Integration of Dietitian Services in a Hospital-Based Pediatric Home Health Care Department

Abstract

LEARNING OUTCOME: To describe how limited dietitian hours can be used to provide nutrition services for the hospital's Home Health Care patientsSince July 1994 a dietitian liaison from the hospital's Nutrition Department has been a member of the Home Health Care (HHC) team. This dietitian acts as a resource to HHC staff and organizes weekly patient case conferences for enteral and total parenteral nutrition (TPN) patients. The dietitian liaison also assisted HHC in the development of a nutrition screening assessment used prior to hospital discharge. Weekly case conferences include the dietitian liaison, a HHC nursing supervisor or metabolic nurse, and a HHC pharmacist. Each person gathers information from appropriate primary care providers and the family, before a round table style discussion and documentation process. Patients are systematically reviewed so that all enteral feeding patients are discussed at least every 6 months and all TPN patients at least every month.Because of the dietitian's involvement, the HHC Department has been able to meet and exceed the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards. Prior to this program, only about 75% (57/73) of the HHC patients receiving enteral feedings and/or TPN had any involvement with a dietitian, even on an inconsistent basis. As a result of the case conferences, patients have been identified who appear to be using less product than prescribed, HHC services have been terminated or nursing visits restarted in a more timely manner, and complete nutrition reassessments have been initiated to ensure that the patient continues to receive the desired intake. When HHC field nurses were surveyed in March 1996, all nurses responding indicated they had consulted with a hospital dietitian in the past 6 months. These nurses also indicated an interest in written guidelines or periodic inservices on nutrition related topics. A repeat survey of the nurses a year later and documentation of patients identified for further nutrition consultation are tools for evaluating how well the dietitian is used as a resource within the HHC Department.