MDI Supervised Practice Competencies Clinical Nutrition: Rural & Small Hospital SP # Possible Competencies to Highlight in Rural & Small Hospital Rotation food service management & clinical 1
1.1/4.7 Select appropriate indicators and measure achievements of clinical, programmatic, quality, productivity, economic or other outcomes. Prepare and analyze quality, financial or productivity data and develop a plan for intervention. Identify components of quality management in a clinical setting. Participate in the collection and evaluation of quality management data as identified in the department quality management plan. Complete one administrative study of one component that is measurable by measuring a specific component and providing recommendations for improvement. 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature (such as the ADA Evidence Analysis Library, 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. Apply evidence to nutrition care plans in clinical case study presentation to professional staff. 1.3/2.8 Justify programs, products, services and care using appropriate evidence or data. Demonstrate initiative by proactively developing solutions to problems: Research current literature and write a review of the cost benefit for the use of medical nutrition therapy/nutrition intervention for a particular diagnosis in a patient population. 1.4 Evaluate emerging research for application in dietetics practice: Complete a scientific research module on identifying quality research, and submit to preceptor a written critique for a research article published in a nutrition related publication. Discuss with preceptor articles from professional literature regarding new aspects of medical nutrition therapy intervention on topics of interest. 2
1.5/4.5 Conduct research projects using appropriate research methods, ethical procedures and statistical analysis. Conduct clinical and customer service quality management activities. Conduct an acceptance survey to evaluate the clinical service related needs of a target market. Write a report that includes an analysis, conclusion, and recommendations; give report to preceptor. 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the ADA Scope of Dietetics Practice Framework, Standards of Professional Performance and Code of Ethics for the Profession of Dietetics: Demonstrate understanding of the Code of Ethics and Standards of Practice of the ADA, HIPAA and Joint Commission in reference to patient care. Identify and discuss with preceptor local, state and federal regulations that influence and affect care in their facility or community. 2.2 Demonstrate professional writing skills in preparing professional communications (e.g. research manuscripts, project proposals, education materials, policies and procedures): Demonstrate an ability to use computer hardware, software technology, web-based resources and the Internet to complete assignments and experiences and communicate effectively. Follow facility format and guidelines when developing documents. 2.3/2.4 Design, implement and evaluate presentations considering life experiences, cultural diversity and educational background of the target audience. Use effective education and counseling skills to facilitate behavior change: Create appropriate education materials, conduct and evaluate an in-service training for employees. Use the ADA Evidence-Based Library and develop written patient / client material for use in a clinical or community setting. Participate in counseling for acute and non-acute conditions with patients/clients in a variety of age groups and cultures. 3
2.5/2.11 Demonstrate active participation, teamwork and contributions in group settings. Establish collaborative relationships with internal and external stakeholders, including patients, clients, care givers, physicians, nurses and other health professionals, administrative and support personnel to facilitate individual and organizational goals. Interact with other healthcare professionals. Participate in information sessions with care givers. Attend patient care conferences as available Discuss diet instructions as needed with team members. 2.6/2.9 Assign appropriate patient care activities to DTRs and/or support personnel considering the needs of the patient/client or situation, the ability of support personnel, jurisdictional law, practice guidelines and policies within the facility. Provide RD staff relief as is appropriate (1 week minimum). Review methods of prioritizing patients for nutritional care in clinical setting. Apply leadership principles effectively to achieve desired outcome. 2.7 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice. Use appropriate judgment and refer clients and patients to other professionals and services when needs are beyond individual scope of practice. Investigate and develop material detailing available resources in the community. 2.10 Serve in professional and community organizations. Attend meeting(s) of professional organizations as available. 2.12 Demonstrate professional attributes such as advocacy, customer focus, risk taking, critical thinking, flexibility, time management, work prioritization and work ethic within various organizational cultures. Use appropriate judgment when initiating change and improving quality in the organization. Use critical thinking, flexibility, and time management skills when completing projects within the organization. Participate in activities to promote the dietetic profession and advocate for clients and/or consumers. 4
2.13 Perform self assessment, develop goals and objectives and prepare a draft portfolio for professional development as defined by the Commission on Dietetics Registration. Work on MDI Self-Assessment Sheet after completing experiences with patients from each major disease state. Begin work on the Commission on Dietetic Registration s Professional Development Portfolio Process. 2.14 Demonstrate assertiveness and negotiation skills while respecting life experiences, cultural diversity and educational background. Participate in and complete a group project with peer interns (during Orientation). Participate in supervisory decision making while completing staff relief. 3.1a Assess the nutritional status of individuals, groups and populations in a variety of settings where nutrition care is or can be delivered. Interview patients/clients and gather information appropriately to complete an assessment and subsequent direction of nutritional needs. Conduct general screening and assessment using lab values, other measures, and facility check-sheets as needed. Demonstrate understanding of Global Nutrition Assessment for interpreting degree of risk. Conduct nutrition assessment of individual patients/clients with uncomplicated instances of common medical conditions, e.g., hypertension, obesity, diabetes, diverticular disease. Complete case studies relevant to common medical conditions. 3.1b Diagnose nutrition problems and create problem, etiology, signs and symptoms (PES) statements. Apply and interpret lab values for appropriate patient / client evaluation. Assess nutritional status of individual patients/clients with complex medical conditions, e.g., renal disease, multi-system disease, organ failure, and trauma. Complete case studies relevant to complex medical conditions. 5
3.1c Plan and implement nutrition interventions to include prioritizing the nutrition diagnosis, formulating a nutrition prescription, establishing goals and selecting and managing intervention. Develop nutrition intervention plans for a variety of acute and non-acute experiences and give an in-service presentation to clinical staff on a selected plan. Conduct nutrition care component of interdisciplinary team conferences to discuss patient/client treatment and discharge planning. Coordinate and modify nutrition care activities among caregivers Chart as is appropriate in the clinical setting. 3.1d Monitor and evaluate problems, etiologies, signs, symptoms and the impact of interventions on the nutrition diagnosis. Manage monitoring of patients / clients food and / or nutrient intake. Achieve an entry level of competency in this area through the activities of case studies, diet instructions, menu modification, calorie counts and other monitoring practices during the course of the internship. Select, implement and evaluate standard enteral and parenteral nutrition regimens. Achieve an entry level of competency in this area through the activities of case studies and client monitoring. Follow at least one client / patient as the individual moves from one nutrition support to another, e.g., total parenteral nutrition to tube feeding to oral diet. 3.2 Develop and demonstrate effective communications skills using oral, print, visual, electronic and mass media methods for maximizing client education, employee training and marketing. Use the SMOG Readability Formula or similar readability formula effectively to develop written materials for patient, client and general populations. Participated in a community awareness activity (i.e., health fair, published an article). 6
3.3/3.4/ Demonstrate and promote responsible use of resources including employees, Write an employee schedule for one cycle. 4.9/4.10 money, time, water, energy, food and disposable goods. Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management merging consumer desire for taste, convenience and economy with nutrition, food safety and health messages and interventions. Obtain and analyze financial data to assess budget controls and maximize fiscal outcomes. Develop a business plan for a product, program or service including development of a budget, staffing needs, facility requirements, equipment and supplies. Participate in a community based health promotion/ disease prevention program. Revise and distribute a modified recipe for consumers or clients. Review organizational chart of hospital to see how nutrition services relates to other departments. Review budget for clinical nutrition services. 3.5 Deliver respectful, science-based answers to consumer questions concerning emerging trends. Identify an emerging trend of concern for consumers and develop a client/patient fact sheet to answer commonly asked questions. 3.6 Coordinate procurement, production, distribution and service of goods and services. Compile a list of food, nutrition and social service resources available in the area. 3.7 Develop and evaluate recipes, formulas and menus for acceptability and affordability that accommodate the cultural diversity and health needs of various populations, groups and individuals. Demonstrate competency in this area by revising individual patient menus. Write a cycle menu for a target population. 4.1 Use organizational processes and tools to manage human resources. Review departmental policy / procedure manual, employee manual, job description and personnel policies regarding recruiting, interviewing, hiring, orienting, training, appraising and terminating employees. 7 Participate in human resources activities, as the experience becomes available.
4.3 Apply systems theory and a process approach to make decisions and maximize outcomes. Use the systems theory model to identify a new service or business in a clinical, community or foodservice setting and discuss with preceptor. 4.6 Use current informatics technology to develop, store, retrieve and disseminate information and data. Review and discuss with preceptor computer resources and applications specific to clinical dietetics, i.e., patient medical charts, laboratory data, financial management. 4.11 Complete documentation that follows professional guidelines, guidelines require by health care systems and guidelines required by the practice setting. Write notes for medical records and review with preceptor. Use appropriate abbreviations for documenting patient/client medical records. 4.12 Participate in coding and billing of dietetics/nutrition services to obtain reimbursement for services from public or private insurers. Participate in billing functions for nutrition services with clinical nutrition manager or other responsible individual. OTHER COMMENTS: 8
Have intern consider best practices for a patient/client interview Patient/Client Interview considerations ask intern: How best will you prepare yourself for a patient/client interview? How might you prepare the patient for an interview? Which communication tools are important to keep in mind when conducting an interview? What will be your approach? How best will you obtain accurate information regarding current dietary habits from the patient/client? How best will you obtain a social history as needed? How best will you obtain additional medical history? How best will you organize and enter written communication, including charting? What steps will you take to be concise? Make sure to use correct spelling / grammar / abbreviations. Will you use standard references, if so under what circumstances? 9
Clinical Knowledge Confirmation Intern demonstrates a working knowledge of the nutritional requirements for: Diabetes Mellitus Type I Type II GI disease Cancer Renal disease Cardiovascular disease Liver or pancreatic dysfunction Enteral nutrition support Parenteral nutrition support Intern demonstrates a working knowledge of the following lab values: Serum albumin Serum transferrin Total lymphocyte count Creatinine / height index Total urine nitrogen Urea nitrogen / nitrogen balance Immune reactivity studies Glucose (blood) Sodium Potassium Hematocrit / hemoglobin Protein (urine) Acetone (urine) Specific gravity (urine) Serum osmolality Cholesterol 10
Tryglycerides LDL, HDL, VLDL TC : HDL Ratio PT PTT Pre-albumin Hemoglobin A1C 3-methylhistidine CBC values (all of them) Liver Function Tests; BUN or SUN GFR (Glomerular Filtration Rate) Urine creatinine Lp(a) C-reactive protein Major Disease States to be covered during the Clinical Comprehensive Hospital Rotation: Cardiovascular Disease Diabetes Gastrointestinal Disease Geriatrics Nutrition Support enteral and parenteral Oncology Pediatrics Renal/Dialysis Weight Management 11