Dr Libby Thomas, Senior Clinical Lecturer at the Blizard Institute and Emergency Medicine Consultant at Kings College Hospital, led a project to create a time-critical resource for frontline healthcare professionals in paediatric wards and emergency departments.
This guidance provides a single point of access to essential resources for critically unwell children and young people who may require restraint in order to instigate nasogastric (NG) feeding but are too unwell to actively consent. Based on the Medical Emergencies in Eating Disorders (MEED) guidance, it compiles publicly available information, ensuring updates with future guidance where possible. An algorithm is embedded to provide a clear, step-by-step process to support clinicians in navigating complex decisions, ensuring they consider all relevant factors while prioritising patient-centred care.
This resource, now available on NHS England’s Learning Hub, integrates key clinical, legal, and emotional considerations, making it a vital just-in-time and learning tool for frontline staff. During the ten-month pilot in 2023, the resource had eleven thousand visits.
In an interview with the DES, Libby Thomas shares insights into how she created this resource and its impact.
Jorge Freire (Senior Learning Designer, DES): Can you tell us about the “Paediatric restrictive practices and NGT feeding guidance” project, and your role in it?
Libby Thomas: The project was aimed at creating time-critical guidance for nasogastric feeding in children and young people with life-threatening eating disorders. It was a co-created tool designed to support healthcare practitioners with just-in-time information when managing these complex, emotional clinical situations.
NHS England commissioned the project, and it emerged from their review of existing practices and nasogastric feeding protocols. Initially, they found that while various guidance documents existed, they were scattered across various places, making them difficult to access quickly, particularly in urgent situations. The decision was to create this resource that collated, organised and gave access to policies and I volunteered to take on the challenge of creating a more accessible, unified resource. I envisioned an interactive, app-based guidance tool that could be used on the spot but also serve as a resource for further learning.
The project took three months, and I worked primarily alone at first, starting with the Word document and PowerPoint presentation from the review. I mapped out all the relevant guidance, policies, and resources using Miro, creating a central algorithm to guide decision-making and support materials around it. I then worked with the project manager using Visio to better visualise the algorithm and share it with key stake holders. Later, I collaborated with a digital learning content creator to bring it all together.
Miro storyboard
Visio storyboard
Throughout the process, we consulted various user groups, including commissioners, patients, and carers, sharing content and sense-checking it with them. Their input was invaluable. The patient voice really makes the guidance come alive; you can see it reflected throughout. One poignant aspect of the guidance is the artwork created by a young person, representing the emotional turmoil as knots inside. This was drawn from a commission for a previous mental health project I had led and truly captures the weight of the decisions being made in these clinical situations.
Jorge Freire: What does the guidance look like, and how does it support healthcare professionals in managing children and young people with life-threatening eating disorders?
Libby Thomas: The guidance is designed to provide rapid, structured access to crucial decision-making information on the rare but challenging occasions when restrictive practices are required to deliver life-saving nasogastric feeding. It is built around an interactive algorithm that takes users through the key steps, such as assessing whether NG feeding is necessary and considering legal aspects including the Mental Health Act.
Dr. Libby Thomas
Twitter @libbylilias
LinkedIn: www.linkedin.com/in/libby-thomas-079732157
Resource: Paediatric restrictive practices and NGT feeding guidance
Illustration of the tool in use
One of the key features is its focus on avoiding restraint wherever possible, ensuring that healthcare professionals explore all alternatives before proceeding with NG feeding. It also includes direct links to existing guidance, such as Medical Emergencies in Eating Disorders (MEED) and other NHS policies, making it a comprehensive, user-friendly tool for front-line healthcare staff.
The involvement of patients, carers, and family members was critical in shaping the guidance, adding a much-needed patient-centred perspective. For instance, quotes from young people and carers with lived experience are inserted throughout, which helps bring the emotional complexity of these situations to life.
Jorge Freire: How do you envision the guidance being used as a learning and development tool, and what impact do you hope it will have?
Libby Thomas: The guidance is designed to be as intuitive as possible, making it useful not only in real-time decision-making but also for reflective learning. One of the key features is its ease of use —it is responsive on different devices like phones and tablets, so healthcare professionals can easily review it during downtime, or on the their commute.
We built the guidance to include links to further reading, including academic papers and other critical resources such as the Mental Health Act, helping users dive deeper into specific topics. It is structured to allow quick lookups through a search function, making it versatile for just-in-time scenarios or for deeper exploration.
This tool also provides healthcare professionals with a repository of essential information about eating disorders, mental health, and relevant legislation. It guides them through a step-by-step decision-making process, helping them visualise their thought processes and improve their clinical skills over time, particularly when reflecting on complex cases
Jorge Freire: How do you see this guidance being applied in clinical placements for medical students or junior healthcare professionals, and what do you hope they will learn from it?
Libby Thomas: This guidance walks you through complex scenarios step-by-step, providing yes/no pathways that make the decision-making process transparent and easy to follow. It also helps healthcare professionals verbalise their thought processes, which is particularly useful for students. It allows them to understand why a certain decision was made at a particular stage, even in fast-paced environments like the Emergency Department.
Jorge Freire: Patient-centred care is a key aspect of the guidance. How did you involve children, young people, and their families in the development process, and why is their input so critical to effective clinical decision-making?
Libby Thomas: Co-creation played a significant role in developing this guidance. We worked closely with children, young people, their families and carers throughout the process, bringing them into stakeholder advisory groups where their insights helped shape not only the content but also the tone and language. Their involvement ensured that the guidance was clinically sound and emotionally sensitive to the complex, often difficult, situations being addressed.
One powerful example of this co-creation was the inclusion of a poem written by a young person with anorexia, which adds an emotional depth and human perspective to the guidance. This contribution helps clinicians step into the shoes of patients, promoting empathy and ensuring that patient-centred care remains at the core of decision-making. Their input was crucial in making sure the guidance reflects the real experiences of those it aims to help
Jorge Freire: Thank you for sharing your insights, Libby. This sounds like an incredibly impactful project.
Libby Thomas: Thank you. It has been a rewarding process, and I hope this guidance will continue to make a real difference in clinical practice or inspire future ways of sharing easy-to-access information.