Phew! This week we officially changed to a new electronic medical record system. Our whole department changed as well, so it felt like my first week of clinicals all over again. To catch up with my previous clinical experiences, check out:
DI: Week 18 – Clinicals and a Seminar
DI: Week 19 – All the Clinicals + Diabetes Education
DI: Week 20 – More Clinicals + Finally Official
DI: Week 21 – Clinicals + Site Visit + Another Seminar
DI: Week 22 – Clinicals + Moving Into a Trailer
DI: Week 23 – Clinicals + Finding a New Normal
In order to maintain patient confidentiality and privacy, I’m being deliberately vague when blogging about where my rotation is and the patients I’m seeing. You can find a more detailed explanation of this in my Week 18 post.
Here’s what my week looked like:
Monday:
Today was absolute insanity because it’s the first day of all of these changes. Luckily, I only had a few patients to see, but somehow the day was still crazy. We figured out how to find out which patients we had to see with the new system before rounds. During rounds, however, a patient in our unit coded, so everyone had to leave to take care of them. This left us just hanging out since dietitians don’t respond to codes. After a while, we decided to just see our patients since rounds were indefinitely postponed. After seeing my patients, all the dietitians and I met up to figure out charting on this new system. It took an hour to get one patient charted, but once the initial confusion was over it got easier. I think with time we’ll figure out a new groove, but for now we’re all bumbling through our charting like we’ve never charted on a patient before in our lives. :P
Tuesday:
Yet another crazy day, despite only having a few patients to see. I was consulted to see a patient to provide a low-fiber diet education. We get these consults for patients that need to go home on a low-fiber diet, so we can teach them what that means and when to introduce more fiber into their diet. When I got to his room, however, he informed me that his doctor had told him he’d be going home on a general diet (meaning my education would be unnecessary for him). The doctor hadn’t placed this diet order in our charting system, however, so I called the nurse to verify. Then, I called another one of my patient’s nurses to check and see if a patient had a pressure injury. We have to see all patients with a pressure injury, but not necessarily other abrasions or wounds. She, like I suspected based on her notes, didn’t have a pressure injury, so that was another patient I ended up not having to see. I did have a different patient with a pressure injury, so I talked to her about nutrition for wound healing. She has dementia though, so this was also challenging since she was lucid but extremely forgetful. I just had to pick a few highlights to talk to her about and repeat them a few times until she felt comfortable with them. Then, in the afternoon, it started snowing. This wouldn’t ordinarily be an issue, but since our office is currently in a trailer, we have to go outside to get from our office to the hospital. Definitely not fun trying to rush from the hospital to the office without all of our papers getting wet.
Wednesday:
Somehow, even though I had way more patients to see today, everything flowed better than it has been. I worked in the general medicine and general surgery floors today, so I had two rounds to go to. I started my morning looking into my patient’s charts before I went to the hospital for my first rounds. Between first and second rounds, I was able to see most of my patients, which was very nice. After lunch, however, I had to run back to the hospital to see a couple more patients. We have three general classes for patients: inpatient, observation, and outpatient in bed. Prior to this week, we pretty much only had two: inpatient and observation. Now that we’ve changed systems, however, we have this third class of outpatient in bed. We are responsible for seeing all inpatients. If a patient is observation, we have to check in throughout the day to see if they’re switched to inpatient, but otherwise we don’t see them. Outpatient in a bed is even lower priority than observation patients, however, the two patients I had to see this afternoon started the day as outpatient in a bed and then became inpatient in the afternoon. Once a patient is switched to inpatient, we have to see them if possible (obviously if they’re switched in the middle of the night we won’t see them until the next morning). This has been a little confusing since in my brain patients should go from outpatient in a bed to observation and then inpatient (which didn’t happen). I’m not the one who knows anything about these patient classes though, so I’m sure there’s an actual reasoning behind it. :P
Thursday:
Another light day; I only had a couple of follow ups, a weight loss education, and a tube feeding assessment. It’s a little disconcerting when we don’t have very many patients because there’s that worry that someone does need us to see them, but we just don’t know about it. Some days though there just aren’t that many patients who need to see a dietitian. Things seem to go in waves here, we’ll have a week chock full of people with eating issues and then the next week hardly any. The same thing happens with diabetes or weight loss educations: there’ll be a ton one week and then none the next. Having fewer patients this week has been nice, however, since it gives us more time to learn the new system and become better acquainted with all the changes that are happening.
Friday:
Another seminar in our Chicago-area dietetic internship seminar series! Today’s seminar was on school nutrition. We had a lot of speakers come in from several levels of school nutrition from the federal level all the way to local organizations. While I don’t see myself getting too involved in school nutrition in the future, it was really interesting to hear about all the ways nutrition professionals are getting involved in promoting health for children through food. They also talked about school wellness policies and the changes Chicago Public Schools (CPS) have made to promote student health. For example, CPS does grab-and-go breakfasts for kids who arrive to school too late to get breakfast. Many schools also have a fruit and vegetable program where they introduce kids to a new fresh fruit/vegetable weekly. Some even have school gardens where the kids learn more about urban agriculture.
Weekend:
Well, you may remember in last week’s post that I was originally planning on attending a seminar on Saturday. After this crazy week though, I decided that I really just needed to take that time to relax and decompress. I have a tendency to overextend myself and have a hard time justifying my own self-care. While I’m a little bummed that I didn’t go to the seminar, I know I made the right decision. It’s always a challenge to balance working hard and taking care of myself, but with this decision at least I know I made the right choice. There will always be other seminars. :) This allowed me to have a more relaxed weekend where I actually had some free time to do things I enjoy–hello, Netflix!
Next week is another full week at the hospital–I’ll officially begin my ICU rotation. Until then!