Just started as a prn RD with a hospice agency. Previous RD isn't available and wasn't utilized much. No standard form for RD assessments. Can someone share with me your recommendations for what to cover in assessment/verbiage for documentation. I have worked as a clinical RD and also in LTACH, but this is different and I'm not receiving much in training (all non-RDs). Hospice seems to be a narro
Hello all! I cant believe this site exists and wish I had found it sooner! I consider myself quite passionate about eating right and believe it plays a huge role in preventing many illnesses. That being said, I would love to help educate people and motivate them to eat better. Thus, dietetics has always been a career path I wanted pursue. However my parents and close friends urged me into nursing
Hello all, I am researching body composition analysis options for my private practice. Does anyone have a recommendation for a scale they use? I am considering a Tanita scale, but cannot decide how important segmental analysis is. Also looking at multi-frequency. I am seeing adults for weight management. Any advice would be much appreciated! Jamie
What diet manuals are you using in your long term care/skilled nursing facilities? We have the AND nutrition care manual, but I'm wondering what else may be a good option - Becky Dorner? DiningRD.com? Morrisons?
I have had the hardest time finding a job in this field ever since I finished my internship in 2011. I worked for WIC for 3 years and then two years as a part time bariatric dietitian. I would really like to get into a full time clinical position at a bigger hospital. I have applied to several places and only had two interviews for prn positions of which I was turned down for both. I'm not ready
I was wondering if anyone had a workflow, etc for a DTR working inpatient. I am a RD that will have a DTR coming to work for me in a hospital and am wondering where to start as far as splitting patients up between the RD and DTR. Any information is helpful!
Hi all! I work with a NP who insists on flushing enteral tubes with gatorade for any patient with a low sodium. There is literally a bag filled with fruit punch gatorade hanging on the pole to be used as a flush. She refuses to use saline because she says it causes diarrhea. I know this is not best practice or evidence based but she insists it is. There are no ASPEN guidelines regarding this and
During my research I came across two nutrition studies done five years apart. The researchers, as far as I know, didn't know each other. The first found high iron levels and attribute it to the higher meat consumption. The second group found, five years later, high diabetes in the same high iron group. I said, the meat eating therefore predicted the diabetes development. They refuse t
The question as to the effects of diet on inflammatory markers has been debated for decades. This study below verifies what I have been saying, hemoglobin hails inflammation. The hemoglobin is the marker which differentiated inflammation between, the vegetarian diet and the omnivore diet. When all is taken into account, hemoglobin, consistently higher in the omnivore, predicts the inf
Recent research has cast a pall on the fortification of our foods with iron, leading to many well respected medical professionals to question the amount of iron added to our foods. Studies have shown adverse effects when trying to supplement children in Africa for their apparent anemia, and this article is but one of many.
I am experiencing Refeeding Syndrome. I am getting sent away from hospital visits because no one is familiar with it and don't believe I have it. Can anyone recommend a practitioner in the state of Illinois who is experienced in the diagnosis and treatment of this condition? Thank you.
Hi all, I'm having a hard time finding a consistent definition of hemodynamic stability. I've seen several different criteria used: MAP >65 for >24 hours, normal BP with stable pressors, no pressors, etc. I end up delaying feeding for longer than I'd like because many of my patients don't reach "stability" until they've been in the ICU for several days. Specific parameters are appreciated!
One of our physicians recently told our nurses that patients on Prozac should not get ProStat (our go-to liquid protein supplement) because of the effect on serotonin. Has anyone heard of this before? I can't find anything that explains this and the doc is currently on vacation.
Hello, I am a renal dietitian with about 85 patients (all hemo except 6 PD), and I work about 25 to 28 hours a week. For those of you in the hemodialysis setting, what percentage of time do you spend in documentation vs. time you spend with the patients? I am spending an estimated 75% of my time in documentation (monthly notes, assessments, and QAPI), and maybe 25% of my time doing education an
Hello, everyone. I've recently come across a few opportunities to consult to groups homes for individuals with disabilities. I think Medicaid reimburses for this? Any one familiar with this type of nutrition service and what the typical reimbursement rates are and/or the typical consultant fee?
I work in a long term care facility for the developmentally disabled. We recently got a new pediatric admission who is on powdered enteral formula. I am curious in other facilities, who prepares the formula for the patient? Nursing wants it to be done by the kitchen staff, but we don't feel that it should be their responsibility (concerned with sterilization and mixing the proper concentration).
I just got consulted for a 12 week meal planning job. The individual felt $100 is fair compensation for 3 months of meal plans. Why does he think that? Because another, less qualified, RD told him she would accept $100 as compensation for what will be hours and hours of work. She should be ashamed of herself. I typically charge between $250 and $150 PER WEEK of a plan depending on how complicated
I am a contracted dietitian for an out patient rehab facility. They pay me an hourly rate to assess patients, provide education consults when needed, teach classes, individualize menus, etc. All very typical RD duties. However, as far as I know, they do NOT bill for any of the consults or classes. They simply absorb the cost of the dietitian and treat it as a "value add" service to their patients
I have a patient in the ICU that has ventilator dependent hypoxemic respiratory failure mostly secondary to decompensated systolic heart failure. He is 54 years old with a BMI of 29, and his weight has been decreasing, going from 245# on March 4 to 225# on March 9. The patient has bilateral foot pitting 1+ edema and a bilateral knee nonhealing wound. His labs are: CO2 38, GLU 251, BLOOD PH 7.5
I have been signing menus for a few years for this juvenile detention center near me. They've always looked very similar to my long term care menus, but this year they've changed to just cold or hot cereal for breakfast every morning with bread. On the cold cereal days they offer peanut butter. The protein portions are now bigger for dinner and in reality I'm sure this is more typical of how thes
What are some useful resources for a dietitian new to LTC? I have checked CMS web site, however it did not answer my questions... I remember being an intern 7 years ago, there were some "rules" i.e. initial assessment within 48 hrs (or was it 72?), quarterly (90 days), annual, however, I cannot remember 14-day (hospice care?), and so forth. Where can I find all these regulations? Also, back when