Emily Sinn

ND 568
Grand View Hospital

Nutrition Services Outline

A. Nutrition Services System

 Tour the patient care areas and food service. Name the patient care areas
within the facility.
o ICU
o 2A, 2B, 3A- telemetry unit
o 3E- Med surg
o 4D- Med surg/Orthopedic
o Rehab
o Labor/Maternity
o Pediatrics
 Read the Diet Manual
o Standard Diets provided at GVH:
o *Explanations provided to those I was not completely familiar with*
 Bland, Pediatrics Bland (Foods that are generally soft, low in
dietary fiber, cooked rather than raw, and not spicy)
 Carb Controlled Diet
 Cardiac (“Heart healthy diet”, consists of nutrient-rich foods—
fruits and veggies, whole grains, lean poultry and fish, no
saturated fats, trans fats, and excess sodium or sugar)
 Clear Liquids (I.e. water, broth, clear juices, tea/coffee, aim to
provide rest to your GI tract prior to a test/procedure such as
colonoscopy)
 Full Liquids (Consists of liquids allowed on the clear liquid diet
with the addition of milk and small amounts of fiber, used for
short term as a transition step between the clear liquid and
soft diet following gastrointestinal surgery or procedures, also
appropriate for those with certain swallowing and chewing
problems)
 Gluten Free
 High Fiber
 House/ Pediatric
 Lactose Free Diet
 Low Fat
 Low Fiber
 Low Lactose
 Low Protein
 Low Sodium (2gm)
  MAOI diet (Monoamine Oxidase Inhibitors (MAOIs) are drugs
used to treat depression, high blood pressure, and other
medical conditions)
 Mechanical Soft
 Neutropenic Precautions (1,000 or fewer neutrophils ones risk
for infection increase)
 Post Gastrostomy 6 meals
 Renal
 Restricted Potassium
 Vegetarian
 Read the services P & P Manual
o See P & P photo uploaded below.
 Review medical library policies. 
 Read - Medical Records Department policies. 
 Describe the clinical nutrition staffing: staff RD's /DTR's areas of
responsibility/specialty
o Jean West- Zawacki – Clinical Nutrition Manager
o 4 Inpatient Dietitians
o 2 Out patient Dietitians
o 3 part-time Dietitians
 Counseling initiating system - According to facility's counseling protocol,
when is counseling recommended / initiated?
o Counseling can be suggested by any health care professional working
in the facility. A request form needs to be submitted by the individual
and sent to the appropriate department. Assessments are initiated as
soon as possible, and when it is a patient who is newly admitted, is
required to happen within 48 hours of their arrival. Counseling is
either initiated by the patient, RD or per request of another health
care professional.
 NPO/clear liquid diet monitoring - What is the action / documentation for
patients who have NPO/clear liquid orders for a prolonged period of time?
o The RD’s are responsible for documentation of patients who have
NPO/clear liquid orders for a prolonged period of time. Their
progress, formula information, nutrient needs and consumption are
all stored via EMR online. All health care professionals working at this
facility then have access to this information. When necessary, the
RD’s may reassess the case to alter or discontinue the tube feed
altogether. If a patient continues on a TF for more than 5 days,
another visit and assessment with recommendations to increase diet
or change TF should occur. Also, helpful to collaborate with doctors
and nurses on patients timeline.
 Food and drug interaction education - What medications are flagged for
education? What is the facility protocol for giving information to patients
discharged on designated medications?
o Coumadin:
 Anticoagulant – caution regarding interactions with Vitamin K
o Tube Feeding drug interactions:
 Dilantin (phenytoin)- stop TF 2 hours before and after
 Synthroid (levothyroxine)- stop TF 1 hour before and after
 Levaquin (levofloxacin)- stop TF 1 hour before and 2 hours
after
 Intake analysis (calorie count) - When is it initiated? Describe procedures.
How is nursing documentation utilized to obtain information about intake?
o Intake analysis are initiation per request by a Dietitian, Physician or
Nurse. All patient information is available on EMR to be utilized by
other professionals when needed.
 Explain the group counseling referral system.
o An example of the group counseling referral system at GVH is the
Diabetes program. In order to get involved, either a self-referral can
be made or if an individual relies on Medicare, they need to have a
physician referral for coverage.
 Explain the outpatient counseling referral system.
o Same procedures as the group counseling referral system.
 Give details on the system of documentation:
1. Identification of patient nutritional status
Determine what criteria are established to identify patients who are
in need of individualized nutrition services/actions by the dietitian.
(Such criteria are unique to each facility, considering the patient
population, level of clinical nutrition services feasible, and availability
of screening data). Read all policies and procedures concerning the
provision of clinical nutrition services (i.e. enteral feeding); observe
actual practices; and discuss protocol with preceptor or clinical
dietitian.
o All of the following are criteria for specialized attention from
the Dietitians:
 Renal diet, Low Fiber diet automatically
 Hemoglobin A1c above 8
 NPO or hypocaloric for more than 5 days
 Patients more than 7 days LOS
 CHF for Nutrition Education
 Diverticulitis
 TF, TPN
 ICU
2. Nutritional Screening / Assessment policy.
o Nurses are the first to interact with the patients as they come
into the hospital and they are responsible for screening
patients upon their admission. If a patient falls out of criteria
then the Registered Dietitian’s are notified and will complete
their own assessment within 48 hours.

3. Nutrition Care Process implementation or types of forms used by the

RD (and or DTR) in the medical record.
o Assessments must be completed within 48 hours of referral
time. The Nutrition Care Process is completed online for all
health professionals to have access to each time an assessment
is completed.