Ana Pelcastre Nutrition 409Joan Rupp March 18, 2015Sharp Memorial Hospital San Diego Dietitians in Critical Care

Over time and as Nutrition knowledge advances, the role of Registered Dietitians has become more important. For example, today RDs hold an important position within the intensive care unit of hospitals. Their role is imperative because they possess unique skills that help on the improvement of critically ill patients. For instance, RDs assess the nutritional needs of patients, they are also considered experts in nutrition support, nutritional access, fluid and electrolyte issues, specialty in enteral products and optimal blood glucose control (1). Some other activities that they do is continuous learning and they are familiar with the latest research on critical care nutrition. They do this as part of their scope of goals where the ultimate goal is improve the quality of care in the intensive care unit (1). Other additional tasks RDs perform are, nutrition therapy, they educate patients, families and colleagues and they do critical care evaluations of their patients (2). Sharp is considered one of the health care leaders in San Diego. It has four acute care hospitals, three specialty hospitals, two medical groups, urgent care centers and other outpatient facilities (3). Sharp Memorial is considered an acute care hospital and it offers a wide variety of services. For example, heart care, cancer treatment, orthopedics, physical rehabilitation, bariatric surgery, robotic surgery and organ transplantation (3). The nutrition care unit on average has 48 beds with another 10 unit bed as a back-up plan.

On March 16, 2015 we visited the Sharp Memorial Hospital where we met Registered Dietitian Michelle Ulrich as well as our instructor Brenda ODay. The visit consisted on a presentation given by Michelle Ulrich followed by a question/answer discussion with Brenda. During the presentation, Michelle talked about Nutrition in Critical Care. She mentioned that the unit is divided in two parts, the Surgical Intensive Care Unit which comprises trauma, cardiac and general surgery patients and the Medical Intensive Care Unit treating respiratory and other medical condition patients. She emphasized that in order to work in this area, RDs are strongly recommended being certified in Nutrition Support (CNSC). Some of her main responsibilities include, routing with other medical teams and nutrition support management. She also mentioned some of the equipment typically used in the ICU room include ventilators, monitors and IV stands. Later, she stated that her job requires a lot of teamwork skills, critical thinking and the RD has to be comfortable with the fast pace environment of the hospital. Some of the things she thinks RDs struggle with are limited practice in terms of nutrition orders and also evidence gaps because there is still not enough research in some areas of nutrition. But she said she loved her job because she is constantly learning. The second part of her presentation consisted on Nutrition care and metabolic stress of patients. In general, she talked about the metabolic response of patients and what their needs are in terms of fluids and minerals. She explained the importance on avoiding sepsis, when to start nutrition support, what factors they considered before they provide nutrition support and what the goals are for feeding their patients (Calories and protein recommendations). In addition to the presentation, Brenda mentioned that there are 8 full time RDs in her unit and about 12 part-time RDs. She also thinks that across the system there are about 60 full time RDs. On a regular basis, RDs at Sharp Memorial see about 10 to 15 patients per day which according to her (Brenda) that number has increased because back in the day RDs would only see up to 8 patients. She believes those changes are because RDs have attained more expertise and are more competent in the medical field than before. In summary, I believe this area of dietetics is very intense and demanding because of the nature of the job. However, I think it is very interesting because RDs get to work along with other medical experts and thus they get to expand their knowledge within the medical field. Personally speaking, I dont see myself working in this area of dietetics because I feel my personality doesnt fit the type of environment. I lean more towards outpatient clinics and community settings, where I get to work with healthier patients and I can follow up with their recovery. Over all, my take home massage after this visit is to always learn and keep myself up to date on my field of interest and to apply what Brenda said Is okay if I dont know because tomorrow I will know.

Work Cited1. Tylor B, Renfro A, Mehringer L. The Role of The Dietitian in the Intensive Care Unit. J Clin Nutr Metab Care. 2005; 3(8): 211-216.

2. Denny S. Find an RDN Anywhere You Need One. AND Website. http://www.eatright.org/resource/food/resources/learn-more-about-rdns/find-an-rdn-anywhere-you-need-one. Published January 7, 2015. Accessed March 18, 2015.

3. Sharp. Health Services and Programs at Sharp Memorial Hospital. Sharp Website. http://www.sharp.com/memorial/programs-services.cfm. Publish 2015. Access March 18, 2015.