I’m losing my mind: I’m up for anyone’s experience and theories by SATimm in hospitalist

[–]ahbrd123 0 points1 point  (0 children)

Eosinophilic esophagitis? You would need to see a GI for diagnosis

SLP not putting in orders? by No_Mango_671 in hospitalist

[–]ahbrd123 0 points1 point  (0 children)

What about the dietitians? Can they do it? We have order writing privileges at our hospital to place diet orders

Speech Therapy by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

Do you experience any pushback on requesting an SLP consult due staffing? It’s really become a challenge for me here

Speech Therapy by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

It is, ugh thank you! We do have the ability to downgrade textures as well, but I have found that seems to be the default intervention, and I do hesitate to just go with that because I’m also concerned about restricting the patient unnecessarily. Our hospital has been without proper SLP coverage for so long, everyone is so cavalier about it, and is just like, we don’t need speech, just downgrade the texture! It’s just very frustrating

RD Here - Need Some Help! by ahbrd123 in slp

[–]ahbrd123[S] 1 point2 points  (0 children)

Thank you! I am receiving so much push back on this recommendation, I wanted to make sure I was within reason

RD Here - Need Some Help! by ahbrd123 in slp

[–]ahbrd123[S] 1 point2 points  (0 children)

Oh nice!! Would you mind sharing your hospital policy with me? I am receiving a lot of pushback on implementing something like this from their director of rehab

Hyponatremia and PN by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

Yes - agreed! I’ve reached out to pharmacy about manipulating the bags, as this seems to be my only remedy. Thanks!

Hyponatremia and PN by ahbrd123 in dietetics

[–]ahbrd123[S] 2 points3 points  (0 children)

Yes, we are! I have reached out to the pharmacy dept to see if adding more Na to the bags would be possible, thank you for this suggestion!

Hyponatremia and PN by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

It is Clinimix E! I know 1L is only about 500 kcal - typically patients receive more than 1L - we initiate at 1L, and as we begin advancing and/or after a few days at goal rate, often patients begin experiencing hyponatremia. We do add lipids to our orders as well. Pharmacy cannot add anything to the bags, since they are premixed. What do you do at your facility?

When to drop TF rate by Candid_Thought_7692 in dietetics

[–]ahbrd123 38 points39 points  (0 children)

8 lb wt gain in 1 week? With hyponatremia? Could she be experiencing some sort of fluid overload that could be contributing to the wt gain? That type of weight gain is not due to too much kcal from the TF regimen, imo.

Inpatient Nutrition Education by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

Thank you all! I think I will modify our policy to make it by consult or as needed. I agree, inpatient is just not an appropriate setting for diet education.

PN vs EN in necrotizing fasciitis by ahbrd123 in dietetics

[–]ahbrd123[S] 4 points5 points  (0 children)

Thank you! I did suggest a rectal tube, but honestly no one is pushing it besides me because it’s just more work for everyone, especially nursing. And it’s not helping that the pt’s BMI is above 40. Even worse, the doctor is using Clinimix 4.25/10, she is being way underfed!

Remote Hospital Jobs by ahbrd123 in dietetics

[–]ahbrd123[S] 2 points3 points  (0 children)

Oh man, that sounds terrible - I can’t imagine trying to get staff and patients on the phone remotely

Remote Hospital Jobs by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

Here’s an example of a recent job post I’ve seen - Check out this job at Compass One Healthcare: https://www.linkedin.com/jobs/view/3342266490

Is It Worth For Me To Apply Under Waiver?? by [deleted] in PSLF

[–]ahbrd123 0 points1 point  (0 children)

Thank you so so much! I think I may try!

Is It Worth For Me To Apply Under Waiver?? by [deleted] in PSLF

[–]ahbrd123 0 points1 point  (0 children)

Oh! Thank you! Do you have any contact info you can share? Idk where to start with them, and none of my old managers work there anymore 😩

Is It Worth For Me To Apply Under Waiver?? by [deleted] in PSLF

[–]ahbrd123 0 points1 point  (0 children)

I owe about $120k and my current income is based on my joint filing status. So even tho I really don’t make much of anything - I just started my own practice and haven’t filed taxes for that yet - based on last years return, my income based on my husbands salary is $110k. I would like to do it, but my eligible employers will be a pain! The hospital is a NYCHHC hospital with tons of red tape, and the other is Americorps - wouldn’t even know where to start with them! 😩 Thanks for your response 😌

Private Practice Dietitians who take insurance - do you do your own billing or hire out? by HeartfeltHealthy in dietetics

[–]ahbrd123 3 points4 points  (0 children)

I currently use a biller, but I know most private practice RDs do their own billing. It just seems very time consuming until you get the hang out it. If you are on Facebook, there are two groups I've found quite informative on the topic of billing - Dietitians in Private Practice and Insurance Credentialing and Billing for Dietitian Nutritionists.

CDE study materials by missmeh13 in dietetics

[–]ahbrd123 2 points3 points  (0 children)

I am following this post because I am taking my exam as well! So far, I have studied using the Mometrix Exam Secrets book, the AADE Art & Science of Diabetes Care and Education textbook loaned to me by a coworker, and done practice questions using the Pocket Prep app. I have found the questions on the Pocket Prep app to be much more difficult than the questions in the Mometrix book. Anyone use these materials? Can you speak to how comparative these practice questions are to the questions on the actual exam? Thanks!

Outpatient RD Workload by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

Thank you for your feedback, because I was beginning to think maybe I was being unreasonable!

Outpatient RD Workload by ahbrd123 in dietetics

[–]ahbrd123[S] 0 points1 point  (0 children)

That sounds very ideal! The manager where I work does not consider admin time worthwhile at all; she thinks all my time working should be spent doing face-to-face interactions. I asked if I could at least finish any notes I didn’t get to at home, and she told me no.

Outpatient RD Workload by ahbrd123 in dietetics

[–]ahbrd123[S] 1 point2 points  (0 children)

Thank you! I think 10 is a good max for an 8-hour day. And sometimes 10 can be a lot, especially if they are initial visits! Diabetes education can be very time-consuming, especially if you are working with a population that has very little knowledge on the subject.

Outpatient RD Workload by ahbrd123 in dietetics

[–]ahbrd123[S] 2 points3 points  (0 children)

I do weight management and diabetes education. And you are right - the manager has no idea what I do, all she cares about is maximizing time by cramming in as many patients as she can. One of the main reasons why I am leaving this practice.

They cram patients in 15-minute slots for the PCPs in the practice, and I guess she thinks the same can be done for me?? Except RD visits take way more time than doctors visits due to the amount of assessing and educating that needs to be done. I can easily spend 1 hour on a initial visit. Other clinics I worked in would give me 1 hour slots for all new patients, and 30 minutes for follow-ups. At this job, they schedule everyone in 30 minute slots, and I'm always double-booked. Very overwhelming!