Rotation: Acute Care Pre-rotation check-list Readings completed Complete quizzes Bowling Green State University Dietetic Internship Program Nutrition Care Process Worksheet printed and ed Review formal case study instructions Site paperwork completed (distance only) Review oncology, cirrhosis and diabetes case studies as needed Traveling evaluation form: comments from past preceptors as applicable and clarify expectations and areas in which you hope to improve with preceptor for this rotation Interns feel free to change formatting as desired related to font size and page breaks. Preceptors: You will note that some of the competencies are addressed at other rotations and are optional depending on your facility needs and availability. Please feel free to modify the planned experiences as needed. If multiple preceptors will work with the intern, you have the option of completing the evaluation forms individually or as a group. Please use the following scale to evaluate whether or not the intern has met the designated competencies N = no information on which to evaluate level 1 = performance is unacceptable, fund of knowledge significantly limited, unable or unwilling to complete work 2 = novice limited knowledge base, skills need significant development, requires considerable support and oversight 3 = beginner - nearly met at entry level: developing fund of knowledge and skills, applies knowledge accurately with some support, requires some cues 4 = competent (entry level) demonstrates sound knowledge and application skills, seeks assistance only after investigating potential solutions, consistently and independently completes work with minimal oversight Intern: Facility: Goal/Objective initial Planned Experience Comments/Alternative Experience This competency is also addressed in the foodservice rotation, but would be beneficial to address here, if possible. CRD 1.1 Select indicators of program quality, and/or customer service and measure achievement of objectives. Participate in a quality improvement audit Reviews current quality improvement policies/ procedures with preceptor facility manual Review Standards for Dietetic Services in the most recent Accreditation Manual for Hospitals or other resources provided by preceptor. Review facility audit form or develop audit form, including criteria to assess quality or performance Audit a sample as determined by preceptor Compile data and prepares a report of the findings, including recommendations for improvement submit report or forms to director Director to assignment CRD 1.2 Apply evidence-based guidelines, systematic s and scientific literature (such as the Academy s Evidence Analysis Library and Evidence-based Nutrition Practice Guidelines, the Cochrane Database of Systematic Reviews and the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality, National Guideline Clearinghouse Web sites) in the nutrition care process and model and other areas of dietetics practice CRD 1.4 Evaluate emerging research for application in dietetics practice. Apply evidence based guidelines in education/counseling Complete and present formal case study Review MNT protocols for CHF, hyperlipidemia (also AHA and NCEP guidelines), diabetes, etc. Apply protocols in in-patient nutrition education and Nutrition Care Process Review formal case study guidelines incorporation of research is required Preceptor to assist in identifying appropriate patient MNT protocols can be round in the outpatient rotation folder disease specific counseling protocols. Preceptor to evaluate using formal case study evaluation form
Review use of alternative therapies for specific conditions Present case study Review readings and case studies from alternative therapy folder Introduction to Dietetic Internship course as needed Read article Alternative Therapies: Part II, Congestive Heart Failure and Hypercholesterolemia Does this population use alternative therapies? Discuss with preceptor and make journal entry Director to journal entries CRD 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the Scope of Dietetics Practice and Code of Ethics for the Profession of Dietetics Perform ethically in accordance with standards of professional practice Review HIPPA guidelines Performs all duties and tasks with the Standards of Practice and Code of Ethics Abides by all organizational policies and procedures Preceptor to evaluate adherence to ethical standards Apply ethical principles to end of life issues Review ADA position paper regarding the withholding of nutrition and hydration at the end of life (Intro to Dietetic Internship shell) if needed Review article End of Life Care in the Setting of Cancer: Withdrawing Nutrition and Hydration Discuss palliative care options with preceptor journal entry Apply palliative care principles to patients as needed Director to journal entries Optional: This competency is addressed in additional rotations CRD 2.2 Demonstrate professional writing skills in preparing professional communications Develop educational materials considering population cultural and literacy needs as needed Review health literacy module from Introduction to Dietetic Internship course as needed Discuss education needs of typical patient in this facility (literacy, cultural issues, print size, age concerns) with preceptor. journal entry. Review current educational materials provided for patient or staff education Under preceptor direction update or develop current materials Use written education materials form to evaluate as needed (evaluation folder) Optional: These competencies are addressed in additional rotations CRD 2.3 Design, implement and evaluate presentations to a target audience. CRD 3.2 Develop and demonstrate effective communication skills for clinical and customer services using a variety of formats. Provide presentation to a target audience as needed Review the Know Your Learner module from Introduction to Dietetic Internship course as needed use the lesson plan outline to develop any presentations Discuss education classes typically provided at this facility weight loss, diabetes, cardiac rehab, employee wellness etc. with preceptor and typical learning needs of the audience with preceptor journal entry Identify topic for class, presentation or in-service Locate or develop appropriate handouts, posters, displays as needed Present class if possible, preceptor to evaluate presentation, lesson plan and handouts to be submitted to director for CRD 2.4 Use effective education and counseling skills to facilitate behavior change. Meet the education and therapeutic needs of individuals across the lifespan and a diversity of people, cultures and issues of ethnic, racial and cultural diversity as needed discuss ethnic diversity of clients typically seen at facility with preceptor are there any special attitudes toward disease/treatment? journal entry any educational materials available to meet, preceptor to evaluate counseling skills assessment of MNT skills form
religions. needs of particular ethnic groups (ie. are any materials available in Spanish?) - journal entry observe preceptor providing education, counseling, and/or training Discuss observations with preceptor- journal entry Provide counseling and education under preceptor observation Independently provide counseling and education Also addressed in long term care rotation CRD 2.5 Demonstrate active participation, teamwork and contributions in group settings. Attend interdisciplinary team conferences to discuss patient/client treatment and discharge planning. Attend and participate with team conference/rounds as available Documents activities as appropriate Preceptor to evaluate participation in meetings CRD 2.7 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice. Refer to other disciplines as appropriate Discuss referral process at facility with preceptor to identify community agencies providing nutrition or related services Discuss referral process to other disciplines OT, PT, SLP journal entry Provide referral to patient when appropriate Document and follow-up as appropriate CRD 2.10 Establish collaborative relationships with other health professionals, administrative and support personnel to deliver effective nutrition services Coordinate nutrition care activities among caregivers Determine need for postdischarge support services. With preceptor, identify internal and external stakeholders journal entry Observe and demonstrate ability to provide comprehensive patient/client care patient charts - assess need for education, referral to other services for family members or other caregivers such as home health, etc. discuss care and treatment of pts with other team members and preceptor provide education /resources to patient and caregivers CRD 3.6 Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodates the cultural diversity and health needs of various populations, groups and individuals. Recommend and evaluate feeding regimens and menus for patients. Evaluate and recommend enteral formulas that best meet nutrient and economic needs facility menu for therapeutic diets related to CVD, CHF, diabetes and GI disorders noting changes. facility menu for therapeutic diets for cancer pts, noting changes consider chewing and swallowing difficulties, mouth soreness, dysgeusia, xerostomia. Does the facility offer a neutropenic diet? journal entry Are the National Dysphagia Diet guidelines being implemented? How are diets modified for neurological problems? journal entry modify patient menu to meet individual patient needs as needed facility formulary evaluate current enteral formulas for acceptability and affordability make recommendations as appropriate Preceptor to evaluate formula recommendations and calculations
CRD 3.1 Perform the Nutrition Care Process (a through e below) and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings CRD 3.1a Assess the nutritional status of individuals, groups and populations in a variety of settings where nutrition care is or can be delivered. Follows facility protocol for nutrition assessment. Obtain and evaluate diet history. Estimate caloric and protein needs. Use appropriate lab values to assess patient status Assess clinical symptoms using nutrition-focused physical assessment Identify relevant drug nutrient interactions policy and procedure regarding patient assessment apply protocol to patients indicated by preceptor obtain appropriate diet history from patient and/or family utilizing appropriate tool such as 24 hour recall, food frequency as needed evaluate intake for nutritional adequacy identify pertinent medications Skim the article Accurate Determination of Energy Needs in Hospitalized Patients this article compares the various equation options Read article: Permissive Underfeeding: Is it Beneficial or Detrimental? Read article: Nutrition Support for the Critically Ill Obese Patients discuss assessment with RD what equations are being used to estimated caloric needs? (Harris- Benedict, Mifflin St. Jeor, kcal/kg), what injury factors are used for specific conditions, what factors for estimating protein needs? Is adjusted body weight being used for obese patients? - journal entry under direction of RD assess caloric and nutrient needs patients using facility protocols Review article Nutrition Assessment in the Intensive Care Unit: Prealbumin, C-Reactive Protein or None of the Above? Read article: Sodium Homeostasis Read article: Acid Base Basics Discuss lab values typically considered when evaluating patients with preceptor journal entry Use lab values in assessment of patients Read article: Micronutrient Assessment Include nutrition-focused physical assessment considering patient s hair, fingernails and skin as appropriate in patient assessment, noting signs and sx in PES statement Review information from drug nutrient interaction module from Intro course as needed Review drug nutrient interactions which require patient education at this facility Provide education to patient (if this education is provided by nursing, role play education with preceptor or director) journal entry Preceptor to evaluate physical assessment preceptor or director to evaluate patient education CRD 3.1b Diagnose nutrition problems, create problem, etiology, signs and symptoms (PES) statements Apply NCP to develop PES statement article Lessons learned in applying the Nutrition Care Process to Critically Ill Patients discuss application of NCP with preceptor what are most common diagnoses? Journal entries Develop PES for in-patients as appropriate. Preceptor to evaluate PES statements CRD 3.1c Plan and implement nutrition interventions, to include prioritizing the nutrition diagnosis, formulating a nutrition prescription, establishing goals and selecting and managing intervention. Determines nutrition care plan, as indicated by patient/client s health status. develop intervention based on diet history, lab values, medical hx considering appropriate factors such as patient prognosis recommend obtaining additional information ie relevant lab values consider dx, rx, education needs of patient Use nutrition care process sheet, as needed, for comprehensive assessment and development of long term and short term goals. The article and worksheet is in the general required readings folder and formal case study folder Design and develop transitional article: Have you passed gas yet? Time for a new approach to feeding patients postoperatively. Preceptor to evaluate transitional
feeding plans article Transitional Feeding: Challenges and Approaches discuss policies for advancement of diet at facility with preceptor journal entry develop transitional feeding plans for post-surgical patients and parenteral to enteral feeding feedings plans CRD 3.1d Monitor and evaluate problems, etiologies, signs, symptoms and impact of interventions on the nutrition diagnosis. CRD 3.1e Complete documentation that follows professional guidelines, guidelines required by health care systems and guidelines required by the practice setting Identify appropriate outcomes and indicators Review section on outcome indicators in the NCP manual Identify measurable outcomes resulting from interventions Discuss indicators commonly used for the following conditions with preceptor: o Diabetes o CHF o Pancreatitis o COPD o MI o Post-surgical patients o Malnutrition o CKD o Pneumonia Make journal entry summarizing indicators Include monitoring and evaluation strategies in chart note. Preceptor to evaluate monitoring and evaluation strategies. Document patient care using facility guidelines Review facility policies and procedures related to documentation Demonstrate appropriate documentation Please evaluate intern s overall ability apply the Nutrition Care Process and assess patients Preceptor to evaluate documentation CRD 4.6 Use current informatic technology to develop, store, retrieve and disseminate information and data. Apply technology as appropriate Review current use of technology, personal computers, and systems currently used or planned by the facility journal entry Make use of any available current technology information retrieval, presentations, communications and data analysis such as nutritional analysis, menu costing, nutrition assessments, charting, etc.. Preceptor to evaluate intern use of technology This competency is addressed in additional rotations but would be helpful to address in this rotation, if possible. CRD 4.7 Analyze quality, financial or productivity data and develops and plans for intervention. Apply financial management principles to the clinical setting Examine policies and procedures related to the budget, i.e. records, demographic reports, financial reports, labor productivity, revenues, cost, etc. Discuss data collection related to the clinical budget and forecasting of budgetary needs with preceptor journal entry Assist in preparation and monitoring of departmental budget. Document patient care using facility guidelines Review facility policies and procedures related to documentation Demonstrate appropriate documentation Preceptor to evaluate documentation Was intern generally on time and ready to work? Yes No Comments: Were competencies generally met? Yes No
Did intern make the expected progress? Please comment: Please make suggestions for future planned experiences Preceptor Signature: Intern Signature: Post rotation checklist: Competency form signed by preceptor and intern Post rotation evaluation form completed by preceptor, signed by intern (for rotations at least two weeks or longer) Traveling evaluation ed and suggestions made for future rotations Submission of case studies and assignments to director hard copy or electronically Submission of journal entries to director in journal or electronically Complete intern feedback form and submit electronically. (under evaluations folder) Evaluation of distance internship program by preceptor (distance program only)