VANESSA B. RAMIREZ

Home Care Supervisory Dietitian

· Uses knowledge, expertise, principles or/and current research to lead nutrition specialty care team to plan, implement, and evaluate organizational initiatives. Uses data trends and patterns to indicate need for change. Manages resources (time, materials, staff) in a cost-effective manner. Maintains productivity standards as outlined by VHA guidelines and facility leadership.

· Provides comprehensive medical nutritional care applying the nutrition care process (NCP) in a specialty program, and/or a variety of patient care settings. Bases interventions on the best available research and/or evidence-based guidelines and best practices.

· Develops procedures and guidelines for clinical operations and monitors compliance with regulatory standards and policies and procedures.

· Plans and develops nutrition-related policies, procedures, and goals that support best practices in a focused area. Develops and revises forms, protocols, age-specific and disease specific Veteran education materials.

· Provide consultant services in specialty area of expertise to the health care team regarding advanced therapies, policies, procedures and latest research in the provision of quality nutritional care.

· Evaluates the impact of nutrition interventions and documents outcomes in comparison with established nutrition care goals; analyzes cost benefit of best practices and outcomes to determine continuation or changes in nutritional therapy.

· Provides nutrition education to individuals, small and large groups, peers, licensed practitioner(s), medical students, interns, and residents on specific nutrition diagnosis(es) as applicable to VHA regulations.

· Represents the Clinical Nutrition Section on projects, committees and/or workgroups within the department and facility.

· Analyses data (i.e., event capture, clinic utilization) to recommend allocation of clinical nutrition resources.

· Ensures evidence-based guidelines are integrated into clinical practice.

Dietetic Internship Clinical Coordinator

· Knowledge on principles of program management and oversight required to develop program goals and objectives, administer and monitor program, evaluate program outcomes/accomplishments, set and redefine priorities and implement effective solutions in processes/systems as needed.

· Knowledge on human resources administration, including such functions as the ability to interview and select qualified applicants, and monitor and evaluate performance.

· Knowledge on designing dietetic internship curriculum to meet accreditation requirements established by the accrediting agency (ACEND) .

· Has in-depth knowledge and maintains knowledge of current practice in food service systems management, nutrition therapy, community nutrition practice, and business/entrepreneurial dietetics within the ability to integrate learning experiences in didactic and practice components of the internship.

· Coordinates with affiliated program directors/coordinates on partnered affiliated dietetic internship and dietetic technician programs within the community for intern placement and schedule. Also, coordinates the rotations, schedules, seminars, workshops or prepares other assignments as needed to ensure the program meets accreditation requirements, facility or service level requirements.

· Review and evaluates all application packets for presentation to established selection committee for each cohort group. Supports affiliated program interview panels with dietetic internship programs.

· Supports facility and service-level initiatives by participating in the development of nutritional care indicators, evaluation criteria, collecting continuous quality improvement data, monitoring outcomes and initiating corrective actions. Participates in the lean methodology approaches to improve processes within the service.

· Stays abreast with current food and dietetic related areas. Analyzes, interprets and collaborates efforts to research initiatives.

Home Care, Long Term Care, In-Patient Care and Out-Patient Care

· Conducts a comprehensive nutrition assessment utilizing the Nutrition Care Process (NCP) for assigned patients.

· Develops and implements an individualized plan for Medical Nutrition Therapy (MNT) in accordance with the patient's medical program goals and objectives.

· Performs a Nutrition Focused Physical Exam (NFPE) during assessments to determine risk and/or degree of malnutrition.

· Calculates nutrient requirements (calories, protein, carbohydrates, lipids, vitamins, electrolytes and fluids) and necessary diet restrictions or food and drug interactions.

· Evaluates patterns and relationships among data obtained and possible root causes for nutrition problems.

· Tailors diet prescription to each individual patient according to physical and metabolic needs. With an understanding of the patient's health condition, designs the nutritional treatment plan with consideration for psychosocial, behavioral, physical activity, ethnic and cultural factors to obtain desirable outcomes and promote long term adherence to a medical nutrition care plan.

· Prioritizes the importance of nutrition problems for optimal health, recovery from illness, management of chronic disease or disease prevention.

· Utilizes evidenced-based Nutrition Practice Guidelines and Whole Health Principles to develop shared goals with the patient and formulates a plan of care that is focused on the etiology of the nutrition problem.

· Actively supports veteran centric food service operations, with a food forward approach through knowledge of computer software programs related to food service systems; and through interfacing with the food service section to ensure patient satisfaction with meals, assisting in implementation of new initiatives, and acting as a liaison between clinical units/wards and the food service section.

· Works cooperatively with foodservice staff to assure conformance to diet prescriptions.

· Identifies patients in need of nutritional support and recommends the appropriate mode of support, including suitable route, formula, and rate of administration. Provides initial and on-going nutritional assessment of patients receiving enteral and/or parenteral nutrition.

· Order labs, diets, and consults. Evaluates and monitors the effectiveness and outcome of MNT interventions. Evaluates the patient's response to care based on identified, measurable outcomes and reviews the plan, as appropriate.

· Document's nutrition care plan in the patient's medical record, including nutrition assessment data, MNT initiated and recommendations, results of nutrition counseling, patient consents and discharge planning. Measures outcomes through selecting indicators relevant to the nutrition diagnosis. Evaluates the effectiveness and measures progress toward outcomes of nutrition interventions by comparing current findings with previous goals and/or reference standards. Documentation supports an interdisciplinary approach and continuity of care.

In-patient (Acute Care, Mental Health and Long Term Care) and Out-patient Clinical Dietitian

· Develops, implements and documents patient nutrition care plans, nutrition monitoring, and provides specific nutrition counseling to patients and their families

· Develops educational handouts and materials for patients.

· Counsels patients for various nutritional needs to include weight loss, diabetes, hyperlipidemia, gastrointestinal disorders, HIV, among other conditions.

· Participates in local community health fairs, clinics and seminars.