Registered Dietitian - LWE

City/State

New Rochelle, New York

Grant Funded

No

Department: MNR Clinical Nutrition

Bargaining Unit

1199

Work Shift

Day

Work Days

DAYS VARY

Scheduled Hours

8 AM-4 PM

Scheduled Daily Hours

7.5 HOURS

Hourly Rate

$43.32

For positions that have only a rate listed, the displayed rate is the hiring rate but could be subject to change based on shift differential, experience, education or other relevant factors.

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Job Summary

Provide in-depth nutritional assessment of nutritional status and needs and develops appropriate care plan to meet nutritional goals for patients at high nutritional risk or per policy. Assessment includes nutrition focused physical examination and identification of nutrition diagnosis(es) and etiology.

Determines appropriate interventions and specific goals. Develops medical nutrition therapy care plan including discharge recommendations. Provide instructions on appropriate diet therapies to patients/family. Monitors progress towards resolution of nutrition diagnosis and achievement of goals.

Actively participates as core team member in interdisciplinary coordinated patient care program and on committees for the development and revision of nutrition related policies and procedures. Acts as a source of nutrition care expertise to MMC staff and associates.

Essential Functions

Triage assigned units daily to identify and prioritize patients requiring nutrition visit as per department standards (CBORD /Epic review) * Determines consults to be seen that day and patients due for follow up care, and identifies unconsulted patients that may need to be seen.

Tallies appropriate on daily Log. * Logs reflect appropriate priorization of daily load. Communicates with team (nursing/provider) to encourage ordering of a consult when appropriate and identified during triage.

Completes nutrition consults within policy time frames. * Documented evidence in medical record and productivity log of timely completion of consults. * Timely intervention of all consults by policy or best practice time frames; no patients missed. * Documents reason for any untimely interventions on Productivity Log.

Assesses nutritional status and needs, and develops appropriate interventions and care plan through review of the medical record, medical diagnosis and history, labs/ medications, patient/family/caregiver interview, nutrition focused physical exam, diet history, fluid balance, weight status/changes, adequacy of diet to meet needs, tolerance to EN/PN, and input from health care team.

Integrates all available information to calculate estimated nutritional needs for calories, protein, fluids, micronutrients.

Calculates estimated nutrition needs based on age, weight status, injury factors including wound healing needs, medical diagnoses and histories, current and past intake, tolerance to oral/enteral/parenteral diet order, including evaluation of EN residuals.

Calculates the degree to which these needs are met by patient. * Completed Comprehensive Assessment as evidenced in the medical record in adherence to policies and procedures, departmental and professional standards of practice, and time frames. * Assessment of needs, status, choices for care plan and interventions are quantified, evident, and clear to the reader. * Determines level of care in adherence to policies.

Determines appropriateness of diet order, nutritional supplements, and/or nutrition support and communicates recommendations for change when indicated. * Accurate calculation of all nutritional needs appropriate for each patient, to include but not limited to calorie, protein, fluid, and micronutrient needs, and weight status.

Nutrition Focused Physical Exam performed on all appropriate patients, and results documented. * Documents reason for variation of calculations when outside of standards of care/policy.

Performs accurate Nutrition Focused Physcial Exam to identify signs of nutritional deficiency or malnutrition on all patients determined by departmental policy. * Physically examines appropriate patients to determine presence of and severity of muscle loss and/or loss of subcutaneous fat stores in all areas of the body as listed by the Academy of Nutrition & Dietetics. * To include: * Muscle or grip strength. * Scalp, hair, mouth, skin and nail health. * Appearance and feeling of different body parts, including the arms, legs, chest, back and face. * Signs of fluid retention or dehydration. Documentation is accurate and specific in EMR.

Identifies patients meeting ASPEN/AND criteria for malnutrition or at high risk for malnutrition and communicates assessment and plan with the interdisciplinary team as needed. * Identifies and documents ASPEN/AND criteria met to identify malnutrition in both the nutrition note(s) and the Evaluation of Malnutrition Note in EMR. * Uses appropriate ASPEN/AND terminology including severity and type of malnutrition. * Quantifies percentage of intake, needs and weight loss per policy. * Lists all criteria in the PES statement. * Adheres to all related documentation policy of undernutrition and malnutrition. * Documents progress in all subsequent follow up notes until resolved or patient is discharged.

Determines appropriate nutrition diagnosis(es) and identifies the corresponding etiology and evidence; formulates appropriate PES statement(s) for each patient seen.

Chooses the appropriate number of nutrition diagnoses based on patient assessment (1-3). * Adheres to Academy of Nutrition & Dietetics Nutrition Care Process Terminology standards for selection of Nutrition diagnosis and PES statements. * Makes appropriate choices of nutrition diagnoses.

Etiology is consistent with the cause of the main nutritional problem. * Symptomalogy listed is inclusive, specific and quantifiable when appropriate.

Formulates appropriate plan of care and goals of care, listing interventions and recommendations through continuum of care to alleviate the signs and symptoms of the nutritional diagnosis, and ultimately resolve the identified problem.

Recommendations include, but are not limited to, modification of diet order, enteral and/or parenteral orders, oral supplements, fluids, micronutrient supplementation, snacks, suggested labs & referrals (food supply, homecare, SW, out pt RDs).

EN/PN to include appropriate formula, rate, route of delivery, flushes, addition of modulars, electrolytes, micronutrients, feeding precautions, and methods for optimal transition in between feeding modes. * Completes Comprehensive Assessment in EMR (or on downtime paper form) including goals and care plan that are realistic, appropriate and in conformance with professional and departmental policies and procedures and professional standards of practice. * Documents reason for interventions when outside of standards of care/policy. * Provides referrals to other members of interdisciplinary team as appropriate to optimize patient care. * Pends diet orders (PO, EN, PN, oral supplements) appropriately, accurately and timely in EMR.

When appropriate, designs a parenteral solution prescription for a patient using the types of amino acid/ dextrose solutions, lipid emulsions, electrolytes and other compounds available. * Adheres to professional, departmental and hospital standards of care, ASPEN /AND guidelines.

Accurate calculations, appropriate for age and condition. * List indications for use of parenteral nutrition. Enters prescription accurately into Epic.

Note and prescription to include: * Calculate protein, calorie, and fluid, requirements for the patient * Calculate protein, carbohydrate, and fat content of parenteral solutions and ensure appropriate distribution.

Monitor non-protein calorie to nitrogen ratio of a parenteral solution * Include appropriate amounts of micronutrient, trace element and electrolyte components into the solution.

Adjust electrolyte and zinc content by taking into account salt based or ion based electrolytes of the entire Rx. * Explain procedures for the termination of a parenteral feeding as appropriate. * Meets Pharmacy time deadline for PN orders; communicates to TPN Pharmacist with relevant problems to meet timeline. * Monitor per policy, preferably by best practice guidelines.

Monitors implementation of and evaluates efficacy of nutrition care plan to determine if patient has achieved or is making progress toward the established goals. Monitors progress toward resolution of nutrition diagnosis. Modifies care plan and/or goals appropriately if necessary.

Monitoring includes, but is not limited to: patient compliance, diet/supplement/EN/PN intake and tolerance, anthropometric measurements, laboratory data, and psychosocial issues. * Completes follow up and progress notes in EMR according to departmental standards and time frames. * Determines and documents clearly if each nutrition diagnosis or goal remains appropriate, making revisions as needed. * Determines and documents clearly in EMR the progress toward resolution of nutrition diagnosis and goals. * Revises interventions, care plan, and goals accordingly. * Documented evidence in medical record of recommendations for change in conformance with departmental policies, procedures, and time frames.

Additional evidence when recommendations and/or implemented by health care team. * Monitors pended orders have been activated or declined by Physicians/providers.

Evaluates patient/caregiver need for nutrition counseling. Provides appropriate counseling/education using method/materials to maximize comprehension and achieve desired outcomes including adherence to nutrition recommendations and enhanced quality of life. * Documented evidence of evaluating need for nutrition counseling, counseling provided or reason to defer, comprehension/motivation level/anticipated compliance according to hospital, departmental and regulatory agency protocols, stan