The Itty Bitty Things

“What’s re-feeding syndrome?”

This is a question the average person might ask, but it's definitely not something you want to hear your doctor say.

On the first day of my rotation at SVRMC (an ER hospital), a very bright eyed, yet confused me overheard this aforementioned line from a doctor. Another Dietetic intern had been reviewing a patient and noticed that 3 of their mineral labs were looking off. The patient had not been eating for quite a while and had just started on tube feeding, which as many of us know, can be a bit risky. Oftentimes, when food is introduced too fast, a patient can get re-feeding syndrome. To put simply, this is when a person’s body has difficulty readjusting to food after a long period of time which can lead to some MAJOR, and possibly fatal consequences.

This is a time when the RD in a ER clinical setting can really intervene appropriately. The RD called the doctor to explain refeeding syndrome, suggested changing the diet, and talked to the nurses. Eventually after communication with the hospital staff, we were able to keep the patient from being discharged and intervened appropriately.

Now, why am I telling you this story?

Oftentimes in the clinical setting, doctors have so many patients to see that nutritionally focused conditions often slip their mind; this is where our role as RDs is so important for patient care.

This story definitely taught me something crucial about the role of the RD; it's part of the RD's job to look at the itty bitty details and pay attention to the small things! If the dietetic intern and RD did not catch those 3 small labs and inform the doctor, there could have been major consequences for the patient. The patient would have been discharged and probably ended up right back in the hospital.

In the ER environment so many things are happening, even when it comes to 1 patient. They might have broken bones, 3-4 comorbidities, abnormal blood pressures, and/or many tubes in place all at once. Sometimes the small details like noticing 3 unusual labs or how many grams of protein someone is eating does not seem to be the priority but…

This is also part of the RD job and RDs are so essential to the ER.

In my first month of clinical rotations, I was often told to do tasks that, I admittedly, did not think were very important at first. I wanted to be doing the, (what seemed to be at the time the most important things) like seeing patients, recommending diets, tube feedings, etc. In my first weeks, I tried all the oral nutrient supplements, tested pudding, apple sauce, and jello with different protein supplements mixed in, and conducted food tray audits. However, these seemingly unimportant small tasks really came in handy! It’s one thing to recommend that a patient should drink a supplement like Ensure or Nepro, but it’s a whole other thing to be able to sit down with them having experienced them yourself.

My homework: try all of these nurient supplements

& more not included in the picture Trying Ensure Chocolate! It’s pretty tasty!

When talking to patients, I was taught to review things that may have gone unnoticed or uncharted. We talk about their meal patterns, their food preferences, and sometimes end up chatting about their personal lives, current situation, and/or their families. In my experience, although talking to a patient for a few minutes may not seem like a lot, many of them seem to enjoy talking about something more than why they are in the hospital. Sometimes, even a simple task like just listening and engaging with a patient may make a big difference and brighten up their day. Even after working for over a month now, I am still sincerely touched when patients thank me for talking to them.

All suited up and ready to talk to my patients!

And really, the solutions are sometimes found when looking at the details. Many times, when talking to a patient who hasn’t been eating their food, it’s because of something small; they just might not like the food or maybe they prefer a smoothie for breakfast. Finding out these details can then lead to a significant change, and hopefully, a healthier and happier patient.

Of course, RDs also work alongside the nurses, doctors, therapists, etc. to save and improve lives and it's not always so simple. However, sometimes they do small and itty-bitty things. They look and examine things that others may have overlooked or not had the time to investigate and get into the finest of details.

And sometimes, these small tasks and details add up and make a profound difference.