DIETITIAN SPECIALIST- GROUP LEADER
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POST DATE 8/20/2016
END DATE 10/29/2016
Brigham & Women's Hospital(BWH)
JOB DESCRIPTIONGENERAL SUMMARY/OVERVIEW STATEMENT:
Responsible for coordination of clinical nutrition services, including enteral and parenteral nutrition on assigned areas. This position requires extensive knowledge and experience in nutrition and metabolism and will be an integral member of the Nutrition Support Service. The dietitian must possess strong leadership and interpersonal skills to appropriately assign daily patients to team members to effectively and efficiently provide nutritional requirements to a variety of highly complex patients. This position requires the technical background and teaching skills appropriate for the education of physicians, nurses, pharmacists, other dietitians, dietetic interns concerning principles of nutritional therapy.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
* Coordinates the nutrition care for the enteral and parenteral patients on team . Oversees clinical care of a variety of patients on a daily basis ensuring effective and efficient nutrition care for all parenterally and enterally fed patients. This includes:
* Determines optimum enteral and parenteral feeding route, techniques, substrate and nutrient formulations considering the limitations inherent indifferent medical and surgical conditions.
* Reports on TF/PN patients per guidelines for presentations to Nutrition Support Service physician
* Accurately enters initial and renewal parenteral nutrition orders
* Employs various methods available of nutrition assessment
* Documents on TF/PN patients per Standards of Practice.
* Serves as the nutritional expert on TF/PN with house staff, nursing, pharmacy and other health care providers.
* Presents cases and issues at weekly Nutrition Support Service Rounds
* Develops educational materials in collaboration with the Nutrition Support Service and Department of Nutrition regarding parenteral and enteral nutrition/techniques and new advances.
* Screens patients for nutritional risk, assesses need and develops care plans. This includes: collection and interpretation of anthropometric, laboratory, clinical and nutrient intake data to determine nutritional risk, nutritional status, requirements and feeding limitations.
* Ensures that established monitoring procedures/protocols are followed for prevention and management of complications. Monitors patient progress and tolerance to nutritional regimes. This includes calculation of caloric and nutrient intakes, and recording of all pertinent biochemical and medical data. Maintains organized and accurate records.
* Participates in discharge planning, teaching and referral. Prepares nutrition discharge summaries and discharge instructions for parenteral and enteral feedings
* Participates in selected quality management programs, as appropriate.
* Counsels individuals and groups in parenteral and enteral nutritional needs
* Contributes to performance reviews of team members as requested by Director of Nutrition
* Collaborates with food service personnel and participates in problem solving food service issues, as warranted
* Orients new staff to the department
* Performs other duties as requested by management staff.
* Participates with the Director of Nutrition to establish indications, administration and preparation guidelines for the safe and cost effective use of nutritional products.
* Maintains current information on new products and nutrition related product changes and provides meaningful interpretation to physicians, nurses and other health care providers. Assesses nutritional composition and clinical efficacy of products.
* Represents the Department of Nutrition and Nutrition Support Service on committees related to the nutritional management of the forced fed patient.
* Serves as a resource in the development of policies and procedures related to nutrition care of the forced fed patient for JCAHO, Department of Health and other regulatory agencies.
* Develops quality improvement projects within assigned area.
* Maintains food safety and sanitation standards within established guidelines
* Educates and serves as mentor to clinical dietitians to current nutrition guidelines and recommendations for parenterally and enterally fed patients.
* Plans, coordinates, evaluates, and teaches dietetic interns current nutrition guidelines and recommendations for parenterally and enterally fed patients during their ICU rotation
* Educates health care professionals to the goals and current nutrition guidelines for parenterally and enterally fed patients.
* Registered, Licensed Dietitian and successful completion of CNSC (Certified Nutrition Support Clinician) exam every 5 years
* Master's Degree strongly preferred. Bachelor's degree with extensive experience in the management of patients requiring forced feeding may also be acceptable.
* Three to five years or greater experience in the management of patients requiring parenteral and enteral therapy. Must have experience and familiarity with a wide variety of medical and surgical conditions and patients (e.g. cardiac, thoracic,oncology, transplant, GI, high risk obstetrical and other critical care patients).
* Knowledge of the physiological and biochemical basis of the nutrient requirements of acute care patients.
* Knowledge of the complex medical and surgical problems commonly managed in the intensive care units.
* Ability to calculate appropriate calories, protein, and carbohydrate requirements and recommend appropriate TPN formulation for a wide variety of patients. Knowledgeable about appropriate TPN additives such as insulin, H-2 blockers, and glutamine. Familiarity with the metabolic complications associated with TPN administration as well as the appropriate adjustments in TPN formulation to prevent and/or treat these complications.
* Familiarity with a variety of enteral feeding formulas and their appropriate usage in various clinical settings. Knowledge regarding transitioning of patients from TPN to enteral feeding and the appropriate advancement of tube feeds.
* Ability to assist team members with formulating a daily treatment plan and a written recommendation for metabolic support of a variety of patients.
* Familiarity with a variety of central venous catheters (e.g. Hickman, porta-cath, and PICC lines) and enteral feeding tubes (e.g. gastrostomy, jejunostomy, nasogastric and nasojejunal tubes). Should be familiar with indications for usage and relative advantages and disadvantages of use of these devices.
* Knowledge of alternative feeding techniques and the nutrient composition for modified formulas, i.e. ability to assess nutritional requirements and make recommendations based on and within the context of the overall clinical status of a patient. Knows indications for administration of TPN vs Enteral Feeding vs PO supplements.
* Management skills to organize effectively nutrition services within a team in an area of highly specialized and complex care. Ability to interact with multiple departments including Nursing, Pharmacy, Nutrition Support Service, Medicine and Surgery.
* Uses independent judgment, ingenuity, and initiative under pressure in a variety of situations.
* Ability to work in a changing environment.
* Communication and Teaching.
* Ability to communicate effectively with the nutrition care group, physicians, nurses and other professional both verbally and in writing. Ability to present information and conduct classes to professionals.
* Excellent interpersonal skills to work within the framework of a multi- disciplinary care team recognizing that the services of many disciplines are essential for comprehensive care.
* Ability to provide nutrition counseling that effectively deals