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Patient Population Served
Nutritional Care is provided to patients of all ages in both inpatient and ambulatory settings. Services include nutritional screening, assessments, calorie counts, diet instruction, and counseling. Patients receiving parenteral nutrition are monitored by a multi-disciplinary Nutrition Support Team. General ambulatory services including that of all offsite clinics are provided by the OPD Dietitians. The hospital provides WIC services and Prenatal Comprehensive Assessment Program (PCAP).
A Community Nutrition Outreach program addresses the nutrition-related issues of the community through Nutrition lectures and work shops provided at schools and senior citizen centers. The hospital also provides weight control programs for children and for adults as a community service.
The practice of dietetics at Wyckoff Heights Medical Center is defined by the Hospital’s mission and a variety of policies, procedures, job descriptions, State & Federal regulations and guidelines, and the American Dietetic Association Standards of Practice. The objective of nutritional intervention is to optimize the nutritional status of patients through the provision of food or medical nutritional products and to educate patients according to the principles of nutrition.
Scope and Complexity of Patients’ Care Needs
Patients of all ages are served, including newborns and neonates. Routine infant formulas are provided by Nursing staff, however, the Dietitian may be consulted for patients that require special needs.
Patients of all diagnoses are served including: oncology, endocrinology, cardiology, gastroenterology, nephrology, maternity, obstetrics, pre-natal care, surgical, rehabilitation medicine, geriatrics, pediatrics, general medicine, infectious diseases, etc. Many patients have multiple diagnosis/diet orders of such complexity as diabetes/renal failure. In such cases, all elements of care are incorporated into the care plan.
Services provided include: nutritional screening, assessment and re-assessment, education, provision of nourishment (meals, nutritional supplements and snacks), and provision of nutrition support (TPN/PPN or enteral feedings).
Methods Used to Assess and Meet Patient’s Care Needs
Upon admission, inpatients are screened for nutritional risk by nursing staff and Clinical Dietitians within 24 hours. Diet orders are written by the medical staff, interns and residents. Based upon the patient’s nutritional risk status, diet order, or referral from any member of the multi-disciplinary team, a plan of care is initiated by the Dietitian. Within 48 hours of admission, the Dietitian performs a nutritional assessment of patients identified as being at nutritional risk by means of the screening process. A personalized care plan identifies the nutritional care needs of each patient and includes the assessment, appropriateness of the diet order, treatment, patient and family education, and discharge planning. The care plan is revised when indicated by changes in the patient condition and or family situation. Re-assessment of patients as defined by departmental policy varies in length from 1 to 7 days based on the complexity of patients’ needs. Through collaboration with the other members of the health care team, nutritional goals are incorporated into the overall plan of care.
Patients attending the ambulatory care and satellite clinics are referred to the Dietitians assigned to these areas for nutrition consultation and intervention, based upon diagnostic results as interpreted by the referring physician. Certain outpatient areas, because of the nature of the services provided, routinely provide nutrition screening and consultation to all patients receiving the services. Currently, this occurs in the Prenatal Comprehensive Assessment Program and WIC Program HIV clinic and Chemotherapy Outpatient Clinics.
Availability of Necessary Staff
Patient care assignments are made by the Management based upon patient/family needs and the competency and skill levels of available staff. The Department of Food & Nutrition Services’ budgeted positions are determined annually during the budget preparation process. Staffing may be modified when increased volume, new policies and/or programs warrant change.
Services of the Clinical Dietitians are available for inpatients seven days a week, from 7 AM to 5 PM weekdays and 8 AM to 4 PM weekends. Services of the Clinical Dietitians are available for ambulatory patients Monday through Friday from 8 AM to 5 PM. The Clinical outpatient Dietitian is assigned to assess and educate patients at the satellite clinics via Web Cam as scheduled.
Patient food service is available daily from 7 AM to 7 PM. Cafeteria meal services are from 7:30 AM – 10:30 AM for breakfast and 11:30 AM to 2:30 PM for Lunch, Monday through Friday exclusive of holidays.
The staffing level plan for assignment of both clinical and operational staff is based upon departmental master work schedules and job assignments. When unanticipated changes in staffing occur, department managers are responsible for adjusting schedules for staffing variances, and assuring that patient care is not disrupted.
The Director of Food & Nutrition Services maintains an on-call pager 24-hours a day, seven days a week, and has overall accountability for assuring the availability of necessary staff.
Determining the Extent to Which Care Provided Meets Patients’ Needs
The quality of patient care is monitored on a regular basis through the department’s Performance Improvement Plan. The quality of patient care is reported and coordinated through the Nutrition Subcommittee of the Pharmacy & Therapeutics Committee, the Nursing Committee and, the Quality Management and Patient Safety Subcommittee. Indicators which measure important aspects of patient care outcomes and organizational functions, as defined by Joint Commission, are used to assess current performance and improve patient care. Opportunities for improvement, if any, are identified and appropriate plans of action are developed and implemented to improve future performance.
Standards of Practice
The Diet Manual and Departmental Policy & Procedure Manual identify approved standards of practice.
The Diet Manual is available on the Infonet for reference by practitioners.
The American Dietetic Association Standards of Professional Practice for Dietetics Professionals is the professional standard of practice for Dietitians.