Day in the life of a dietitian

Hi everyone! I thought I’d do another post about what I get up to every day as a band 5 dietitian in a busy NHS hospital. No day is the same so I’ve mixed together a few different days to give you an idea of what I might see.

What do we look for?

I thought I’d start by explaining what I’m looking for when seeing patients. In dietetics we follow an ABCDE structure and use this to shape our assessment. A lot of people don’t realise there’s more to us than just talking about food!

A – anthropometry. This means someone’s weight, weight change, height, and BMI. This is a key part of our assessment, and it can give a (very) rough idea of someone’s health. For example, if someone has been unintentionally losing weight, it could be a symptom of a disease such as cancer or coeliac disease.

B – biochemistry. This means looking at someone’s blood results and it gives us an idea of what’s going on inside their body. Looking at someone’s blood can tell us how hydrated they are, if they have an infection, and how well their body can metabolise protein for example.

We can then link this to their eating and drinking, e.g., if someone has an infection then they may be on antibiotics and a common side effect of antibiotics can be feeling sick. If someone is feeling nauseous, then they might not be eating very well.

C – clinical. This is everything that’s happening with the patient medically and their general condition. We then look at any existing medical conditions they may have. It also includes looking at any medications they're on, as some are linked to their eating and drinking e.g., a diabetes medication.

We also look at their skin condition and check the notes for any pressure sores, as these would increase someone’s energy and protein needs. Finally, we look at someone’s bowels. Yes, dietitians love to talk about poo! If you’re constipated or having diarrhoea, we can suggest dietary changes to help manage it.

D – dietary. Now we look at someone’s dietary intake, estimate the number of calories they’re consuming and compare it to their estimated energy requirements that we’ve calculated. We also consider people’s eating patterns, dietary preferences, and any allergies/intolerances.

E – environmental, and psychosocial. This considers someone’s social situation, job, family life, and any other things that could be impacting their eating and drinking.

Once we’ve looked at all of this, we can then conclude our assessment and make a plan for the patient. A plan could look like: getting a patient extra snacks between meals, prescribing nutritional supplement drinks, or creating a nasogastric tube feeding regimen.

So, with all this in mind, here’s a typical day…

Day in the life:

I look after 3 wards and do a weekly clinic in my current role.

8.30: I start work at 8.30 and head to the office. I first look at our referral tray and pick out any new patient referrals from my wards. I have a spreadsheet for all of my wards with all the patients that are under dietetic care.

On these spreadsheets is the date the patient was seen, when they're due to be reviewed, and a quick summary of the plan. I then cross check my ward spreadsheets with our online system to make sure that all the patients on my spreadsheet are still admitted to hospital. If they’ve been discharged, I put them in another pile to sort later. I then look at which patients are due for a review assessment today and make a note of them.

9.00: we have a daily huddle, which is where we all share what our day looks like and prioritise our caseload if we haven’t got capacity to see all the new patients. I have 2 new patients to see and 2 patients to review so have capacity to help out a colleague that had 7 new patient referrals but wouldn’t be able to see them all.

9.15: I look at all the patient’s biochemistry on the computer system and note them down. My hospital uses a paper documentation system so the bloods are the only thing we can access from the office.

10.00: I head to wards and am off to see patients! 

For every patient I look through the medical notes to gather the information I need to inform my assessment, using the ABCDE approach. After I’ve got all the information, I then go and speak to the patient and form a plan with them. After each patient, I write an entry in their medical notes and follow the ABCDE structure when writing. I also write down the aim of my dietetic treatment and the plan made.

The first patient has alcoholic liver disease. Patients with this condition have higher calorie and protein requirements so I give some dietary education. This includes the importance of them snacking throughout the day, eating all of their meals, and having a carbohydrate based snack before bed. As this patient’s eating wasn’t enough to meet their nutritional needs, I also prescribe a supplement drink to give them extra calories and protein.

11.00: The next patient has dementia, and their eating depends on their mood. Because of their poor eating, they’ve lost some weight too. I speak to the patient’s partner, and they agree to bring in foods that they know the patient likes to encourage them to eat. I order the patient extra snacks to have between meals. 

Their partner also says the patient has been a bit constipated lately, so I feed this back to the doctors so they can review the patient’s laxatives.

12.00: the patient I’m seeing now has some bad pressure sores on their bum. The patient is eating well but because their skin needs extra nutrition to heal, I prescribe some nutritional supplements drinks for them to have while in hospital.

1.00: I head back to the office for some lunch! Today is rigatoni and Bolognese.

1.30: I’m still in the office for some admin. I update my ward spreadsheets with the patients I saw this morning. I also order extra snacks for the patient with dementia, we order snacks via email, so I complete this and then it’s back to the wards.

2.00: I go to see another patient that the referral says they need help with irritable bowel syndrome (IBS). When I get to the ward and read the notes, the patient doesn’t have IBS, they have inflammatory bowel disease (IBD) which is a completely different condition! I call the gastro dietitian for some help but as the patient is eating well and not in an active flare up of their IBD, they don’t need further dietetic support.

Sometimes the information we get on a referral is quite unhelpful, or just plain wrong! So, it’s always important to have a read of the medical notes to fully understand what’s going on with a patient.

2.30: I see a patient that came into hospital with a broken hip. In my hospital, there’s a treatment pathway for patients with a broken hip and they automatically will be prescribed nutritional supplement drinks to help their recovery after surgery. 

This patient doesn’t like the supplements they’re prescribed (the default is a milkshake style drink) so I give them a custard style supplement to try instead, which they prefer. I switch their prescription on the drug chart and encourage them to keep eating.

3.30: I review a patient that has reduced appetite and was losing weight as they were not meeting their nutritional needs. When I initially saw the patient I ordered them extra snacks, and prescribed supplements. When I review them today their weight has remained stable from before which is a great news. I keep the plan the same and will renew their snack order.

4.00: it’s back in the office to do more admin. I update the spreadsheets, and order snacks. I also sort through the patients that have been discharged from the hospital, that I identified when checking my wards in the morning. If they need follow up, I can refer them to my outpatient clinic, but if they don’t then they’ll be discharged from dietetics and there’s nothing more to do.

4.30: the day’s over and I head home!

As you can see, it’s a very varied day. This was a day that I didn’t have my weekly outpatient clinic, any meetings, or training, so it was purely patient based. I also didn’t see any patients with alternate routes of feeding, e.g., a nasogastric feeding tube. No 2 days are the same in the NHS.

I hope this gives you an insight into what dietitians do!

You can leave any comments below.

Bye for now 👋