The long term care dietitian’s quick reference guide

Here’s what to do on your first day

The registered dietitian plays an essential leadership role in improving the quality of life of residents in long-term care facilities. The RD works closely with the interdisciplinary team (IDT) to ensure optimal quality care for all residents within the facility.

Unfortunately, many dietitians have little to no experience in this particular field, so it can be intimidating when it comes to taking a contract position or job at a long-term care facility.

This quick reference guide provides a few tips/suggestions when it comes to stepping into a long-term care facility for the first time.

Get to know your facility

• Overall layout–
  • Take note of how many beds your facility has, current and average census, types of rooms (private, semi-private), location of courtyards/visitor areas, and employee breakrooms
  • Find out where your office and computer are located, and the time clock if applicable
  • Where the diet manual, policy and procedure manual, and temperature logs are kept

• Kitchen(s)–
  • Determine locations of walk-in freezer and refrigerator, dry storage, etc.
  • Find out where the diet manual, policy and procedure manual, and temperature logs are kept
  • Familiarize yourself with the facility’s supplement and tube feeding formulary, and find out where they are stored

• Dining room(s) –
  • Determine the serving style of resident food service (traditional tray service, self-service, restaurant-style, etc.)
  • Find out how residents order their meals (paper menu, via telephone, via hostess, etc.) and locate posted menus
  • Determine if there are separate areas for different units

• Nurses station(s) –
  • Locate the printers/copiers, ‘shred-it’ bins, binders with pertinent resident info (such as wound binder), and paper charts if applicable
  • Determine if there are unit pantries, where families can store residents food and where facility nourishments are kept

Get to know your staff/co-workers

• Take a tour! Introduce yourself to the residents, nursing staff, administration staff, doctors, department heads, and most importantly – your dietary staff members and dietary manager.
• Who are your speech language pathologists (SLP) and how do you communicate with them? **very important when working with this population**
• Who are your doctors and/or nurse practitioners, and what is the preferred way to contact them?
• Make sure your upper management staff (Administrator, Director of Nursing (DON), Assistant Director of Nursing (ADON), MDS coordinator, maintenance, and directors of all departments) have a confidential/secure way to communicate with you and vice versa – get a list of phone numbers and emails.

Clearly define your responsibilities in the facility

• Charting – what type of EMR is being used?
• Who completes the MDS (Minimum Data Set) Assessments – Section K and V?
• Who updates the care plans in the EMR?
• Who completes kitchen audits (Dietary Manager vs. RD)?
• How do orders get put into the medical record?
• How does staff communicate consults and other information to the RD? Is there a communication binder, bulletin board, or mailbox?

Find out where and when facility meetings are located

Examples of meetings to attend may include:

• Stand-up/morning meeting – a daily meeting usually held with department heads where pertinent information is communicated about new admissions, discharges, facility issues, resident issues, etc.
• Stand-down – similar to Stand-up (above), but held towards the end of the day to go over anything that has happened throughout the day
• Care conferences/care plan meetings – meetings organized by social workers that include various facility team members to go over the current plan of care for a resident
• Wound rounds and weight meetings – held weekly to discuss any significant weight gain/loss, skin issues (old and recent), and document pertinent interventions discussed by the interdisciplinary team.
• Resident council – usually a monthly meeting held by the social and activities department and is an opportunity for residents to voice any recent concerns whether with nursing care, food, etc. If your schedule allows, definitely attend. It is a great opportunity to get to know the residents as well as hear first-hand what some of the areas of improvement may be.
• QAPI (Quality Assurance/Performance Improvement) – a monthly or quarterly meeting that usually requires RD attendance. Food and nutrition quality measures may be discussed, including unplanned weight loss and other issues which vary from center to center.

Dietitians On Demand offers both local and travel consultant dietitian positions. Our dietitians cover a vacancy, maternity leave, vacations, FMLA or increases in census. Check out our job openings, or request your coverage today!