And we’re back! Spring semester has officially begun, and I’ve finished my first week of clinicals.
Here’s what my week looked like:
Monday:
No school or rotations today because of Martin Luther King Junior Day. It feels weird to start a new semester on a Tuesday (it was always like this in my undergrad too), but I’m thankful. I desperately needed today to get everything organized to start up my dietetic internship again. There’s always emails to double-check, things to print, and stuff to organize to get the semester started off right. I wrote down all of my due dates for the semester, which is scary to see them all laid out, but does make me feel better because I’m less likely to forget something. I also finished up another blog post for the Chicago Academy of Nutrition and Dietetics which will be posted on Friday.
Tuesday:
My first day of clinicals! I will have four preceptors at my clinical site who I’ll rotate through as the semester progresses. To start off, they gave me a brief overview of the hospital. Then, I learned how diet orders are entered in the diet office. The hospital that I’m at does call-in orders. This means that a patient can call any time the diet office is open and place a food order. The order is delivered whenever the patient would like, or within 45 minutes of when the order was placed. It was interesting to see how diet ordering works with the different diets in the hospital. The diet techs place orders in a computer program that disallows certain foods for certain diets. It also warns diet clerks when they’ve entered foods that contain too much of a certain nutrient for that diet. So, for example, diabetics on a consistent carb diet can only have a certain number of carbs per meal. If a diet tech enters too many based on foods the patient wants the program alerts them automatically. When this happens, they have to remove items until the carb count is correct.
After shadowing the diet office, the food service supervisor gave me a tour of the kitchens. She also showed me how the trayline works, and the systems they have in place to ensure that all patients orders are correct. I spent my afternoon reviewing the diets that the hospital offers, and familiarizing myself with where things are.
Wednesday:
I spent another day in the kitchens, this time shadowing tray delivery. I observed the tray runners bring meals up to patients, and deliver them. Lots of measures are in place to ensure that trays are correct and properly delivered. After spending my morning learning more about food service operations in the hospital, I spent my afternoon reviewing the hospital’s specific diet manual and some of their educational resources.
There are a lot of different medical diets, however, the most common ones at the hospital I’m interning at are regular, heart healthy, consistent carbohydrate, gastrointestinal (GI) soft, clear liquid, and mechanical soft. Regular is for patients with no diet-related illnesses or issues. Heart healthy is exactly how it sounds: low-sodium, fat and cholesterol to promote heart health. Consistent carbohydrate is for patients with diabetes to help control their blood sugar. Gastrointestinal soft includes foods that won’t irritate the GI tract and is for patients who have GI distress or have recently had GI surgery. Clear liquid includes just that, clear liquids, and is most often for patients after surgery. Mechanical soft includes foods that are easy to chew for patients who have chewing difficulties.
Thursday:
I spent my morning doing chart review with one of my preceptors. Not only do we have patients on our “task list” referred by a doctor or screened by a nurse, but we also have to check and see if there are any other patients that might need to see a Registered Dietitian. Some red flags are: patients who haven’t been able to eat or have been on a clear liquid diet for 5 days, patients with pressure ulcers, patients who have been in the hospital for 7 days or longer, and patients who have recently been prescribed a medication that requires a large dietary change. Nurses also screen patients to determine whether or not they should have a consult with a dietitian. Unintentional weight loss, very high or very low BMI (<18.5 or >40), and difficulty with eating while in the hospital are all automatically referred to us. After figuring out which patients we had to see for the day, and reviewing their charts we went up to the floor (the dietitian’s offices are in the basement).
Before seeing any of our patients we went to rounds with the nurses. Each nurse runs through the patients they’re responsible for. They give a brief overview of pertinent information about their patients. This includes: reason for admission, current status, and discharge date/time (if known). This helps make sure that everybody caring for the patients is on the same page. It also sheds more light on how the patient is the day-of.
After rounds, it was time for us to see our patients. All of the patients we saw today were in acute care or observation. In general, this means they are in the hospital for only a few days to manage a sudden illness/injury. While they entered the hospital for a short-term problem, many of them have underlying chronic illnesses as well which complicates things. Essentially, we visit patients and find out more about their weight history, appetite before and while in the hospital, and answer any questions they may have about food/nutrition. We also “prescribe” nutritional supplements if needed. I use quotes because you can buy these supplements at the grocery store without a prescription. The dietitians prescribe a nutritional supplement (calorie and protein-rich drink) to patients with a really low appetite, chewing difficulty, or those who are malnourished to help them recover. We also screen for malnutrition by checking patients for fat and muscle depletion, unintentional weight loss, fluid retention, and/or really low food consumption for an extended period of time. I haven’t spent much time in a hospital setting, so it was interesting to see the things I’ve learned about in Medical Nutrition Therapy (MNT) classes in undergrad being executed.
Friday:
I was with a different dietitian today, so we visited patients in the telemetry (heart), oncology (cancer), and observation units. We had a lot more patients to see today. The dietitian has to see patients at least once every 7 days they’re in the hospital. We saw all of the patients whose length of stay reached 7 days over the weekend because the dietitian’s offices are only open Mon-Fri.
In the afternoon, the dietitian taught me how to use their charting system. She walked me through our notes for the patients we saw, and asked me about what I thought an appropriate nutrition diagnosis for that patient would be.
Once I finished at the hospital for the day, Spencer came to visit! We went out for supper which was very nice to celebrate the completion of my first week of clinicals. Then, we watched a really cute movie, “Unleashed”. My fourth blog post with CAND went up today as well, you can find it here. It provides a brief history of popcorn and how it became such a popular snack food.
Weekend:
Spencer wasn’t feeling too great after Friday night, so we had a pretty low-key weekend. I had some clinical work to finish up, and readings to do to prepare for my Monday night class.
Next week I’ll be at the hospital Mon-Thur before driving into Chicago for a seminar on Friday. Until then!