day two… the diet office and computrition madness

day two of orientation went smoothly.

natalie and i headed into the diet office at 8 a.m. and emerged at about 3 p.m. it was a long day, but getting home at 4 p.m. for a glass of wine isn’t too shabby.

today we learned a ton about how the diet office operates. in short, the diet office receives and processes menu requests from patients and diet orders from their attending staff: RNs, RDs, MDs, etc. The office then passes on the information to the PNRs (patient nutrition representatives) who build and deliver trays of food to the patients at each meal.

with 700+ beds at the hospital, how does one diet office process so many requests? computrition. (FYI: computer + nutrition = computrition) computrition is a computer software that tracks patient-specific diet orders (e.g. heart-healthy diet, renal diet, regular diet), food preferences, food dislikes, allergies, demographic data, and more. so… if a woman allergic to mushrooms orders a lasagne that happens to have some hidden shitakes, the computrition system will automatically change the woman’s dinner tray to accommodate her allergy. pretty cool.

computrition also manages recipes and menu items so that even if a patient on a heart-healthy diet orders a saturated-fat laden meal, he/she won’t receive it. the system will automatically make adjustments to the meal. suckers.

so…. all this is to say that natalie and i got a good peek inside how patients order and receive food and how diet orders materialize into actual meals.

working in the diet office also gave me an idea for my special project. each UNC dietetic intern is responsible for completing a project during her internship that would ultimately benefit the hospital. the point of the project is to see a hole in the organization and do something (or suggest a policy, create a handbook, etc.) to fix it.

so… normally, patients choose their own foods at every meal by circling the items they would like on a paper menu. the diet office then enters that info into computrition, a tray ticket is printed, the tray is assembled and delivered to the patient.

however, today, when i was plugging into the system a patients’ menu request, i came across one carb-control diet patient who had circled nearly every item on the menu. carb city. carb-control diets are designed for patients with diabetes or other types of endocrine dysfunction who are limited in the number of carb items they can choose. thus, the diet office was forced to make a decision.

i was instructed to simply “take off a few items” from the menu with no real direction as to which items would be best to remove. let’s say the patient selected a hamburger, fries, salad, fruit, lasagna, jello, roast beef sandwich and cherry cobbler. it is difficult for a diet office employee with zero nutrition education to decide what items would be best to remove. seeing as though it’s the hospital’s prerogative to keep the patient healthy and also (from a business standpoint) happy, this is a tricky situation.

a special project could easily focus on educating the diet office on smart ways to make substitutions (or teaching the employees how to use computrition to count carbs for them!) when faced with a patient who is on a very specific diet with a very spacious appetite.

anyway… we’ll see how that goes.

tomorrow i am reporting at 7 a.m. to one of the pediatric dietitians. so excited.

more to come!