Include dietitian in discharge planning
Incorporating nutrition particularly important
In a 2005 survey of case managers and social workers who handle discharge planning in almost a dozen Florida hospitals, 30% of those surveyed described registered dietitians as "not important," to discharge planning, and 45% said they consult dietitians infrequently or not at all.1 Those responses stand in sharp contrast to another finding by the authors: Almost all of those surveyed said nutrition-related medical conditions strongly influenced how patients' post-discharge care plans were shaped.
Among the authors' conclusions were that registered dietitians and nutritionists on staff at hospitals need to promote themselves as valuable contributors to discharge planning, a suggestion echoed by registered dietitian Joyce Buhler, RD, CD, CDE, of Ashley Regional Medical Center in Vernal, UT.
At Ashley Regional, dietitians are part of the multidisciplinary care planning meetings held twice a week, where care planning and discharge planning are coordinated among nursing, pharmacy, physical therapy, dieticians, physicians, and other specialists. But making sure nutrition is kept in mind requires some self-promotion, Buhler says.
Buhler says that generally, nutrition is part of discharge planning; however, to ensure that nutrition and diet needs are considered at discharge, dieticians need to make themselves "visible."
In elderly, nutrition key to recovery
A literature search isn't necessary to demonstrate the importance of good nutrition for health, self-sufficiency, and recovery. This is especially true in older patients; the Institute of Medicine Committee on Nutrition Services for Medicare Beneficiaries reported in 2000, in The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population, that more than 85% of seniors have chronic conditions that good nutrition practices can improve. On the other hand, poor nutrition can impede recovery, contribute to post-hospitalization complications, and increase length of stay.
Obstacles to good nutrition in older patients can include loss of appetite and the inability to obtain or prepare nutritious food.
"The dietitian's role includes coordinating such things as encouraging seniors to go to congregate meals or to register for Meals on Wheels," she says.
If diabetes is part of the diagnosis, the dietitian works with discharge planners to provide diabetes education for families and patients, and coordinate with home health or infusion companies for nutritional support for the patient.
"Patient education is probably addressed [by dietitians] more than the discharge planning component," she adds. "But together with the pharmacists, physical therapy, and nursing, we can talk about strength issues, hydration and intake issues, food and drug interactions, and nutrition support as we go over the various patients."
"At that point we begin the planning process; but of course, a lot of it is Medicare-driven," she says.
Foster relationship between dietitian, DP
"In my experience, it always starts with the working relationship with the discharge planner," says Courtney Allgeier, MS, RD, LD, a metabolic science researcher for Abbott Nutrition in Columbus, OH, and formerly a dietician at Dayton (OH) Children's Hospital. Dieticians not only perform diet education, but also help work with WIC, pharmacies, and insurance companies to help families obtain the formulas, supplements, and nutrition counseling they need as part of their post-hospital care.
In the pediatric setting, Allgeier says, the dietician can spend time with parents, grandparents, or other childcare providers, educating them on the dietary requirements related to the child's diagnosis, with an eye to establishing the foundation of an ongoing relationship with the family.
"If it was a new diagnosis, then this might be a family we'd be seeing quite often, so we can do demonstrations and education along the way to make it easiest on the parents," she explains. "Parents can have control over their child's food, whereas they might not have control over anything else, so we can work with the parents to give them that."
Buhler says a relationship between discharge planners and dieticians that recognizes the value of integrating nutrition into patient education and post-acute care planning allows the strengths of both disciplines to enhance each other.
She points out that meal preparation, either with family or community support, is an important piece of the plan, and dieticians are the obvious experts; but in order to equip patients and families with information that is best tailored to their situation, dieticians can use information from the social worker or case manager about the family's social situation and support network.
Reference
1. Baker EB, Wellman NS. Nutrition concerns in discharge planning for older adults: A need for multidisciplinary collaboration. J Am Diet Assoc 2005;105:603-607.
Sources
For more information:
- Joyce Buhler, RD, CD, CDE, Food and Nutrition Service and Diabetes Education Manager, Ashley Regional Medical Center, Vernal, UT. Email: [email protected].
- Courtney Allgeier, MS, RD, LD, Scientist, Pediatric Research and Development, Abbot Nutrition, Columbus, OH. Email: [email protected].
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