Dietary Manager Criteria For Competency Checklist

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Criteria for DietaryManager Clinical NutritionCompetency Review3.02.2009

Criteria for Dietary Manager Clinical Nutrition Competency ChecklistSkillCriteria for successfully demonstrating competency.Resources & HandoutsDemonstrates understandingHealth Insurance Portability & Accountability Act is a federal law intended to protect theof HIPAA requirements related privacy of healthcare residents, while also standardizing the exchange of healthcareto clinical nutritioninformation.information.HIPAA dictates that resident information and health-related data will be kept secure.“Secure” is defined in the law refers to resident privacy and the right to keep personal andmedical information confidential. Does the Dietary Manager leave paperwork with resident names and information settingout where anyone can read it? Does the Dietary Manager walk away from an open medical record? Does the Dietary Manager talk about a resident in ear-shot of visitors or others thatdon’t need to know the information?Demonstrates understandingof DMA Scope of PracticeDietary Manager accurately verbalizes role delineation of RD vs CDM.RD “assesses” nutritional status.Attached DMAs CDM, CFPPScope of Practice and [email protected] www.dmaonline.orgCDM “screens” & “gathers data” for nutrition assessment.Demonstrates knowledge &understanding of the“Nutrition Care Process”The Nutrition Care Process is defined in four steps:1. Nutrition Assessment2. Nutrition Diagnosis3. Nutrition Intervention4. Nutrition Monitoring & EvaluationThe first component of the “Nutrition Assessment” is a screening of residents for those atrisk for nutrition problems and is a candidate for further intervention. One of theresponsibilities of many dietary managers is to conduct the routine nutrition screenings.Nutrition & MNT for DietaryManagers by Sue Grossbauer,RD pg. 225-6.

Resident (&/or family) Interview:(Observe the Dietary Manager’s interview skills.)Demonstrates ability to:1. Conduct interviews withresidents gatheringpertinent information The Dietary Manager includes in interview: Food preferences / taste alterations:o Are there any foods you dislike?o Do any foods taste different than they use to? Do you follow a special diet? Weight history / usual weight:o Have you experienced any weight changes within the past 6 months? Special dietary considerations such as:o meal pattern preferencei. When do you usually eat?ii. How often do you usually eat?iii. How is your appetite?iv. Do you have any hunger or cravings during the day?o allergies or intolerances,v. Are there any foods you avoid? If so, why?o cultural, ethnic & religious preferenceso dietary supplement use, Difficulty chewing or swallowing:o Are you having any problems chewing?o Are you having any problems swallowing? Are you experiencing any digestive concerns, such as nausea, vomiting, orconstipation? 2. Identify possible physicalindicators of poor nutrition&/or psychosocial issuesthat may interfere withnutritional status.Physical indicators: Eyes: sunken, pale, dry, or swollen Lips: swollen, red, dry, cracked Gums: sore, spongy, red, swollen Tongue: purple, white-gray coating, smooth, slick Teeth: missing, loose or chipped Skin: pale, dry scaly, bruises easily, warm to the touch Nails: brittle, thin Shortness of Breath Psychosocial issues: Dx: Alzheimers, Dementia, Depression, mental illness Not getting along with tablemates Eating off other resident’s plates/traysPocket Resource for NutritionAssessment

3. Clearly communicatebasic diet restrictions andspecial dietaryconsiderations toresidents – i.e,- fluidrestriction.Utilizes effective communication skills: Asks questions about something with which they are unfamiliar or uncomfortable. Does not interrupt the resident or try to put words in their mouth. Notes resident’s responses, a “yes” response does not necessarily indicateunderstanding or willingness to do what was discussed. (It may simply be respect forhealthcare provider’s status.) Uses visual aids, i.e., handouts, models; when appropriate.Nutrition & MNT for DietaryManagers by Sue Grossbauer,RD pg. 353.4. Utilize effectiveinterviewing techniques.YYNutrition & MNT for DietaryManagers by Sue Grossbauer,RD pg. 245.YYYYYYYYYYY5. Participate appropriatelyin care conferences withfamiliesN Were questions planned in advance and a form used to keep track of responses?N Garnered enough background information from medical record to prepare foreffective interview know if resident has hearing or sight deficits, therapeutic dietorder, food allergy, religious preference, etc.?N Introduced self by name & title?N Was friendly & sincere?N Established rapport by taking a genuine interest in the resident?N Avoided “yes-or no” questions using open-ended questions, such as “Tell memore about ” ?N Remained neutral during the interview and did not judge resident’s dietary habits?N Asked for more information or clarification when needed?N Allowed the resident time to give an answer?N Used nonverbal language to show resident he/she was listening? Maintained goodeye contact & leaned slightly toward the resident to demonstrate attention?N Avoided leading questions, which give the resident the answer expected?N Actively listened to the resident & observed nonverbal responses?N When closing the interview, expressed appreciation to the resident and reviewedthe next steps, if appropriate?Observe Dietary Manager participate in resident care planning session to determineappropriate level of participation.YYYYYYYYYNNNNNNNNNarrived prepared for care conferencelistened to each team member to understand comprehensive clinical picturecontributed ideas to help meet needs.had knowledge of resident’s eating abilitieshad knowledge of resident’s meal intakereviewed any areas of concernbrought documentation for reference, i.e., tray card, cardex, etc.supported the plan and follows through on approaches.Overall, the Dietary Manager related specific facts and observations that contributeto the evaluation of the resident’s care.Nutrition & MNT for DietaryManagers by Sue Grossbauer,RD pg. 324-5.

Gathering & Application of Nutrition Screening Data:(Utilizing a resident’s medical record, have the Dietary Manager demonstrate skills.)Demonstrates ability toaccurately:1. Convert:a. weight in pounds tokilogramsb. weight in kilograms topoundsc. height in inches tocentimetersDemonstrates ability toaccurately calculate & record:1. Ideal Body Weight Rangeand % IBWR2. IBW in disabilities3. % weight gain or loss fromusual weight for:a. 30 daysb. 90 daysc. 180 days4. BMI, based on height andweighta. weight in pounds / 2.2 weight kilogramsb. weight in kilograms x 2.2 weight in poundsc. height in inches x 2.54 height in cm Dietary Manager utilizes same standards & references for determining IBW range asClinical RD.Utilizing a resident’s medicalrecord, have the DietaryManager demonstrate skills.

5. Estimated nutritionalneeds for:a. Caloriesb. Proteinc. FluidsMethod used Dietary Manager utilizes same equations as RD when calculating calorie, protein, & fluidneeds. Dietary Manager demonstrates ability to estimate adjusted energy needs for obeseadults or the critically ill. Dietary Manager demonstrates knowledge of different factors used when estimatingprotein for:a. Normal nutritionb. Adult vs pediatricc. Protein depletiond. Pressure ulcere. Renal failuref. Hepatic failure Dietary Manager verbalizes knowledge fluid requirements may differ based on age,presence of fever, cardiac problems, renal failure, dehydration.6. % meal intake required tomeet estimated needs7. Seven (7) day average:a. Percent meal intakeb. Fluid consumption incc/mlc. Calculation of meal %or fluid cc’s for mealswhich include refusalsor holes in mealmonitor.8. Approximate calories andprotein consumed frommeals and snacks/supplements for oneresident - based on thefacility menu.

9. Supplement and snackconsumption in % orvolume10. Calculation of 50% of fluidrequirements11. Supplement and snackconsumption in % orvolume12. Calculation of 50% of fluidrequirementsMedical Record review & documentation:(Utilizing a resident’s medical record, have the Dietary Manager demonstrate knowledge & skills.)Demonstrates ability toaccurately:1. review and transfernutrition-related dataonto appropriatenutritiondocumentation forms2. Demonstratesknowledge ofnutrition-relatedMedical Terminology,commonly usedsymbols, & usesacceptableabbreviations indocumentation.Dietary Manager documents in the medical record in compliance with the facility’s policies &procedures and accepted standards of practice: Dietary Manager uses standardized forms for recording assessment data. All medical records are legal documents; entries in the medical record are in black ink,dated, signed with full name and title, and never backdated or erased. All entries are concise, timely, and reflective of the resident’s current condition. Chart errors are corrected by a one-line strike out, initialed, dated, and labeled “error”OR as facility policy dictates.“Nutrition-related abbreviates & common symbols” is attached. Those abbreviatesdesignated: * “in bold letters” are on the JCAHO “Do-Not-Use” List.Answer key is attached.Nutrition-related MedicalTerminology & commonsymbols QuizJCAHO “Do-Not-UseAbbreviations: List”

3. Locate AdvancedDirectives inresident’s medicalrecord and correctlyinterprets resident’schoices.Have the Dietary Manager locate a resident’s Advanced Directives in the medical record andexplain what the resident’s choices are.Background:The term Advance Directive is used to describe documents that can be used to direct yourmedical care if you were to lose decision-making capacity.A Living Will sets forth your instructions for dealing with life-sustaining medicalprocedures in the event you are unable to decide for yourself. A Living Will directsyour family and medical staff to continue, withhold, or withdraw life-sustainingsystems, such as tube feeding for hydration (water) and nutrition (food), if you areincapable of expressing this yourself due to an incurable and terminal condition orpersistent vegetative state.A Durable Power of Attorney for Health Care allows you to appoint a person tomake all decisions regarding your health care, including choices regarding healthcare providers and medical treatment, if you are not able to make them yourself forany reason.Everyone has the right to accept or refuse medical care. A Living Will protects the resident'srights and removes the burden for making decisions from family, friends, and physicians.It is also important to understand that a decision not to receive "aggressive medicaltreatment" is not the same as withholding all medical care. A resident can still receiveantibiotics, nutrition, pain medication, radiation therapy, and other interventions when thegoal of treatment becomes comfort rather than cure. This is called palliative care, and itsprimary focus is helping the resident remain as comfortable as possible. Residents canchange their minds and ask to resume more aggressive treatment.When does a Living Will take effect?A Living Will takes effect when two medical doctors certify that you have a terminal andincurable illness or you are permanently unconscious or in a persistent vegetative state.When does a Durable Power of Attorney take effect?Although both a Living Will and Durable Power of Attorney are available on the same form,they have separate legal significance. The Durable Power of Attorney takes effect when youare no longer able to communicate with your healthcare provider.4. Document medicationlist and recordpotential nutritionrelated side effectsusing an approvedfood/drug interactionbookLiving Wills & Idaho’s NaturalDeath Act. State of Idaho Officeof the Attorney GeneralLaurence Wasden

5. Complete Section K ofthe MDS6. Document nutritionaldata gathered on aresident in the form ofa RAP note.7. Document pertinentdata in the care plan& update changes tonutrition interventionson the care plan in atimely manner. Were food/fluid- related interventions added to plans of care, as appropriate?Were goals measureable?Are all approaches current?Are interventions planned with the dietitian to address family, staff, or resident’s foodconcerns and dietary manager’s information shall be added as approaches to the careplan.8. Verbalize process forobtaining a caloriecount; demonstratesability to calculate; &can relate results toresident’s estimateddaily requirements forcalories & protein in aprogress note.Can the Dietary Manager locate the proper form(s) for a calorie count? accurately describe the facility’s process, in the correct order? given a fictitious total number of calories & protein, accurately calculate & can relateresults to resident’s estimated daily requirements for calories & protein in a progressnote?Interpretation & Use of Ancillary reports:Verbalize process forobtaining and comprehendingthe content of:1. Weight reports withweights over 180 dayperiod2. Pressure ulcer/skinreports

3. Recent laboratoryreports4. Medication, treatment,and blood glucosemonitoring formsThe Idaho Diet Manual:(Utilizing the current edition of the Idaho Diet Manual, have the Dietary Manager demonstrate knowledge & skills.)Can verbalize rationale fortherapeutic diets on facility’sformulary: alteredDiabetic/LCS/Calorie Controlled DietsLow Sodium/NAS dietsRenalDysphagia dietsDemonstrates ability toreference manual for nonroutine diet orders.List diets for which the facility may have received orders in the past:1. “Cardiac Diet”2. Low Residue3. Gluten-free4.5.Can accurately explain therationale of liberalizingtherapeutic diets in the longterm care setting.“To meet the needs of every resident, dietetics professionalsmust consider each person holistically, including personalgoals, overall prognoses, benefits and risks of treatment and,perhaps most important, quality of life,” the paper states. Insome cases, a more liberalized nutrition approach allows theolder adult to enhance both quality of life and nutritional status,to participate in their diet-related decisions and enjoyment ofthe meals provided, as well as increasing customer satisfaction,and reducing the risk of malnutrition and weight loss.5Position Paper of the American Dietetic Association, Liberalized Diets for Older Adults in Long-term Care.Implementation of Facility’s Standard Nutrition Protocols:Idaho Diet ManualTherapeutic Diet lications/articles/2005 03 nitiatives/index 21039.cfm

Demonstrates ability toidentify nutrition-relatedproblems and uses goodjudgment on timelyimplementation of standardnutrition care protocols/interventions i.e., enhancedmeal program, between mealnourishments, etc. until theRDs next visit.Dining Observation Skills:(With the Dietary Manager, observe residents during a meal.)Demonstrates ability todetermine resident diningskills by DependentRestorative dining Demonstrates ability toidentify & make proper referralfor resident’s with:problem with appetitedifficulty chewing &/or swallowingalertnessabnormal food behaviorimpaired feeding abilitydifficulty using regular feeding utensils/dinnerwareReferrals:Verbalizes appropriateconditions/issues for referralto: DietitianDirector of NursingSpeech TherapistOccupational TherapistSocial ServicesPharmacist

Demonstrates ability to:1. identify Tube feeding &TPN orders2. locate information theRD needs to know3. uses good judgment inthe timely referral to theRDDietary Manager gathers the following information, as available on resident to notify RD: height weight sex age tube feeding & water flush order OR TPN order, as written oral diet order or NPO Dx &/or reason for tube feeding tolerance of feeding thus far labs as appropriate to protocol for tube feeding or TPNVerbalizes knowledge &demonstrates ability to identifycriteria for immediate referralto RD: Tube feedings/TPNDx: malnutrition or failure to thrivenew pressure ulcer stage II or abovenew Dx: renal diseaseweight 20# below IBWalbumin level 2.8 or belowrefusal of food & fluids 3 daysNPO diet order for more than 48 hoursMD order for Diet Consultorders for “Comfort Care” Has the Dietary Manager NOT made a referral or NOT made a referral timely?Describe instance:Miscellaneous:S & S Nutrition, Inc. Protocol forNotification of the RD.

Demonstrates understandingHealth Insurance Portability & Accountability Act is a federal law intended to protect theof HIPAA requirements related privacy of healthcare residents, while also standardizing the exchange of healthcareto clinical nutrition information. information.HIPAA dictates that resident information and health-related data will be kept secure.“Secure” is defined in the law refers to resident privacy and the right to keep personal andmedical information confidential. Does the Dietary Manager leave paperwork with resident names and information settingout where anyone can read it? Does the Dietary Manager walk away from an open medical record? Does the Dietary Manager talk about a resident in ear-shot of visitors or others that don’tneed to know the information?Demonstrates understandingof DMA Scope of PracticeDietary Manager accurately verbalizes role delineation of RD vs CDM.RD “assesses” nutritional status.Attached DMAs CDM, CFPPScope of Practice and [email protected] www.dmaonline.orgCDM “screens” & “gathers data” for nutrition assessment.Knowledge & understandingThe Nutrition Care Process is defined in four steps:of the “Nutrition Care Process”5. Nutrition Assessment6. Nutrition Diagnosis7. Nutrition Intervention8. Nutrition Monitoring & EvaluationNutrition & MNT for DietaryManagers by Sue Grossbauer,RD pg. 225-6.The first component of the “Nutrition Assessment” is a screening of residents for those atrisk for nutrition problems and is a candidate for further intervention. One of theresponsibilities of many dietary managers is to conduct the routine nutrition screenings.Other:3/02/2009

CDM, CFPP Scope of PracticeA Certified Dietary Manager, Certified Food Protection Professional (CDM, CFPP) has passed a nationally recognized credentialing exam offered by the Certifying Board for DietaryManagers. Continuing education is required to maintain these credentials. The exam is written by content experts, and administered by The American College Testing Program (ACT). Theexam consists of 200 questions that have been pre-tested and proven valid and reliable. Questions cover 10 competency areas which fall under four major headings: Nutrition, Managementof Food Service, Sanitation, and Human Resource Management. The CDM, CFPP credentials indicate that these individuals have the training and experience to competently perform theresponsibilities of a dietary manager.CDM, CFPPs work together with registered dietitians to provide quality nutritional care for clients and perform the following tasks on a regular basis: Conduct routine client nutritional screening which includes food/fluid intake information Calculate nutrient intake Identify nutrition concerns and make appropriate referrals Implement diet plans and physicians’ diet orders using appropriate modifications Utilize standard nutrition care procedures Document nutritional screening data in the medical record Review intake records, do visual meal rounds, and document food intake Participate in client care conferences Provide clients with basic nutrition education Specify standards and procedures for food preparation Continuously improve care and service using quality management techniques Supervise preparation and serving of therapeutic diets and supplemental feedings Manage a sanitary foodservice environment Protect food in all phases of preparation, holding, service, cooling, and transportation Purchase, receive, and store food following

The Nutrition Care Process is defined in four steps: 1. Nutrition Assessment 2. Nutrition Diagnosis 3. Nutrition Intervention 4. Nutrition Monitoring & Evaluation The first component of the “Nutrition Assessment” is a screening of residents for those at risk for nutrition problems and is a candidate for further intervention. One of the

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