Nutrition Counselling Development Haliburton Highlands  Family Health Team March 2, 2007
Big Picture <ul><li>Nutrition Counselling: </li></ul><ul><li>Integral part of the health care system </li></ul><ul><ul><li...
Roles of the FHT Dietitian <ul><li>Individual Client Consultation/Education </li></ul><ul><ul><li>physician-referred, self...
Documentation <ul><li>Dietition Notes can be accessed through the  Care Plan  button in the Master Record of a client.   <...
Who Do I Refer? <ul><li>Cardiovascular Disease </li></ul><ul><ul><li>CAD, stroke, hyperlipidemia, hypertension </li></ul><...
Cardiovascular Disease <ul><li>Counselling consists of: </li></ul><ul><ul><li>Dietary  Fats : Saturate, Trans, Poly- and M...
Celiac Disease <ul><li>Counselling consists of: </li></ul><ul><ul><li>Modifying diet to relieve symptoms, prevent nutrient...
Diverticulosis <ul><li>Counselling consists of: </li></ul><ul><ul><li>Dietary fiber: soluble and insoluble </li></ul></ul>...
Food Allergies & Intolerances <ul><li>Counselling consists of: </li></ul><ul><ul><li>Determining foods that provoke sympto...
Inflammatory Bowel Syndrome <ul><li>Counselling consists of: </li></ul><ul><ul><li>Adjustment of eating pattern </li></ul>...
Irritable Bowel Syndrome <ul><li>Counselling consists of: </li></ul><ul><ul><li>Review of the client’s diet to determine f...
Nephropathy <ul><li>Counselling consists of: </li></ul><ul><ul><li>review of biochemical data to determine the need to adj...
Weight Management <ul><li>Counselling consists of: </li></ul><ul><ul><li>Health risks </li></ul></ul><ul><ul><li>Healthy w...
Email Referral To Dietitian Email Referral To Dietitian Appropriate self-referral forwarded to Team Support for appt Walk-...
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Nutrition Counselling Presentation

  1. 1. Nutrition Counselling Development Haliburton Highlands Family Health Team March 2, 2007
  2. 2. Big Picture <ul><li>Nutrition Counselling: </li></ul><ul><li>Integral part of the health care system </li></ul><ul><ul><li>provides primary, secondary and tertiary prevention. </li></ul></ul><ul><li>offers nutrition education and medical nutrition therapy </li></ul><ul><ul><li>reduces the risk and impact of diseases and illnesses </li></ul></ul><ul><li>Impacts positively management or prevention of many diseases and illnesses </li></ul>
  3. 3. Roles of the FHT Dietitian <ul><li>Individual Client Consultation/Education </li></ul><ul><ul><li>physician-referred, self-referred, walk-ins </li></ul></ul><ul><li>Group Education </li></ul><ul><ul><li>community workshops etc. </li></ul></ul><ul><li>Information and Resources for Health Professionals and clients </li></ul><ul><ul><li>Developing workshops, and resources (i.e. handouts) </li></ul></ul><ul><li>Interdisciplinary Planning </li></ul><ul><ul><li>program development </li></ul></ul><ul><li>Interdisciplinary Teaching </li></ul><ul><ul><li>Physicians, allied health professionals, nurses, nursing students/residents and dietetic interns </li></ul></ul>
  4. 4. Documentation <ul><li>Dietition Notes can be accessed through the Care Plan button in the Master Record of a client.  </li></ul><ul><li>By clicking the Care Plan button you will be able to locate encounters by date and description </li></ul><ul><ul><li>example: Mar 20, 2007…...…Dietition Initial Consult </li></ul></ul><ul><ul><li>Apr 3, 2007……...…Dietitian Follow Up </li></ul></ul><ul><li>Direct client care documented using templates: </li></ul><ul><ul><li>Assessment Template for initial consultations </li></ul></ul><ul><ul><li>SOAP for follow-up appointments </li></ul></ul><ul><li>Telephone appointments documented as above or by internal email to family physician / FHT member </li></ul>
  5. 5. Who Do I Refer? <ul><li>Cardiovascular Disease </li></ul><ul><ul><li>CAD, stroke, hyperlipidemia, hypertension </li></ul></ul><ul><li>Celiac Disease </li></ul><ul><li>Diverticulosis </li></ul><ul><li>Food Allergies and Intolerances </li></ul><ul><li>Inflammatory Bowel Disease </li></ul><ul><ul><li>Crohn’s, Ulcerative Colitis </li></ul></ul><ul><li>Irritable Bowel Syndrome </li></ul><ul><li>Nephropathy </li></ul><ul><li>Weight Management </li></ul><ul><ul><li>Overweight, obese, underweight </li></ul></ul>
  6. 6. Cardiovascular Disease <ul><li>Counselling consists of: </li></ul><ul><ul><li>Dietary Fats : Saturate, Trans, Poly- and Mono- unsaturated fats </li></ul></ul><ul><ul><li>Reducing Cholesterol intake </li></ul></ul><ul><ul><li>Increasing Fiber : Insoluble, and Soluble </li></ul></ul><ul><ul><li>Reduction of Sodium </li></ul></ul><ul><ul><li>Dietary Approaches to Stop Hypertension (DASH) diet for appropriate clients to reduce BP (this will happen automatically for all appropriate clients referred to the Health Living Program for HTN) </li></ul></ul>
  7. 7. Celiac Disease <ul><li>Counselling consists of: </li></ul><ul><ul><li>Modifying diet to relieve symptoms, prevent nutrient deficiencies and to maintain good health of the intestinal tract </li></ul></ul><ul><ul><li>Adherence to a gluten-free diet </li></ul></ul>
  8. 8. Diverticulosis <ul><li>Counselling consists of: </li></ul><ul><ul><li>Dietary fiber: soluble and insoluble </li></ul></ul><ul><ul><li>Low residue or elemental diets </li></ul></ul><ul><ul><li>Importance of increased fluid intake </li></ul></ul><ul><ul><li>Fiber supplements if appropriate </li></ul></ul><ul><ul><li>Healthy eating guidelines </li></ul></ul>
  9. 9. Food Allergies & Intolerances <ul><li>Counselling consists of: </li></ul><ul><ul><li>Determining foods that provoke symptoms and hidden forms of these foods </li></ul></ul><ul><ul><li>Avoidance of foods that cause the reaction </li></ul></ul><ul><ul><li>Replacement of trigger food(s) with other foods that provide the missing nutrients </li></ul></ul>
  10. 10. Inflammatory Bowel Syndrome <ul><li>Counselling consists of: </li></ul><ul><ul><li>Adjustment of eating pattern </li></ul></ul><ul><ul><li>Determining the foods that aggravate symptoms </li></ul></ul><ul><ul><li>Increased fiber intake, psyllium fiber or fiber supplements to relieve diarrhea </li></ul></ul><ul><ul><li>Determining the need for multivitamins </li></ul></ul><ul><ul><li>Importance of physical activity </li></ul></ul><ul><ul><li>Management of stress </li></ul></ul>
  11. 11. Irritable Bowel Syndrome <ul><li>Counselling consists of: </li></ul><ul><ul><li>Review of the client’s diet to determine foods that may trigger symptoms </li></ul></ul><ul><ul><li>Increasing dietary fiber </li></ul></ul><ul><ul><li>Healthy eating guidelines </li></ul></ul><ul><ul><li>Determining the need to increase physical activity </li></ul></ul><ul><ul><li>Management of Stress </li></ul></ul>
  12. 12. Nephropathy <ul><li>Counselling consists of: </li></ul><ul><ul><li>review of biochemical data to determine the need to adjust intake of: </li></ul></ul><ul><ul><ul><li>Calcium </li></ul></ul></ul><ul><ul><ul><li>Phosphorus </li></ul></ul></ul><ul><ul><ul><li>Potassium </li></ul></ul></ul><ul><ul><ul><li>Sodium </li></ul></ul></ul><ul><ul><ul><li>Protein </li></ul></ul></ul>
  13. 13. Weight Management <ul><li>Counselling consists of: </li></ul><ul><ul><li>Health risks </li></ul></ul><ul><ul><li>Healthy weights </li></ul></ul><ul><ul><li>Healthy eating guidelines and dietary modifications </li></ul></ul><ul><ul><li>How to set realistic goals </li></ul></ul><ul><ul><li>(Above will be coordinated with counselling on physical activity, stress management and other lifestyle behaviours provided by Healthy Living RN) </li></ul></ul>
  14. 14. Email Referral To Dietitian Email Referral To Dietitian Appropriate self-referral forwarded to Team Support for appt Walk-in Physician Referral Rostered Affiliated Unattached FHT Program Referral Rostered Affiliated Enrolled in FHT programming Primary Practitioner Referral Rostered Affiliated Inpatient (to be discharged) <ul><li>Email Referrals: </li></ul><ul><li>Client Name </li></ul><ul><li>Indication for referral </li></ul><ul><li>Reason for consultation </li></ul><ul><li>Attach Patient History </li></ul><ul><li>Lab results as indicated </li></ul><ul><li>Level of Urgency </li></ul><ul><li>Who to follow-up with if different than Referring Physician </li></ul><ul><li>(ie. Resident) </li></ul>Registered Dietitian Encounter Direct Telephone <ul><li>. Dietitian documents encounter in client </li></ul><ul><li>electronic medical record using Careplan template: </li></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><li>Information / Resources Provided </li></ul></ul><ul><ul><li>Recommendations </li></ul></ul><ul><ul><li>Referral to other (if any) </li></ul></ul><ul><ul><li>Dietitian Follow-up (if any) </li></ul></ul><ul><li>2. Dietitian will send Email to Referring and / or Primary Care Practitioner with notice of client encounter. </li></ul><ul><li>1. If Documentation required: </li></ul><ul><li>Same actions as Direct Encounter. </li></ul><ul><li>2. If Documentation not required : </li></ul><ul><li>Email to Referring and / or Primary Care Practitioner with notice of telephone encounter and attach email to client electronic medical record: using Careplan template </li></ul><ul><li>Assessment </li></ul><ul><li>Information / Resources Provided </li></ul><ul><li>Referral to other (if any) </li></ul><ul><li>Dietitian Follow-up (if any) </li></ul>Follow-up as required Will coordinate Client careplan as appropriate with other health professional(s) (ie. Healthy Living RN)
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