Department of Clinical Nutrition and Education Services
Scope of Services
- Definition of the Department
a. The mission of the Clinical Nutrition and Education Services is to support Stony Brook Medicine in pursuit of excellence in patient care. Educating patients, the community and students, as future healthcare professionals, are focused goals for this department.
b. Extensive patient assessments and education are provided by highly qualified registered dietitians. Annually dietitians provide comprehensive initial nutrition assessments for 13,500 admitted patients follow up assessments for 11,000 patients and educate 6,500 or more patients on physician prescribed diets.
c. The department exists to provide high quality nutrition care, programs, counseling, and education for in patients, out patients, staff, students and the community.
d. The in patient population served is comprised of neonates, infants, children, adolescents, adults and geriatrics.
e. Registered dietitians are on duty three hundred and sixty-five days a year including holidays to respond to consults, follow-ups, and the need for patient education when required by level of care.
f. Registered dietitians are on duty in staggered shifts from 7:30 a.m. to 5:00 p.m. Monday through Friday and 8:00 a.m. – 4:30 p.m. weekends and holidays.
- Clinical Nutrition and Education Goals
a. To provide nutritional assessments based on the patient’s level of care and to ensure Medical Nutrition Therapy.
b. To provide an increasing number of outpatient nutritional services through counseling and education.
c. To provide required counseling for those who are potential kidney transplant patient and potential donors.
d. To provide highly visible education programs to the community in fulfilling the mission of Stony Brook Medicine. Specific focus in juvenile obesity, cardiac care, diabetes care is provided in conjunction with the department of community relations.
e. To provide mentoring and professional rotations for the Dietetic Internship Program to meet the mission of The Stony Brook Medical Center. This goal is accomplished in conjunction with The Dietetic Internship Program and the department of Family Medicine.
- Identification of the Needs of Patients, Students and Community
a. The needs of the patients are assessed and met nutritional screening, nutritional assessment and care planning.
b. Considerations are given to meet patient’s individual needs including religious, ethnic, cultural and personal preferences.
c. The nutrition education community needs are identified in conjunction with the department of community relations.
d. Out-patient nutrition services are identified through periodic needs assessment surveys.
e. The department ensures adequate staffing to meet the needs of patients, students and the community through staffing models which ensure quality monitor thresholds and industry standard compliance.
- Recognized Standards or Guidelines for Practice that are used by this Departmenta. >The department of Clinical Nutrition and Education Services adheres to national, federal, state and local regulations, standards and practices of both regulatory and voluntary compliance agencies, including but not limited to New York State Department of Health, Joint Commission on Accreditation of Healthcare Organizations, Occupational Safety Health Administration, American Dietetic Association, American Diabetes Association, and American Heart Association, Press Ganey, Healthcare Foodservice Management, and Solucient Services.
- Protected Healthcare Information
a. Clinical Nutritionists for purposes of nutritional assessment and development of a plan of care collect patient identifiable data.
b. The data is collected from the medical record, hospital information systems and the patient. The data in the computerized diet office system and electronic medical record.
c. Authorized Clinical Nutritionists, diet office personnel and patient services supervisors have access to the data. All computer-generated information requires an individualized password for access.
d. Data is used in the development of a treatment plan for the patient. Pertinent discharge planning data would be disseminated to a home care company or nursing home as required.
- Continuous Quality Improvement Activities
a. The Clinical nutrition and Education Services follows the Focus- PDCA model (plan, do, check and act)
b. The following indicators are being recorded and analyzed: timeliness of nutritional assessments and follow-up care, timeliness of nutrition screens, patient education, interdisciplinary plan of care, dish machine and pot/pan machine temperatures, refrigerator temperatures, in house patient and client satisfaction survey, food temperatures, sanitation, accidents and incidents, employee orientation.
c. This analyzed data with comprehensive action plans is reported monthly at the departmental CQI meeting, to the Administrator of Clinical Nutrition and Education Services and the Food Service Director. Through the tracking of our performance and the initiation of CQI teams we continue to improve upon quality services and the satisfaction of our patients, students and customers.
- Orientation, staff development and continuing education
a. Newly hired nutritional services staff members attend Hospital and departmental orientation for new employees. Additional training and professional development classes are provided during weekly staff meetings. Standard operating procedures and policies are reviewed and discussed with the staff. Professional staff is encouraged to participate in JACHO teleconferences arranged by University Hospital. Corporate training seminars and professional conferences are an additional avenue for staff development and education.
b. Most of the professional staff has attained advanced degrees in their respective field of expertise. Some department staff holds board certification in their respective fields.
i. In-services are provided to educate employees regarding policy and/or programmatic changes. Weekly meetings and monthly group meetings afford the opportunity to apprise staff of changes in policy and/or procedures, field questions and initiate changes.
ii. Staff members who hold registration (RD) certifications are given the opportunity to maintain them. Attendance at professional development conferences and seminars is encouraged and supported. Monthly Journal Club sessions are required.
c. Training records are maintained for all training conducted by the department, both internal and external. Copies of certifications and degrees are maintained in the employee’s personal files. Participation in training and professional development in tracked and reviewed annually as part of the employee performance program.
Scope of Practice for Individual Registered Dietitians/Nutritionists
Registered dietitians at Stony Brook University Hospital provide medical nutrition services in our approximately 600 bed tertiary care facility.
- Nutrition Assessment. The nutrition assessment process identifies patients requiring intervention for nutrition abnormalities using, but not limited to the following criteria: nutrition history (i.e., evaluation of nutrient intake and hydration status, appetite, intake of vitamins, minerals, and/or nutrition supplements, weight history); documented medical history, results of nutrition-focused physical examination; current diagnosis and medical treatment modalities; current drug therapy; and anthropometric measurements.
- Medical Nutrition Therapy Plan and Intervention. In Cooperation with patients or significant others and with other medical center disciplines, and the nutritionist develops and implements the interdisciplinary nutrition care plan and communicates, monitors, and documents (in the medical record) response to nutrition therapy in accordance with The Joint Commission ( TJC). The plan and intervention includes, but not limited to the following: determination of calorie and nutrient requirements; recommended oral, enteral or parenteral diet prescription or modifications; provision of nutrition supplements, as appropriate; recommendation of appropriate feeding modalities; and assessment of tolerance to regimens with recommendations for changes as appropriate.
- Monitoring Response to Nutrition Therapy. The dietitian ascertains the effects of intervention methods and the patient’s response to the intervention used, which includes, but not limited to the following: recommendation for appropriate laboratory tests to monitor nutritional status; requesting measure weights and heights as appropriate; initiating referral of clients to appropriate services warranted.
- Nutrition Counseling. The dietitian initiates nutrition counseling consistent with the patient’s current diet or nutrition therapy needs, recording intervention and counseling in the medical record. This includes the patient’s degree of comprehension and the clinician’s assessment of the patient’s readiness to learn, expected compliance, and identification of respective barrier.