Monday- day 1

I shadowed one of the newer dietitians, who by the way looks like Natalia Kukulska's twin sister (if you don't know the name, look her up, she's a singer in Poland). I got the overview of what happens as the day unfolds: printouts come first thing in the morning with the pre-screened list of patients to be prioritized to be seen for the first time and for follow up. The list was super long already. I found out the RDs usually get a list as short as 5 and as long as 20 (there are four dietitians total in Ocean Springs Hospital). The patients are divided by floors/units so that one person frequents the ICUs (there are two- medical and surgical) another person has her wing and floor and so on. Although our list was long we were only able to see maybe a third of the patients. Why? The hospital doesn't have an electronic medical record yet, so all pertinent data is in the charts. If the chart is in use- we can't have it, which means we can't access the patient's history, current meds and progress notes. The other reason why we couldn't see patients were anything from the patient being busy with another consult, being moved from the unit to a floor or vice versa, or being gone completely (MIA- perhaps gone for a walk). There were a few instances where we would come back three times to see if we can see the patient. The good news is: the medical record is being ordered and tailored to special needs of the hospital.

TIL:

1. RDs do not do education about insulin- it's RNs job.

2. Patients with Coumadin are screened as a Performance Improvement project for this hospital. They are then educated to be consistent with their consumption of dark leafy greens to ensure the drug is well tailored to their daily needs.

3. If there are too many first time consults, the follow ups get booted to second priority.

4. The hospital just staffed the Congestive Heart Failure clinic with an RD- yay!

5. 1 cup of melon counts as 5 oz of liquid (important for people who have fluid restrictions, like CHF folks or dialysis).

6. The assessment and education charts have been developed to make it easier to write notes in ADIME format (you know, the NCP thing).

7. RDs don't get to order anything here, only recommend to MDs on what to do.

8. RDs don't use Harris-Benedict, only kcals/kg, Mifflin STJeor or Ireton for folks on ventilator. 9. The other personnel is very kind and helpful. With very very few exceptions.

10. Things get hectic and there is nothing you can do about it.