3 days with diet techs in the psych ward

I have been working with the diet techs this week. They do all of the initial assessments at the VA, and so this is a good way to begin learning their system. After they complete the initial nutrition assessment they pass on any patients who are classified as being moderately or severely compromised to the RD. They handle all of the patients who are normal or who are mildly compromised.
This morning I got to do the initial assessment of two patients in the psych ward while the diet tech watched and stepped in when necessary. I really enjoy working with the patients, and it was fun to do it myself after having watched her during the past 2 days. After talking with the patients we went back to the office and evaluated them based on the information they gave us and the other information we obtained from their medical file in the computer. It is pretty neat to be able to access all of the nursing notes, the doctor notes, their lab values, etc. After determining their status we wrote up modified SOAP notes on them, entered their food preferences, and then entered what we had done and our time. There is a lot of documenting that must be done in several different computer systems. One neat thing about their system is that they use electronic signatures. When someone writes a note that they want someone else to see they can select that person’s name and the note will show up on that person’s computer, indicating that it is awaiting their signature. For example, when the diet tech writes a note she often sends it to the PA to sign.
I also taught a 30 minute class today to a group of 17 men in the psych unit. I was told it could be on anything, so I modified a class I taught with Melissa on the food guide pyramid. Some members in the audience were active participants, but it was also interesting how many were asleep by the end. I enjoyed teaching the class. After the class we had to document in each patient’s file (in 2 places for most patients) that they had attended. It was quite a process! We got to write a generic template describing the lesson, but then for each patient we had to make a note about how they participated in the class. I recognized over half of them, but knew the names of less than 20% of them. Luckily the diet tech was familiar with these patients. We had to document the specific questions that each patient asked to the best of our abilities.
Many of the psych wards are locked and I have been warned to be careful. When leaving the ward we have to make sure that a patient isn’t right behind us who might try to escape. Despite this, I actually really like working with these patients. They eat in groups and I enjoy going on meal rounds and finding out how they like their meals and what they would like changed for next time. The diet tech I was with tries to do meal rounds almost every day. I did meal rounds with the RD once last week, but she sees sicker patients in their rooms individually, and the experience was very different.
I attended a nutrition meeting/celebration today, and so I got to meet the dietitians I hadn’t met earlier. It was also interesting to see how they conduct their meetings.
I will be working with the techs for the rest of the week. They are the only ones who cover weekends, so I will have my weekend experience on Sunday. I have spent the last three days with psych patients, but staring tomorrow I will be seeing everyone.