you documented that Service User A was suffering from stomach distension and was in significant discomfort, however, you did not document anything in Service User A’s notes to evidence that you had taken any action to address their abdominal distension directly;

m) On 28 July 2022, when you were unsure what was causing the patient’s abdominal distension, you did not speak to other medical professionals to determine whether any medications could be prescribed to reduce or alleviate Service User A’s discomfort;

n) On 28 July 2022, Service User A reported to you that their “stomach was loaded with faecal matter,” however you did not document the frequency of Service User A’s bowel movements or the type of stools passed over the previous couple of days;

o) On 28 July 2022, you changed Service User A’s regime by introducing a multi-fibre feed and pump feed at a rate of 125ml/hr with no clinical justification;

p) Between 20 July 2022 and 29 July 2022, you did not document a food chart or bowel chart for Service User A;

q) On 29 July 2022, you increased Service User A’s pump feed from a rate of 125ml/hr to 130ml/hr with no clinical justification;

r) On 1 August 2022, you did not identify that Service User A’s “very loose, large bowel motions” was a gastrointestinal symptom evidencing that Service User A was not tolerating the feeding regime;

s) On 2 August 2022, you asked a Consultant whether non-invasive ventilation (‘NIV’) causes abdominal distension, however, when questioned about NIV by Heather Trudgill on 16 August 2022, you were unable to explain what NIV was;

t) On 5 August 2022, you did not identify that Service User A’s small intestinal bowel overgrowth (‘SIBO’) could have lead to further distension or gastrointestinal problems; and

u) On 5 August 2022, you increased Service User A’s pump feed to 500ml at a rate of 125ml/hr without documenting any clinical justification for this.

2. Between 13 July 2022 and 18 August 2022, you failed to produce a safe and clinically justified dietetic care plan for Service User B, a diabetic patient, in that:

a) You did not liaise with the diabetes team before recommending Fortijuce supplements;

b) When Service User B was discharged home, you did not provide adequate information regarding insulin administration or advice on food fortification at home;

c) You did not complete a follow-up review with Service User B via telephone after Service User B’s discharge;

d) When Service User B was discharged home, you prescribed a dose of four Fortijuce supplements per day, which was not clinically indicated;

e) You did not demonstrate an understanding of why it was necessary to ask Service User B about insulin administration and blood glucose levels;

f) You reduced Service User B’s supplements to two Fortijuce per day without informing Service User B’s diabetes nurse or providing advice to Service User B; and

g) You did not provide Service User B with information about level four puree options and food fortification.

3. On 21 September 2022, during a telephone consultation, you did not complete a thorough check of Service User D’s glucose levels, or obtain sufficient information about their insulin administration and hypoglycaemic incidents in order for you to produce a safe and clinically justified treatment plan for Service User D.

4. On or around 21 September 2022, you did not finalise or send a letter detailing Service User E’s assessment and ongoing action to Service User E or their GP.

5. Between 23 August 2022 and 6 September 2022, you did not maintain accurate and complete records for Service User F in that:

a) you did not document any clear reason for Service User F’s referral or initial admission;

6. On 23 August 2022 you restricted Service User F’s diet by placing them on a renal menu when this was not clinically indicated.

7. On 8 and 9 September 2022, you did not maintain accurate and complete records for Service User G in that:

a) On 8 September 2022, you did not document any clear reason for Service User G’s referral or initial admission;

b) On 8 September 2022, you did not document Service User G’s current diagnoses or medical problems;

c) On 9 September 2022, you did not document what Service User G had been eating or drinking since their last review.

8. Between 26 August 2022 and 5 September 2022, you did not maintain accurate and complete records for Service User H in that you did not document or provide any indication as to when or why Service User H’s nasogastric feed was stopped.

9. On or around 14 October 2022, you did not complete and finalise Service User J’s clinical attendance note.

10. You did not review the dietetic care plans for the following service users in a timely manner:

a) Following a review of Service User O on 31 May 2022, you did not review or arrange for another dietitian to review Service User O until 7 June 2022. 11. On 31 May 2022, you failed to produce a safe and clinically justified dietetic care plan for Service User O, in that: a) You started Service User O on a tube feed when Service User O was nil by tube and nil by mouth;

b) You commenced Service User O’s feed at a higher rate than recommended for their clinical presentation;

c) You did not provide a rationale for commencing Service User O’s feed at a higher rate than recommended for their clinical presentation;

d) You did not review or request a colleague to review Service User O to ensure that the feed was being tolerated and whether the rate as suggested was safe; and

e) You did not review or request a colleague to review Service User O’s care plan until seven days after the plan was put into place.

12. The matters set out in particulars 1 to 11 above constitute lack of competence.

13. By reason of your lack of competence, your fitness to practise is impaired.