Date: 7/20/18                           Rotation: Clinical            Location: Woodhull Hospital

Activities / Assignments:

• Patient risk screenings
• Patient assessments
• Patient re-assessments
• Patient follow-ups
• Patient education – verbal and with written materials from the AND nutrition care manual
• Documented assessments/re-assessments/food preferences in Quadramed and CBORD
• Recommended diets and supplements (and changes to either) to doctors
• Attended patient rounds
• Dietitian weekly huddle
• Attended a presentation about Enhanced Recovery After Surgery (ERAS) Protocol– given by Abbott nutrition representative

Comments / Thoughts / What You Learned / Challenges:

This week I was assigned to the geriatric medical/surgical and psych floors. I had the opportunity to observe the dietitian perform the NCP for multiple patients, and I also had the opportunity to do it myself, both with her shadowing me and on my own. I provided nutrition education to patients about the diets they were currently prescribed – explained why they were on a certain diet and if I was going to recommend the doctor prescribe a different diet. I provided verbal education using the teach-back method and written materials, both in the patients preferred language. If their preferred language was not English, either an in-person translator or the translator phone was used to communicate with the patient. I performed patient charting for patients I saw as well as the patients I observed with my preceptor. I also attended the weekly full-team rounds. During this time, the doctors and nurses went over each patient’s condition and status, social workers went over discharge plans/issues that need to be resolved, and the dietitian gave updates on needed changes to diets/supplements.

I also attended the weekly dietitian’s huddle where the following topics were discussed:

• Health and Safety Weekly Message: Know the Symptoms and Care of Heat Cramps
• Food Safety Weekly Message: Follow Recipes to Prevent Misrepresentation
• Understanding Quality of Life: Well-Being Breaks

All of the dietitians attended the Enhanced Recovery After Surgery (ERAS) presentation. I found the presentation to be thorough and informative, as well as really interesting – it was the first time I had heard about this topic. The representative from Abbott went over the protocol developed by Abbott Nutrition and the American Society for Enhanced Recovery (ASER), the evidence that supports the protocol and products they developed, the role that each supplement/step of the protocol plays in the patients care before and after surgery, and their impact on the patient’s outcomes during and after surgery. We had the chance to sample the vanilla-flavored post-surgery supplement, which is called “Ensure Surgery Immunonutrition Shake”, and is specifically designed to support immune health and recovery from surgery. It actually tasted pretty good, but it was very sweet. My supervisor then went over how they planned to begin implementing the protocol at Woodhull. At first, it will only be used with colorectal surgical patients, and if the hospital feels it is improving outcomes it will be extended to all surgical patients. Since the person giving the presentation works for Abbott I did feel like he may have been slightly biased or over-selling the efficacy of this protocol and the strength of the research behind it. At the same time, I did feel that the information and research provided was sound, and I definitely think implementing the protocol could lead to improved patient outcomes.I’ve included an outline of the protocol, the rationale/research behind it, and a summary of the products below.

Learning Objectives Met: CRDN 2.1, CRDN 2.3, CRDN 2.4, CRDN 2.10, CRDN 3.1, CRDN 3.3, CRDN3.6, CRDN 3.8, CRDN 4.1, CRDN 4.10

Clock Hours: 40 Hours

• Monday 7/16/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh
• Tuesday 7/17/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh
• Wednesday 7/18/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh
• Thursday 7/19/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh
• Friday 7/20/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh