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- All in-patients are screened by the nursing staff upon admission for nutrition risk.
- All patients identified as at risk are referred to dietitian for nutritional assessment, counseling and education when indicated.(IPP : 8010-01-01-09),
- The team of all dietitians provides evidence-based nutritional expertise in following areas through Saturday to Wednesday from
- 08:00 – 17:00. (IPP: 8010-01-01-01).
- Oral support – Counseling and education
- Tube feeding including Orogastric, Naso-gastric, Naso-jejunal, Gastrostomy, and Jejunostomy.
- Advisory service on call per telephone over weekends for high risk critical care patients.
- Within 24-48 hours of admission services: The clinical dietitian provides inpatient services to all patients requiring nutritional intervention. Nutritional care is provided by a credentialed registered dietitian and involves:
- Anthropometric information
- Nutrition history
- Medical concerns
- Interpreting biochemical and other laboratory results
- Analyzing nutrient intake and Diet orders
- Monitoring drug-food interactions
- Recommending specialized nutrition support
- Modifying menus for therapeutic diets (if needed)
- Performing an in-depth nutrition assessment of all patients identified as at risk for nutrition-related problems
- Developing, implementing, and documenting an individualized plan of care for each patient, analyzing subjective and objective information to define nutrition problems and goals.
- Providing nutritional counseling and education to patients and their caregivers, including information on modified diets and food-drug interactions, and evaluation of the effectiveness of counseling based on objective information when possible.
- Participating in the interdisciplinary team approach to care by attending all care-planning meetings and other meetings as determined by management.
- Nutrition Screening
- Dietitian's Referral
- Nutrition Care Process
- Nutrition Assessment
- Nutrition Diagnosis
- Nutrition Intervention
- Nutrition Monitoring and Evaluation
- Follow Up
- Anthropometric Measurements
- Laboratory Reports
- Patient and Family Education
- Discharge planning
The purpose of a nutrition screening is to quickly identify individuals who are malnourished or at nutritional risk and determine whether a more detailed assessment is warranted. The nutrition screening can usually be completed by nurses and physicians. Once completed, patients who are at nutritional risk are usually referred to a registered dietitian for further assessment.
All newly admitted patient will be screened within 24 hours of admission. Screening Form will be used to identify the patient on nutritional risk. Patients at nutrition risk will be referred to the Dietitian for more comprehensive nutrition assessment.
Nutrition Care Process is a standard process for dietetics professionals and not a means to provide standardized care. Therefore, nutrition care provided by qualified dietetics professionals should always reflect both the state of the science and the state of the art of dietetics practice to meet the individualized needs of each patient.
Nutrition Assessment is the first step of the Nutrition Care Process. Its purpose is to obtain adequate information in order to identify nutrition – related problems. Nutrition assessment is an on – going, dynamic process that involves not only initial data collection, but also continual reassessment and analysis of patient’s needs. Nutrition assessment provides the foundation for the nutrition diagnosis at the next step of the Nutrition Care Process.
Nutrition Diagnostic (Problem-Etiology-Signs & Symptom”PES”) is the second step of the Nutrition Care Process, and is the identification and labeling that describes an actual occurrence, risk of, or potential for developing a nutritional problem that dietetics professionals are responsible for treating independently.
Whenever possible, a nutrition diagnostic statement is written in a PES format that states the Problem (P), the etiology (E), and the Signs & Symptoms (S). However, if the problem is either a risk (potential) or wellness problem, the nutrition diagnostic statement may have only two elements, Problem (P), and the Etiology (E), since Signs and Symptoms (S) will not yet be exhibited in the patient.
Nutrition Intervention is the third step of the Nutrition Care Process. Nutrition intervention are purposefully planned actions designed with the intent of changing a nutrition – related behavior, risk factor, environmental condition, or aspect of health status for an patient. All interventions must be based on scientific principles and rationale and, when available, rounded in a high level of quality research (evidence – based interventions).
Nutrition Monitoring and Evaluation is the fourth step of the Nutrition Care Process. The purpose of monitoring and evaluation is to determine the degree to which progress is being made and goals or desired outcomes of nutrition care are being met. It is more than just "watching" what is happening; it requires an active commitment to measuring and recording the appropriate outcome indicators (markers) relevant to the nutrition diagnosis and intervention strategies. Progress should be monitored, measured, and evaluated on a planned schedule until discharge.
The dietitian will determine the type and frequency of follow – up care after the initial nutrition assessment. Follow up may include evaluation of nutritional care, patient compliance, patient's response to diet therapy and other nutritional concerns. Frequency of Follow up and Reassessment of each patient is based on Nutrition risk level of care.
Anthropometry involves obtaining physical measurements of an individual and relating them to standards that reflect the growth and development of the individual. These physical measurements are another component of the nutrition assessment and are useful for evaluating over-nutrition or under-nutrition. They can be used to monitor the effects of nutrition intervention.
Valuable measurements are height, weight, skin – fold thickness, and girth measurements. Head circumference and length are commonly used in pediatric populations. Birth weight and ethnic, familial, and environmental factors affects these parameters and should be taken into consideration when anthropometric measures are evaluated.
Laboratory tests are ordered to diagnose diseases, evaluate treatment plans, monitor medication effectiveness, and evaluate medical nutrition therapy. Acute illness or injury can trigger dramatic changes in laboratory test results, including rapidly deteriorating nutritional status. The nutrition professional can use laboratory data to support subjective judgment and clinical assessment findings.
This is given to patient and/or family member to fully understand the diet that needs to be followed while in the hospital or even after discharge. It can be oral diet or tube feeding diet preparation.
It is done usually weekly in the ward. The team will determine who among the in-patient can be discharge in the coming days of the week. Planning should be ahead of time to prepare for the materials needed for reference at home. It can be diet brochure/pamphlets or even take home supply form for those needing nutritional supplements for oral or tube feeding purposes. |