Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
Intern Name:__________________________________ Site: ___________________________________Date Submitted: __________________
Instructions: Within two weeks of completing each clinical rotation, submit an electronic copy of this list, along with a link to your e-portfolio
(include password to access if necessary) to the instructor. Be sure to indicate below the items you have included in your portfolio for grading.
Please complete a new checklist for each clinical rotation site.
The instructor will provide feedback to you using a master form, which is similar to this one. You will have the opportunity to make any required
revisions within one week of receipt.
Documentation Descriptions:
Artifact – End product of activity.
Assignment guidelines – Will specify requirements for documentation (may include artifacts, lesson plan, attendance roster, evaluation form,
reflection or other)
Plan for Improvement – Complete the Plan for Improvement form and submit as artifact.
Summary – Description of activity and results, if indicated
Reflection – Includes your thoughts on the effectiveness of the activity; what went well/not so well; what you might do differently in the future;
how this might influence your future practice
Patient Education Evaluation – Have your preceptor complete the patient education evaluation form for the required number of patient education
sessions. (You may complete additional educational sessions, but not all will require formal evaluation)
Nutrition Care Plan – Document assessment data used to complete the nutrition care process.
Be sure to share all artifacts, assignment materials, plans for improvement, and summary/reflections with preceptor as appropriate or requested.
Most of these activities can be completed at any clinical rotation and do not necessarily have to be repeated (although it may be beneficial to
experience the differences between sites). Be sure to see additional checklist sections below for acute care, extended care, and outpatient rotations.
Culminating Projects: These projects are required to be completed at one of your clinical rotations. It is suggested that you complete them at
your longest rotation.
Date
Project/Activity
Competencies
Details
Completed
Clinical Case Study and Presentation
CRD 1.2, 1.4, 2.2,
See assignment Guidelines
If possible, present the case at your site. This is one of three options to present
2.3, 3.1(a-e)
on campus toward the end of supervised practice.
Clinical RD staff relief: Your preceptor will assign you to a specific area/type
CRD 1.2, 2.1, 2.4,
Detailed summary of duties and
of patient based on site needs and/or your personal interest area. The goal is to
2.5, 2.6, 2.7, 2.8,
activities for your assigned area
take on approximately the patient load of an entry level RD.
2.10, 2.11, 2.13, 3.1
(a-e), 3.2
Reflection on experience
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
Date
Completed
Project/Activity
Competencies
Required Reading: General (applies to all rotations)
Adult Nutrition Assessment Tutorial
N/A
Consensus Statement of the Academy of Nutrition and Dietetics/American Society for
Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and
Documentation of Adult Malnutrition (Undernutrition)
Hospital Malnutrition Related to Fasting and Underfeeding
Details / Documentation
Required
Summary/Reflection
2013 American Heart Association/American College of Cardiology Guideline on
Lifestyle Management to Reduce Cardiovascular Risk: Practice Opportunities for
Registered Dietitian Nutritionists
Malnutrition and Cachexia in Heart Failure
Diabetes Care in the Hospital
Diabetes Self-Management Education and Support in Type 2 Diabetes: A Joint Position
Statement of the American Diabetes Association, the American Association of Diabetes
Educators, and the Academy of Nutrition and Dietetics
Nutritional Assessment and Treatment of Patients with Liver Cirrhosis
The Origins of Cachexia in Acute and Chronic Inflammatory Diseases
Nutrition Support in Acute Kidney Injury
Review of the Mechanism and Nutrition Recommendations for Patients Undergoing
Continuous Renal Replacement Therapy
Review of the Refeeding Syndrome
Enteral Nutrition for Adults in the Hospital Setting
Diarrhea in Critically Ill Patients: The Role of Enteral Feeding
Parenteral Nutrition Basics for the Clinician Caring for the Adult Patient
Oral Diets and Nutrition Support for Inflammatory Bowel Disease: What is the
Evidence?
The International Scientific Association for Probiotics and Prebiotics consensus
statement on the scope and appropriate use of the term probiotic
Required Reading: Extended Care Rotations General (only complete if you are spending time in an extended care setting )
Position of the American Dietetic Association: Individualized Nutrition Approaches for
N/A
Summary/Reflection
Older Adults in Health Care Communities
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
American Dietetic Association: Standards of Practice and Standards of Professional
Performance for Registered Dietitians (Competent, Proficient and Expert) in Extended
Care Settings
Beyond Malnutrition Screening: Appropriate Methods to Guide Nutrition Care for Aged
Care Residents
Requirements for All Clinical Rotations (must be completed – not optional)
Complete diet education/counseling sessions for assigned patients. A minimum of one
CRD 1.2, 2.3,
session per week must be formally evaluated by a preceptor
2.4, 3.4, 4.5, I
Complete nutrition care plans for various patient types. A minimum of one plan per
week must be formally evaluated and signed by a preceptor
CRD 1.2, 2.6,
2.7, 3.1(a-e),
4.5
Patient education evaluation
form, signed by preceptor
Written reflection on your
overall experience counseling
patients at the end of the
rotation.
Nutrition Care Plan
Written reflection on your
overall experience using the
ADIME process with patients at
the end of the rotation.
Coding & Billing Assignment
Guideline
Complete the Coding and Billing Assignment
CRD 4.11
Note: this assignment must be completed once during your supervised practice. If not
able to complete in your acute or extended care setting, please use the alternate (case
study) assignment
Suggested Activities for Clinical Rotations (applies to acute and extended care rotations)
1. Review all policy and procedure manuals related to clinical nutrition. Revise or
CRD 1.1, 2.2
Artifact
develop one policy and procedure
2. Discuss the purpose of the diet manual used by the facility. Discuss its use, criteria
CRD 2.1
Summary
for selection, procedure for approval, and location with your preceptor
3. Discuss regular and modified diets used by facility with preceptor. Determine
CRD 3.1c
Summary
disease states for which each is used.
4. Discuss protocols in place for screening and consultation with preceptor
CRD 2.1
Summary
5. Discuss the Joint Commission and/or other federal and state regulations related to
patient care and education and how these regulations are implemented in the facility
with your preceptor. Note: you will be required to adhere to these during the clinical
rotation
CRD 2.1
Summary
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
6. Attend management meetings, clinical staff meetings, in-services, sales rep/vendor
meetings, as possible.
CRD 2.5, 2.10
Listing of dates/meeting type
7. Become familiar with floor stock and enteral feeding distribution, cleaning and
return procedures. Discuss indications, initiation protocols and monitoring guidelines
and assist with stock/ordering as possible.
8. Review oral supplement formulary with preceptor. Discuss indications for use and
assist with stock/ordering as possible.
9. Discuss indications / contraindications for enteral and parenteral support and
consequences of refeeding and overfeeding with preceptor
10. Discuss procedures for preparing foods/beverages for dysphagia, including
thickening fluids. Observe and assist with these procedures as possible.
11. Conduct a quality audit of a clinical activity. Research the issue, create a plan for
improvement based on your results, and work with clinical manager to implement.
Utilize descriptive statistics in your summary of results.
CRD 3.1c, 3.5
End of Rotation Reflection
Summary
CRD 3.1c, 3.5
Summary
CRD 2.5, 2.10
Summary/Reflection
CRD 3.5
Summary/Reflection
CRD 1.5, 4.4,
4.6
Summary of project and results
(must include stats)
12. Complete at least one nutrition focused physical examination on a patient suspected
to be malnourished. Use the ASPEN clinical characteristics and physical exam
parameters to assess the patient (see resources on Blackboard under Malnutrition)
CRD 3.1a
Plan for Improvement
Summary of patient encounter
and your assessment
Reflection on the experience
13. Conduct nutrition education/counseling sessions, individual and group, if available
and become familiar with materials used and common referrals
14. Develop an educational handout to be used for patient care; consult with preceptor
for topic needed
15. Develop and present an in-service to clinical RD staff. Work with your preceptor to
determine a topic of interest (examples include emerging research, review of patient
care topics, reducing stress in the workplace, etc).
CRD 2.4, 2.5,
2.7, 2.10
CRD 2.2, 3.2,
F
CRD 2.3
ADIME note for the patient (do
not include any identifying
patient information)
End of Rotation Reflection
Artifact
Artifact (copy of handouts,
PPT, talking points, etc.)
Presentation evaluation form
16. Discuss current public policy issues in hospital nutrition services with preceptor.
Choose an issue to review and write a letter/email to an official in congress
CRD 4.3, H
Reflection
Reflection
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
requesting their support on the issue (may use the eatright.org Advocacy site
http://www.eatrightpro.org/resources/advocacy/action-center
and https://www.govtrack.us/congress/bills/ as a resource)
Note: you should complete this assignment at a minimum of one of your rotations
17. Review the Academy’s Evidence Analysis Library Guidelines for each disease state
encountered, and incorporate them into care of assigned patients. You may include
the following:
a.
b.
c.
d.
e.
f.
g.
h.
Artifact (letter)
CRD 1.2
Summary of guidelines used for
each patient type / reflection
CRD 2.5, 2.7,
2.10
Summary - include how each
interacts with the RD and
contributes to the health care
team.
CRD 2.10,
3.1a
CRD 3.1a - e
End of Rotation Reflection
CRD 2.10
Summary (include medication
name, indications for use, and
nutrition related side effects)
Diabetes (Type 1, Type 2, and Gestational Diabetes)
Lipid Metabolism, Heart Failure, and Hypertension
Celiac Disease
Oncology
Critical Illness
COPD
HIV/AIDS
Spinal Cord Injury
18. Observe and discuss major job responsibilities with the following health care
providers, as applicable/available at site:
a. Staff Nurse
b. Case manager
c. Ostomy/Wound Care Nurse
d. Hospitalist (MD)
e. Pharmacist
f. Respiratory Therapist
g. Physical Therapist
h. Speech Therapist
i. Occupational Therapist
j. Social Worker
19. Participate in patient care rounds, bedside rounds, and grand rounds, as possible
20. Conduct a calorie count, or follow institution’s procedure for monitoring patients’
intakes.
21. Discuss common medications utilized in patient care with preceptor and/or
pharmacist. Suggestions include:
a. Medications used to control gastric acid secretion, diarrhea, and constipation
b. medications used to control blood glucose levels
Reflection
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
c. medications used to control cholesterol, triglyceride, blood pressure, and blood
clotting
d. medications used to control complications of ESRD
e. with pre and probiotic formulations and products used to maintain GI health
22. Observe various medical procedures and surgeries as available. Suggestions include: N/A
Summary/reflection for each
a. cardiac catherization
procedure observed
b. CABG
c. endoscopy (upper and/or lower)
d. PEG tube placement
e. ERCP and paracentesis
f. bedside swallow exam
g. modified barium swallow study
h. compounding of TPN solution
23. Observe a hemo or peritoneal dialysis treatment. Discuss with nurse the equipment
CRD 2.10
Summary/Reflection
and dialysate used.
24. Assist in the care of patient with mental health diagnoses as possible. Discuss ways
CRD 2.7, 2.10 Summary/Reflection
in which mental health client/patients may differ from general patients in relation to
diet and diet instruction, including others on the medical team and common referrals
required.
Suggested Additional Activities for Acute Care Rotations (complete if you are spending time in an acute care facility)
1A. Shadow each position in the diet office. Summarize duties, including collection and
CRD 2.10
Summary
processing of menus, write-ins, menu corrections/substitutions, charging for
trays/supplements/tube feedings. Assist as possible.
2A. Conduct meal rounds for 2 different patient care areas. Summarize findings and
CRD 4.2, 4.4, Summary and
develop a plan for improvement for any trends identified.
4.6
Plan for Improvement, if
needed
3A. Provide discharge instructions for a patient on modified diet
CRD 2.4
Summary/reflection
4A. Assist with a WIC certification, if possible
5A. Observe lactation consultant or post-partum nurse provide education/support to a
new breastfeeding mom.
6A. Discuss formulas for infant feeding, including specialty formulas with your
preceptor. Participate in the mixing of infant feeding formulas, if possible
CRD 1.3, 2.1
N/A
CRD 3.5
Summary
Summary/Reflection
Summary
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
7A. Complete a Subjective Global Assessment form for an oncology patient who is
receiving chemotherapy or radiation.
8A. Complete a Subjective Global Assessment form for a liver disease patient
CRD 3.1 (a-e)
9A. Observe a CDE teach self-monitoring of blood glucose, insulin injection, and/or
insulin pump training
10A. Interview and/or observe the nurse diabetes educator discuss signs and treatment of
hypo- or hyperglycemia with a client to understand his/her role in patient education.
n/a
Artifact – SGA form (found on
Bb)
Artifact– SGA form (found on
Bb)
Reflection
CRD 2.10
Summary
11A. Discuss the process of becoming a certified diabetes educator (CDE) with an RD
CDE at your facility
12A. Discuss potential eating problems related to cancer and its treatment with your
preceptor. Become familiar with common strategies to minimize impact on nutrition
status.
13A. Discuss common medication used to control nausea, stimulate appetite, or
minimize side effects of cancer treatment with preceptor or pharmacist.
CRD 2.10
Summary
CRD 3.1(a-e)
Summary/Reflection
CRD 2.10
Summary
14A. Review the neutropenic precautions used and the criteria for implementation
CRD 4.2
Summary
Other projects completed during rotation:
CRD 3.1 (a-e)
Summary/reflection/artifact as
applicable
Suggested Additional Activities for Extended Care Rotations (only complete if you are spending time in an extended care facility)
1B. Discuss state regulations related to patient care and how these regulations are
2.1, 4.4
Summary
implemented in the facility with your preceptor. Note: you will be required to adhere to
these during the rotation Audit a past dietary state deficiency and discuss the findings
with your preceptor
2B. Read protocol on weight procurement. Observe weight procurement process, analyze CRD 2.5,
Summary
and summarize findings, discuss findings with weight procurement team.
2.10, 4.4
3B. Review the Academy’s Evidence Analysis Library Guidelines for Unintended
CRD 1.2
Summary of guidelines used /
Weight Loss in Older Adults and incorporate them into care of assigned patients
reflection
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
4B. Discuss common medications/supplements used to treat nutritional anemias and
osteoporosis with preceptor or pharmacist.
5B. Discuss common medications/supplements used to increase oral intake with
preceptor or pharmacist.
CRD 2.10
Summary
CRD 2.10
Summary (include medication
name, indications for use, and
nutrition related side effects)
Summary/reflection/artifact as
applicable
Other projects completed during rotation:
Suggested Activities for Outpatient Care Rotations (only complete if you are spending time in an outpatient care area)
Observe and participate as possible in a group class or support group.
CRD 2.3, 2.4
Summary/Reflection
Observe and assist with conducting individual counseling and education sessions, as
available
Assist with health fairs, information tables, wellness presentations, and other events as
available
Develop an educational handout or other material to be utilized in patient/client care
Discuss coding/billing of dietetic/nutrition services to obtain third party reimbursement
with the clinical nutrition manager or RD for Diabetes Management.
Other projects completed during rotation:
CRD 2.4, 2.5,
2.7, 2.10
CRD 2.2, 2.3,
3.2, F
CRD 2.2, 3.2,
F
CRD 4.11
End of rotation reflection
Include ADIME note for one
patient/client (with identifying
information removed)
Summary/reflection
Artifact
Summary
Summary/reflection/artifact as
applicable
Weekly Preceptor Evaluations (Completed by preceptor(s) and submitted via Typhon)
may have up to 10 total depending upon # weeks spent in rotation
End of Rotation Evaluation (Completed by preceptor(s) and submitted via Typhon)
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Fontbonne University ISPP
Clinical Nutrition Rotation
Checklist with Documentation
Weekly Self Evaluations (Completed by you and submitted via Typhon)
may have up to 10 total depending upon # weeks spent in rotation
End of Rotation Self Evaluation (Completed by you and submitted via Typhon)
Supervised Practice Site Data Form (Completed by you and submitted via this link)
Intern Evaluation of Preceptor and Rotation (Completed by you and submitted via this
link)
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