I just finished up my first week of my clinical nutrition rotations! I have just one more week left at Monongalia General Hospital before I move on to my next set of rotations. I have learned so much this week on the overall role of clinical dietitians and how it is to really utilize the Nutrition Care Process on real patients.
Monongalia General Hospital is one of two major hospitals in the Morgantown area – in fact they are practically right next to each other! These two hospitals serve very different needs in the community. Ruby Memorial Hospital is a large teaching hospital that is over 500 beds and is fully equipped with a cancer center, children’s hospital, and a level I trauma unit. Monongalia General Hospital is only 189 beds equipped with a level IV trauma unit. It is definitely more a community hospital with less high-risk patients, which makes it an ideal location to start for my clinical journey.
So, what exactly does a clinical dietitian do? This is a very common question that, unfortunately, not many know the answer to! While I knew the basics of what a clinical dietitian was responsible for, this week gave me a much deeper understanding what a typical day was like as a clinical RD. Each day there are two clinical dietitians that are available to assess and treat patients. The day begins by looking at the list of patients that have been given “consults.” These consults can be sent to the RD’s for multiple reasons. First, nursing staff always conducts a basic nutrition risk assessment on all newly admitted patients. If the patients are considered high risk, then a consult is sent to the dietitians. Physicians can also order consults on patients who they feel will benefit from a nutrition intervention, education, or that require monitoring. The final way that a consult can be sent to the RD’s is by what is called a “system consult.” System consults are triggered by the electronic medical database for patients with a length of stay greater than seven days, a stage II or greater pressure ulcer, recent cardiac surgery or diagnosis, or a variety of other scenarios. Once the dietitian receives the list of patients for the day, the assessment process beings.
The assessment process involves a very comprehensive reading of all the lab values, and medical notes from physicians, mid-levels, nurses, and other allied health fields. Even though dietitians deal with nutrition interventions, they are still required to understand all the lab values, medical terminology for the conditions, surgical procedures, medications, and the abbreviations that other medical professionals are required to know. Before any patient is seen there is an extensive review so that the patients’ condition can be fully understood. After preparing a preliminary chart note for the patient with the information from the electronic medical records the patient is then visited. During the visits with the patients the dietitian assesses current intake and collects any information to determine if the patient requires any education or additional nutritional intervention (i.e. Ensure, tube feeding, parenteral nutrition (IV feedings), supplements, etc.). After finishing up with the patient, chart notes must be written and entered into the electronic medical record system. In addition to visiting patients that have consults, dietitians also participate in interdisciplinary care meetings and grand rounds with the physicians, case managers, and nursing staff.
I always had imagined that I would end up in clinical nutrition and being able to actually assess patients, deliver nutrition education and interventions, and write chart notes on patients throughout this rotation has confirmed my desire to become a clinical dietitian! This past week I was able to assess and deliver nutrition education to a variety of cancer and cardiac patients and write the chart note! I am looking forward to this next week with Monongalia General Hospital to focus on more nutrition interventions!