I’m a fairly new dietitian. I’ve been practicing in clinical a little over a year. I initially started my career in community and wanted a change. My facility is overdue for a state survey and I’m anxious and nervous about the process because it is my first. I have tried my best to document and intervene as best as I know. Sometime I am very nervous and the job is
I want to hear your opinions about transitioning residents to bolus feeding. Is your facility encouraging you to do bolus feeding for most residents? If so, what type of bolus are you doing? (gravity, syringe, feeding pump (Kangaroo)). I currently work at a facility (vent and trach dependent) where the administration are encouraging us to transition to bolus feeding to give residents breaks and s
Are we required to write a note or fill out an assessment in addition to completing the quarterly MDS? I've heard from one RD that it is not necessary for the quarterlies but I would like confirmation.
One of our physicians recently put a resident on a low potassium diet (although he did not give a measurement of how low) because he was titrating her lisinopril up. No hx of hyperkalemia but does have CHF and is on K+ sparing diuretic (HCTZ). Has anyone else heard of restricting K+ in this case? If so, is it a permanent change or just until the goal dose of lisinopril is reached. Thanks so m
I'm a R.D. working in LTC and responsible for 100% of the documentation, MDS, care plans, etc. I do not have a DTR or CDM. 140 bed facility.
My question is this-- what is the timeframe for actual MDS charting in the medical record? I am familiar with the timeframe for entering the MDS/CAAS in the database, but I'm uncertain as to actual documentation in the medical record. Could someone
Tell me, is this just in Los Angeles? /California?
RD in LA area with 4yrs experience as consultant for LTC. I rotate facilities at times with RD colleagues. Practically each facility has staffing issues that affect my line of work. This isn't all the time but here's examples: ht/wt not done on time, recommendations not carried out on time, other IDT members unable to join weight variance mee
Does anyone have a generic consulting agreement that could share? The company whom I asked for coverage from >6 months ago just told me they don't have anyone (I leave on Friday). I have someone who can provide some coverage for me but I need to get the paperwork together. Thank you in advance!
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?
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
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.
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
Does anyone know of a Medicare/ CMS regulation stating that hospice residents must be weighed. My practice in other nursing homes has been to advise Nursing that weights are not necessary when residents start on Hospice as weight loss is typically expected. My current facility wants these residents weighed per some CMS regulation that I am not aware of... any thoughts?
We have recently started a Heart 2 Home program for CHF patients. Obviously the importance of daily weights is being stressed. We are placing "home type" scales in each room. I know our other scales have to be calibrated routinely and state has asked for these records in the past. Does anyone know if that would hold true with regular bathroom scales? And if so, can we just have our maintenan
I'm being offered some menu planning consulting work with an assisted living facility. I have clinical and ltach experience, but didn't do much w menus. I've been a stay at home Mom for 8 years, and stopped prn work 6 years ago. Need some updating.
Some questions... making sure I meet standards- are there state requirements? Just RDAs? I obviously need to research.