Week 30 – Clinical – Woodhull Hospital

Date: 7/27/18                           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
  • Group education for psych 4 unit
  • Dietitian weekly huddle
  • Tray assessments
  • Meal rounds

Comments / Thoughts / What You Learned / Challenges: I was assigned to the geriatric medical/surgical and psych floors Monday. The rest of the week I was assigned to the labor and delivery/post-partum and psych floors. I had the opportunity to observe the dietitians perform the NCP for multiple patients, and I also had the opportunity to do it myself, both with them 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 weekly full-team rounds twice this week – once for the geriatric floor and once for the post-partum/labor and delivery floor. During this time, the doctors and nurses went over each patient’s condition and status, social workers went over discharge plans/issues that needed to be resolved, and the dietitian gave updates on needed changes to prescribed diets/supplements.

On Tuesday, I conducted a nutrition education group on the principles of MyPlate for the psych 4 unit under the supervision of my preceptor. Three patients attended, and they were very engaged with the material and asked a lot of questions. I provided them with a handout from the AND Nutrition Care Manual that gave an overview of all of the information provided during the group so that they could follow along with the things I was talking and so they could review the material at a later time if they wanted to.

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 Rash
  • Food Safety Weekly Message: Foreign Materials in Food
  • Malnutrition screening protocol: it is the dietitian’s responsibility to check if malnutrition diagnosis was documented by MD, and if not follow up
  • Performance Improvement (PI) – Enteral Goal Rates: dietitian’s need to look at patient’s who started tube feeding (TF) in the month they’re doing PI for; once they meet > 80%, mark them as reaching goal; mark anyone who cannot reach > 80% TF because of intolerance or change of diet to PO as N/A

The patient load was a little light Thursday, so I performed meal rounds, which involved interviewing the patients about the quality of their meals during lunch time. During this interview I asked the patient how they felt about the taste and quality of the food provided and whether or not the temperature of the food was appropriate (trying to determine if foods that were supposed to be hot were actually hot, and if foods that were supposed to be cold were actually cold). I also took the time to find out how the patients were eating (asked how their appetite was and how much of the food provided were they consuming), and if they had any food allergies or food preferences.

I also performed a tray assessment which involved ordering a lunch tray from the kitchen to be delivered to a fake patients’ room and measuring and recording the temperature of everything on the tray to make sure all the food was the appropriate temperature. Checking the expiration dates of the prepackaged items provided was also part of the tray assessment.

Learning Objectives Met: CRDN 1.1, CRDN 2.1, CRDN 2.3, CRDN 2.4, CRDN 2.10, CRDN 3.1, CRDN 3.3, CRDN 3.5, CRDN 3.6, CRDN 3.8, CRDN 4.1, CRDN 4.3, CRDN 4.10

Clock Hours: 40 Hours

  • Monday 7/23/18 → 10:00 AM – 6:00 PM (8 hours) – Geriatrics Med/Surg/Psych w/ Colleen Jones-Baksh
  • Tuesday 7/24/18 → 9:00 AM – 5:00 PM (8 hours) – Labor and Delivery/Post-Partum/Psych w/ Diana Hu
  • Wednesday 7/25/18 → 9:00 AM – 5:00 PM (8 hours) – Labor and Delivery/Post-Partum/Psych w/ Diana Hu
  • Thursday 7/26/18 → 9:00 AM – 5:00 PM (8 hours) – Labor and Delivery/Post-Partum/Psych w/ Diana Hu
  • Friday 7/27/18 → 9:00 AM – 5:00 PM (8 hours) – Labor and Delivery/Post-Partum/Psych w/ Diana Hu
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