Re: Re: Full Liquid Diet mini-Rant

January 2, 2008

Holly,

Do the nurses write the menus? Why can't you change the FL diet to whaterver you

find acceptable? After all, it is RDs that write menus, as well as diet

manuals, and I'm certain you and your team are free to edit and change the diet

manual if needed. I do that all the time, so I assume you can too. I'm certain

that inservicing nurses as well as writing a protocol they can use to order

refeeding would work for you and them, but especially for the patients.

As to " covering dietitians " , it would be an act of kindness to them to provide a

protocol or guidelines they could follow when covering for you. Or else, maybe

you can be " on-call " 24/7 and avoid the embarrassment. I for one, would not

appreciate being embarrassed like that if I ever covered for someone else.

Digna Cassens, MHA, RD

http://groups.msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

Re: Full Liquid Diet mini-Rant

,___

The Full Liquid diet is Horse****! Should be banned from any hospital -

" sorry, not on our formulary " (cause it is no longer in the current ADA Manual).

Cream based soup & milk products - too often ordered after CL for postop chole

and post-pancreatitis patients when the doctor writes " advanced diet as

tolerated " and the nurse thinks that everyone should progress from CL to FL to

S. I'd love for those nurses to sit in a room starving and face a tray of cream

of mushroom soup, custard, whole milk, pudding. Talk about a post-pancreatitis

patient not tolerating??? YUCK!!!!

Thank goodness the pediatric side of the house barely knows what a FL diet

actually is (and they only order it when they are looking for TF to be sent to

the ER). I'm also fortunate in that every pediatric resident graduating our

program learns to ask the RD to help with any nutrition needs, for diabetes

treatment advice, and to see a FTT patient the minute they show up in the ER.

It's actually kinda cute when they see me and ask me to " fix this patient " . It's

a little embarressing when they expect covering dietitians to do the same things

I do (like recommend the appropriate insulin dose for a new diabetic, or write

out the supplies prescription - but they aren't CDEs and haven't worked with

Type 1 diabetics as much as I have).

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian & Diabetes Educator, Las Vegas, NV

---------------------------------

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January 3, 2008

We do what we can to overwrite or advance diets beyond the Full Liquid (if the

doctor wrote " adv diet as tol " we are free to do so, but if the doctor wrote

" full liquid " we have to contact the ordering physician). On the adult side of

the house these are physicians who do NOT work for the hospital, they work for

the patients who they admit to the facility. Trust me when I say we have

numerous protocols in place and some of these physicians have never bothered to

follow a few of them (let's not get started what we went through during the

Atkins craze and how many cardiologists continued to order " low carb diet "

despite the fact that it was NOT in the diet manual/formulary).

Yes, of course I have provided outlines and protocols for what I do in

pediatrics to help the covering dietitians. But they do not have the

experience/competancy to do some of the diabetes treatment that I provide - so

the residents/attending physicians have to call the endocrinologist for the

insulin dosing guidelines instead of me. However, I did create a good cheat

sheet for the residents a few years ago so that helps a bit.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Las Vegas, NV

Digna Cassens wrote:

Holly,

Do the nurses write the menus? Why can't you change the FL diet to whaterver you

find acceptable? After all, it is RDs that write menus, as well as diet manuals,

and I'm certain you and your team are free to edit and change the diet manual if

needed. I do that all the time, so I assume you can too. I'm certain that

inservicing nurses as well as writing a protocol they can use to order refeeding

would work for you and them, but especially for the patients.

As to " covering dietitians " , it would be an act of kindness to them to provide a

protocol or guidelines they could follow when covering for you. Or else, maybe

you can be " on-call " 24/7 and avoid the embarrassment. I for one, would not

appreciate being embarrassed like that if I ever covered for someone else.

Digna Cassens, MHA, RD

http://groups.msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

Re: Full Liquid Diet mini-Rant

,___

The Full Liquid diet is Horse****! Should be banned from any hospital - " sorry,

not on our formulary " (cause it is no longer in the current ADA Manual). Cream

based soup & milk products - too often ordered after CL for postop chole and

post-pancreatitis patients when the doctor writes " advanced diet as tolerated "

and the nurse thinks that everyone should progress from CL to FL to S. I'd love

for those nurses to sit in a room starving and face a tray of cream of mushroom

soup, custard, whole milk, pudding. Talk about a post-pancreatitis patient not

tolerating??? YUCK!!!!