Inpatient Nutrition Services

The Brigham and Women's Hospital Inpatient Clinical Nutrition Service provides nutritional care and
education to all patients and families admitted to the Brigham.

Team Approach

At BWH, the registered dietitians (RD) work in teams. The patient care load is divided into 4 teams. 
The teams are lead by Team Leader Dietitians, who are Certified Nutrition Support Dietitians (CNSD).
The CNSD is especially trained in the assessment and care of the forced fed, metabolically
compromised patient. Our nutrition care is integrated with the Metabolic Support
Service (MSS) to ensure expert nutritional interventions for the most complex nutritional deficiencies. The
Team Leader Dietitian and the MSS physicians meet 3 times per week to consult on new patients and
review nutrition plans on current parenterally fed patients. An integrated note signed by both the MSS
physician and the Team Leader Dietitian is documented in the medical record. The MSS and Team Leader
Dietitian have the responsibility of approving or disapproving all new parenteral nutrition orders and any
new order for anabolic steroids. If an order is not approved, the MSS physician or dietitian notifies the
ordering physician, explaining the reason for non-approval, and offers alternative recommendations.

                                 BWH Adult and NICU Inpatient Nutrition Staff 

Clinical Care

Daily monitoring of enteral and parenteral feedings is completed by the dietitian to ensure adequacy of
intake and to make additional recommendations for advancement or modification of the feeding. The
dietitians calculate and record all information pertaining to parenteral, enteral and oral intake in the
medical record. The dietitians document on-line in a note that has been specially designed for their use
only. The note details objective criteria, classification of malnutrition, and assessment/recommendations
for medical nutrition therapy.

The dietitians attend work rounds with the house staff. They are assigned patients by physician team or
service line to ensure effective communication and continuity of patient care throughout the patient's
hospitalization. 

Patients admitted to the hospital are screened for nutritional risk as part of the Nursing assessment.
Once a patient is identified by the nurse, the dietitian assesses the patient and determines the level of
risk and complexity of assessment, including: age; diagnosis/procedure or treatment; NPO/enteral status;
metabolic/mechanical problems; height/weight changes; and laboratory values. A formal physician referral
is not required for nutrition assessment. 

Patients are educated on their modified diet prior to discharge. The dietitians educate patients and
families in individualized sessions. For cardiac surgery patients, the dietitian teaches patients and families
in  group education classes.

The RDs are actively involved in the discharge process of the patients. Any patient being discharged to
home or a facility on enteral or parenteral feedings is educated by the dietitian prior to discharge. The RD
completes a "Discharge Nutrition Care Plan," which is distributed to the primary care MD and home care
company.

We also staff our Neonatal Intensive Care Unit (NICU) with 1.5 FTE dietitians. They are responsible for the
screening, assessment, daily monitoring and nutritional discharge plan for all infants in the NICU.

Education

The dietitians participate in many nutrition related rounds and conferences. Each week the RD's and
dietetic interns assigned to clinical rotations attend MSS patient care rounds for 1 hour. During this time
the dietitians present challenging and interesting cases to the director of MSS for discussion and further
recommendations. Bimonthly the RD's attend Teaching Rounds which include outside speakers who
present different aspects of nutritional management. Monthly, the dietitians attend Longwood Medical
Rounds. These rounds are organized by Harvard Medical School and the Nutrition Departments of the
hospitals in the Longwood Medical Area (Brigham and Women's, Children's Hospital, and Beth Israel-
Deaconess Medical Center). National and local experts in nutrition present their latest research or clinical
expertise to the RD's at Longwood Rounds.

Director of Nutrition:
Kathy McManus, MS, RD

To contact our department:

Kathy McManus, MS, RD, LDN
Director, Department of Nutrition
Brigham and Women's Hospital
75 Francis Street,
Boston, MA 02115
Phone: 617 732-5577
email: kmcmanus@partners.org

Other related links:

• Outpatient Nutrition Department (the Nutrition Consultation Service)

• Health-e-Weight for Women - Our website offers up-to-date, scientifically based information, advice,
  and tools. It's for anyone who would like to lose weight or learn more about good nutrition for
  themselves and their families. The site considers other factors that affect weight management in
  addition to calories. These are covered in four main sections: "Eating", "Exercising", "Emotions", and
  "Success Strategies" (practical tips). The behavioral pieces are what makes this a weight loss support
  site, rather than just a great nutrition site.