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Nutrition Counselling Presentation


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