Back in Acute Care, a New Approach

I was back in acute care today with a dietitian who has been on maternity leave. It was a slow day, but it was a nice way to ease back into things after having been in Long-term care. It also gave me a chance to become acquainted with her system.

I will definitely learn a lot from this woman. She has a different way of doing things than the other dietitians, and I really liked her methods. They make more sense to me. We have a computer program called VISTA that does the calculations to determine the patient’s needs. However, the dietitian must specify the method she wants and the injury and activity factor to be applied if the HBE is used. Most of the dietitians use the HBE, and you always have to select either 1.2 or 1.3 for the activity factor. This often throws me off because in class we often just multiplied BEE by a single factor (injury factor). The dietitian I was with today uses kcal/kg, which is more logical to me and easier for me to use. I like being able to quickly calculate it and then decide if that estimate seems reasonable. She determines fluid needs by using ml/kcal. I did that occasionally, but usually dosed fluids based on age and weight, per instruction from the other dietitians, except when the kcals needed exceeded the number of mL, then I used ml/kcal. This method is definitely more logical to me under most circumstances.

This RD also uses a slightly different template. The S part of her SOAP note is more of a narrative, and I like the way that it flows. She also does not go through the labor of trying to explain all of the irregular lab values, which initially I thought I was instructed to do. However, I have noticed that the other dietitians do not do it as extensively as I do, and so maybe I misunderstood. With so many possible explanations for the irregular lab values, it is probably better not to speculate.