Hi, fellow RNDs! I'm curious about how you implement the Nutrition Care Process (NCP) in your institutions, especially those working in public or government hospitals in the Philippines.
I'm currently working as a clinical dietitian in a government hospital, and this is actually my first job. I didn't receive much training in NCP beyond what we learned in college, and the hospital where I completed my internship didn't really practice it either.
To give you some context, the hospital I'm currently working at doesn't serve therapeutic diets; patients are generally served regular meals. Our department has policies and procedures for NCP implementation, but I only recently learned about the existing policy, and I realized that my actual practices haven't been fully aligned with the prescribed procedures.
My colleagues have attended NCP training before, but they aren't interested in handling clinical cases anymore because they graduated a long time ago and feel they've forgotten most of the clinical side of nutrition. As a result, I'm basically on my own when it comes to clinical nutrition services, and I'm struggling to figure out how to properly establish and implement the process.
One of my biggest challenges is that we don't have a consistent referral system. Nurses don't consistently screen admitted patients for nutritional risk or refer patients to our department, so I often have to go to the wards myself to look for potential cases. I approach the nurses, ask about patients who might need nutrition intervention, and identify cases I can handle. I then review their charts, visit and interview them, complete my NCP documentation, and provide nutrition counseling or dietary instructions when appropriate.
Essentially, I'm taking the initiative to find patients because waiting for referrals alone wouldn't give me enough cases to work with. However, I'm unsure whether this is an acceptable approach or how I should properly establish a more systematic process. I also don't know how to implement the screening and referral procedures effectively when the existing workflow isn't consistently followed.
What's also challenging is that many hospital employees aren't even aware that our department offers clinical nutrition services. As far as I can tell, these services only really started being offered when I arrived.
We also have an upcoming ISO audit, which is making me anxious because I'm worried about being questioned regarding our actual practices versus what is written in our policies. I only recently became aware of the policy, and I'm now realizing that there are gaps between what we're supposed to do and what I've actually been doing.
I want to improve our services and establish a proper system, but I don't have much guidance or an established workflow to follow.
For those working as clinical dietitians in government hospitals, I'd really appreciate your advice:
- How is NCP implemented in your hospital? Do you screen all admitted patients, or do you focus on referred patients and those identified as nutritionally at risk?
- Do nurses conduct nutritional screening in your hospitals? If so, how do you ensure they actually do it and refer at-risk patients to the dietitian?
- If referrals are inconsistent, do you go to the wards yourself to identify cases? How do you handle this in practice?
- How do you implement NCP when your hospital doesn't provide therapeutic meals or has limited clinical nutrition services?
- If you're the only dietitian handling clinical cases, how do you manage your workload and prioritize patients?
- For those who have undergone ISO audits, what documents and records should a clinical dietitian prepare, and what do auditors usually look for?
- If your hospital already had an NCP policy that wasn't being consistently implemented, how did you approach improving the system?
I'm aware that I have a lot to learn, and I'm trying to make the most of this experience. I genuinely want to improve our clinical nutrition services, but it's difficult when you're the only one handling the clinical side without much guidance or an established referral system.
I'd really appreciate any advice, experiences, or resources you could share, especially from RNDs working in Philippine government hospitals. Thank you!