1. Lauren Stierstorfer ARAMARK Dietetic Intern

2.  To gain a greater understanding of the role, responsibilities and impact of the clinical dietitian in an acute care setting

3.  Academic Path to Becoming a Clinical Dietitian  Responsibilities of the Clinical Dietitian in a Hospital Setting  How Does Nutrition Influence Patient Status?  Impact on Patient Outcomes  Expertise of the Clinical Dietitian on Performing Nutritional Calculations  Malnutrition  Clinical Order Writing Privileges

4.  Minimum of a bachelor's degree at a U.S. regionally accredited university or college ◦ course work approved by the Accreditation Council for Education in Nutrition & Dietetics (ACEND) of the Academy of Nutrition & Dietetics (AND)  Complete ACEND supervised practice program at a healthcare facility, community agency, or a foodservice corporation, or combined with undergraduate or graduate studies ◦ ~1400 hours of supervised hours  Pass national examination administered by the Commission on Dietetic Registration (CDR).  Complete continuing professional educational requirements in order to maintain registration and licensure (75 CEU’s for RD every 5 years; 30 CEU’s for LDN every 2 years)  “The Commission on Dietetic Registration (CDR) in 2013 advised in their Entry-Level Registration Eligibility Requirements Update that by 2024, any student intending to become Registered Dietitian/Nutritionist will be required to complete a Master’s degree. This will apply to incoming freshman in 2017.” Registered Dietitian: Educational and Professional Requirements. Eat Right. Academy of Nutrition and Dietetics. 2014. http://www.eatright.org/BecomeanRDorDTR/content.aspx?id=8143 Didactic Program in Dietetics. Youngstown State University. 2014. http://web.ysu.edu/gen/bcohhs/Didactic_Program_in_Dietetics_m112.html

5.  Conduct Medical Nutrition Therapy for all patients screened at nutritional risk by either MD, RN or RD  Participates in interdisciplinary patient rounds for trauma/critical care/medical/surgical patients  Participates in committees (Project RED, Wellness, Dermal Defense, Infection Control, Diabetes Advisory)  Maintains open communication with other disciplinary team members including medical staff, RN, PT/OT, pharmacy, respiratory therapy, speech therapy, case management, and social work to determine appropriate plan of care for each patient.

6.  Recommends care plan based on changes in patients’ nutritional status and/or needs  Acts as a liaison between nutrition department and other hospital staff members  Act as a preceptor for dietetic internship programs

7.  Optimal health of patients rely on good nutrition from all aspects. Nutrition plays a key role in the care of the critically ill, those with inadequate gut function, eating disorders, patients with food intolerances, the obese, and a vast range of other clinical problems.  Majority of illnesses are linked to nutrition either with nutrition being a potential causal factor, or in assisting the treatment

8.  Increase wound healing  Decrease number of days on a ventilator  Reduce length of stay  Aid in discharge planning  Reduce readmission rates  Decrease prevalence of malnutrition  Decrease rate of hospital-acquired infections

9.  Clinical Dietitians are educated on how to perform nutritional calculations including: ◦ Caloric needs ◦ Protein, carbohydrate, and fat needs ◦ Fluid needs ◦ Tube feeding/TPN requirements ◦ BMI/% weight changes  These calculations help determine the nutritional needs of patients and steer the clinical dietitian to efficiently make recommendations for PO diet advancement, supplement use, enteral and parenteral nutrition.

10.  What is malnutrition? ◦ “Malnutrition begins with inadequate intake of protein and/or energy over prolonged periods of time which results in loss of fat stores and/or muscle stores. Malnutrition occurs in the presence of absence of inflammation and can be related to:  Starvation  Chronic illness  Acute disease or illness ◦ Malnutrition causes adverse effects on body function and clinical outcomes and can occur at any BMI.” 1 1. The facts on malnutriton. Alliance to Advance Patient Nutrition. (2014). http://static.abbottnutrition.com/cms- prod/malnutrition.com/img/Alliance_Malnutrition_Fact-Sheet_2014_v1.pdf.

11.  If patient has at least two of the following six criteria, they are diagnosed with malnutrition. 1.Insufficient food intake compared to nutrition requirements 2.Weight loss over time 3.Decrease in muscle mass 4.Decrease in fat mass 5.Fluid accumulation 6.Measurably decreased grip strength 1. The facts on malnutriton. Alliance to Advance Patient Nutrition. (2014). http://static.abbottnutrition.com/cms- prod/malnutrition.com/img/Alliance_Malnutrition_Fact-Sheet_2014_v1.pdf.

12.  Complications of malnutrition can cause increased risk for: ◦ Pressure ulcers ◦ Falls ◦ Hospital-acquired infections ◦ Surgical site infections postoperative pneumonia ◦ Morbidity and mortality ◦ Anemia ◦ Decreased cognition ◦ Edema ◦ Hip fractures ◦ Immune dysfunction ◦ Muscle loss ◦ Osteoporosis Rosenthal M. Malnutrition ‘skeleton’ still rattling in hospital closets. Gastroenterology and Endoscopic News. November 2014. Volume 65:11.

13.  Effective Treatment of Malnutrition can: ◦ Reduce incidences of pressure ulcers ◦ Reduce incidences of hospital-acquired infections ◦ Reduce incidences of surgical site infections ◦ Decrease readmission rates ◦ Reduce length of hospital stay ◦ Reduce risk of falls, hip fractures, and osteoporosis ◦ Decrease morbidity and mortality rates

14.  Currently, at MLHS, Registered Dietitians do not have clinical order writing privileges  A dietitian may make recommendations, and the MD may or may not consider them  MLHS dietitians are currently working to gain order writing privileges ◦ This will include:  Changing diet orders/restrictions  Ordering supplements/protein  Ordering tube feedings  Ordering labs

15.  “Registered dietitians can play an important role in a multi- disciplinary team at the bedside to apply evidence-based nutritional intervention that can improve patient outcomes,” said Sylvia Escott- Stump, President of the American Dietetic Association (ADA) 1  “MNT by RDs is an essential component of comprehensive healthcare that prevents or alters the course of diseases including diabetes, obesity, hypertension, disorders of lipid metabolism, heart failure, osteoporosis, celiac disease, and chronic kidney disease,” said the ADA’s Escott-Stump 1 1. The Impact of Clinical Dietitians on New Healthcare Delivery Modes. Aramark Healthcare. http://www.aramarkhealthcare. com/ docs/default-source/position-papers/the-impact-of-clinical-dietitians-on-new-healthcare-delivery- models.pdf?sfvrsn=4.