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 narrow slice of our profession, and I'd love someone to talk with!

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 narrow slice of our profession, and I'd love someone to talk with!

Im interested also, I work at a Rehab center with a hospice attached and would love to broaden my job duties.

Im interested also, I work at a Rehab center with a hospice attached and would love to broaden my job duties.

I don't work in hospice but I noticed Becky Dorner (www.beckydorner.com) has a manual for end of life nutrition, that may be a good start?

I don't work in hospice but I noticed Becky Dorner (www.beckydorner.com) has a manual for end of life nutrition, that may be a good start?

Wonderful idea! I hadn't thought to look there, but Becky Dorner & Assoc is a great resource for anything LTC, so it seems like a great place to start. Thank you!!!

Wonderful idea! I hadn't thought to look there, but Becky Dorner & Assoc is a great resource for anything LTC, so it seems like a great place to start. Thank you!!!

I have worked as a PRN RDN for Hospice for 11 years. It really is a "learn as you go" position. I work at a hospice house, where most of my patients are at extreme end of life, so no nutrition assessments are necessary. I am generally speaking more with families about the pros/cons of withholding food and fluids at end of life. I am also providing for any food preferences (ie comfort) that the pt may have and providing support for caregivers/families who are dealing with mixed emotions. I also work in the home-based hospice program and that usually involves using nutrition to help alleviate symptoms such as nausea/vomiting, diarrhea/constipation, lack of appetite, chew/swallowing problems, but also troubleshooting issues with tubefeeding, etc...I do not use a formal nutrition assessment form since each situation is different. I mostly use Word to type a synopsis of the visit and any plan/recommendations the nurse needs to implement. Hope this is helpful!

I have worked as a PRN RDN for Hospice for 11 years. It really is a "learn as you go" position. I work at a hospice house, where most of my patients are at extreme end of life, so no nutrition assessments are necessary. I am generally speaking more with families about the pros/cons of withholding food and fluids at end of life. I am also providing for any food preferences (ie comfort) that the pt may have and providing support for caregivers/families who are dealing with mixed emotions. I also work in the home-based hospice program and that usually involves using nutrition to help alleviate symptoms such as nausea/vomiting, diarrhea/constipation, lack of appetite, chew/swallowing problems, but also troubleshooting issues with tubefeeding, etc...I do not use a formal nutrition assessment form since each situation is different. I mostly use Word to type a synopsis of the visit and any plan/recommendations the nurse needs to implement. Hope this is helpful!

Thanks for your reply! That helps a lot. My job is entirely composed of patients at home or in LTC... so maybe a narrative note will work just fine for me. I will be doing as you describe- consults only on those who may benefit. Super PRN, since I'm a stay-at-home mom. Should be a good fit. I was concerned because there was next to nothing as far as training or information in general. The more I hear from kind people here, it seems almost typical. Interesting! Specifically, so you use a loose estimate of nutritional needs, or an equation, and I've heard that midarm circumference is commonly used- do you assess this? And a guideline for follow up? Just "RD available?"

Thank you again!!

Thanks for your reply! That helps a lot. My job is entirely composed of patients at home or in LTC... so maybe a narrative note will work just fine for me. I will be doing as you describe- consults only on those who may benefit. Super PRN, since I'm a stay-at-home mom. Should be a good fit. I was concerned because there was next to nothing as far as training or information in general. The more I hear from kind people here, it seems almost typical. Interesting! Specifically, so you use a loose estimate of nutritional needs, or an equation, and I've heard that midarm circumference is commonly used- do you assess this? And a guideline for follow up? Just "RD available?" Thank you again!!

I don't really know any other RDN's who work in hospice care, and I've learned a lot over the past 11 years, just trial and error mostly!

When the pts are early on in hospice, I may do a nutrition focused physical exam where I assess fat or muscle wasting, weight loss, edema, po intake, etc...to diagnose malnutrition and what nutrition-related strategies may help improve their quality of life. And, if I am doing a tubefeeding assessment/calculation, I will certainly estimate needs to determine correct feeding rate and fluid needs. However, for most of the pts I see, a routine nutrition assessment with calculated needs is not necessary. I'm just trying to troubleshoot nutrition related problems, not necessarily reach a goal for calories, protein, etc...So, I focus more on how nutrition can improve their daily life and educate the pt and family on how to implement what I think could be beneficial. A lot of times, my pts do not want to eat and I am educating family members/caregivers that it's ok for the pt to refuse food and fluids and I explain what process the body goes through in a life-limiting illness when preparing for death. The family/caregivers usually have high expectations for what the pt should be eating, so it's good for the RDN to be another voice for comfort measures and to avoid force feeding.

For my hospice, I also write a monthly "dietitian tip" that I email to all hospice staff. I just pick a nutrition topic that I think could be beneficial for pts, caregivers and staff. Just a one page, simple article that can be printed out and given to families and patients. It's kind of another way for me to keep my nutrition services at the forefront, so it helps with referrals, etc...

I don't really know any other RDN's who work in hospice care, and I've learned a lot over the past 11 years, just trial and error mostly! When the pts are early on in hospice, I may do a nutrition focused physical exam where I assess fat or muscle wasting, weight loss, edema, po intake, etc...to diagnose malnutrition and what nutrition-related strategies may help improve their quality of life. And, if I am doing a tubefeeding assessment/calculation, I will certainly estimate needs to determine correct feeding rate and fluid needs. However, for most of the pts I see, a routine nutrition assessment with calculated needs is not necessary. I'm just trying to troubleshoot nutrition related problems, not necessarily reach a goal for calories, protein, etc...So, I focus more on how nutrition can improve their daily life and educate the pt and family on how to implement what I think could be beneficial. A lot of times, my pts do not want to eat and I am educating family members/caregivers that it's ok for the pt to refuse food and fluids and I explain what process the body goes through in a life-limiting illness when preparing for death. The family/caregivers usually have high expectations for what the pt should be eating, so it's good for the RDN to be another voice for comfort measures and to avoid force feeding. For my hospice, I also write a monthly "dietitian tip" that I email to all hospice staff. I just pick a nutrition topic that I think could be beneficial for pts, caregivers and staff. Just a one page, simple article that can be printed out and given to families and patients. It's kind of another way for me to keep my nutrition services at the forefront, so it helps with referrals, etc...
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