SOAP format is absolete

Salaam,

we were informed that SOAP format should not be used anymore. As mentioned by one of our senior dietitian in HKL, it was "zaman pak kadok" format. huhu.. So, suppose to use nutrition care process (ADIME). We've learnt this theoretically right. But not so much in practical. So, here's an example:

JB pulak ek!

Pertamanya, maaf atas kelewatan di kejauhan Johor Bahru menyampaikan khabar kami di sini..maklumlah, busy sungguh hari2 kami di sini. Tidaklah dapat mengirim khabar melainkan berjalan-jalan ke Danga Bay, Pasar Larkin, Kebun Bunga Diraja dan pelbagai tempat menarek..hehe..

Tanpa lengah masa, biar Nawa yang start intro entry nih.. kami berempat menempatkan diri di rumah sewa beralamat 11-A Jalan Yusof Taha..walaupun tanpa perabot, kecomelan hiasan dalaman rumah kami mmg tak dapat disangkal walaupun oleh Eric Leong sekalipun..hehe..details nati leh tgk gamba eh..mesti kagum

Arakian kerana mengutamakan khabar clinical dalam entry nih, nawa nak mulakan pasal outpatient dulu

Klinik kat sini dipanggil Klinik Runding Cara Diet menggantikan istilah kaunseling yang menjadi kontroversi di kalangan kaunselor (marah Br. Airil nih) yang jugak bertempat di Jabatan Dietetik dan Sajian HSAJB (Hospital Sultanah Aminah Johor Bahru)

Memperkenalkan rekod jabatan diet atau buku kuning yang menyimpan rekod patient antaranya diet recall, biochem dan segala assessment termasuklah apa yg menjadi priority management kita on 1st visit. So, next follow up senangla..sume da ada..just tgk changes and reassess. Pt balik, simpan buku kat pigeon hole.

O ye, nak gtau pt kat sini byk follow up, so no need to bgtau sume in one go..prioritize mana nak manage dulu..next visit tambah lagi..so pt pn xpenim n kurang rate incompliance insyaAllah. Biasanya follow up after 1 month lbh kurg from 1st visit..xpayah tggu 3 bulan utk next jumpa doctor..lame sgt

Yang lebih bergaya.. dietitian kat sini kene buat GM (Glucose monitoring) dan blood pressure measurement (tp xpakai sphygmomanometer la, just yg cepat tu je).. bergaya ke terketak2 kami nak nyucuk pen utk prick jari pt.hee..sume ni wat kalu perlu n before counselling..ups, runding cara diet.

Seterusnya yang lg best, kitorg kene terus kira energy patient tang tu jugak..lepas pt selesai bg diet recall..dan report kat pt sama ada intake dia tlebih ke kurg..kat sini terdetiklah sedikit kesal..sr. fathin awal2 dah pesan suh kira cal terus masa practical lepas tp wat dono ..hee..tp xmengapa, masih belum terlewat..marilah kita bersama2 kira kalori pasni..mulakan dgn mengira kalori diri sendiri..(hoh, baru terpikir nak makan kuih masala vadee lebih, da xjadik)..hee

Skrip bantuan pamphlet? No3..dietitian xnak ktorg bgantung pd pamphlet so nak tgk ktorg ckp without pamphlet..bg pamphlet kat akhir2..hehe, nawa mule2 gelabah jgk..counseling pun jadi x sesmooth ngn sr. niza. Sr niza dnga penim kepala nih..bagus jugak utk elak jadi dietitian pamphlet.

Sekian serba sedikit cerita outpatient..nawa personally masih kene byk improve opd nih..ape nk ckp kne dlm kpala..FFQ, MNT in layman term, baca body language pt, bila nak mencelah bile dah berjela dia cerita, macamana nak garang ngn patient bila dia ambik mudah diet ni, mcmana pulak nak motivate pt..banyak3..n sume come with experience insyaAllah..=)

untuk inpetient, kte tunggu miya @ mazu @ ija cerita part masing2..nati free2 topup lagi =)..hah, kamu bertiga..ada bran?hee

salam alaik..
emm entry d tahun baru..
bile baca SP n HSNZ punya post rasa excited gak nk bercerita..hehe..
here we come from Hospital Ampang..
em hospital ni kecik je..
current bed opened dlm 300 cm2 la..
ada 4 org dietitian HOD U48-ct bersalin (Pn. Hasliza, dia dulu HOD kt Hosp Sungai Buloh ms sy n mia praktkal kt ctu..), skrg pemangku HOD Pn Murni U44, Pn. Suhaila U41 (dia dulu kerja kt UIA, tp xsempt jp dgn kita dia da resign, dia senior dr Sr Fathin) n lastly Pn. Rosmaniza U41 (dia sama batch dgn Sr Jamilah).

pejam celik da sebulan kita praktkal, bnyk blaja, cuma nk digest betul2 2..huhu..
kita kt cni setiap minggu attach dgn sorg dietitan..
OPD kitorang 1x jer/week (untuk setiap dietitian), OPD pt by appointment n bila appmt ni ada je yg xdtg..
so xramai la, dlm seminggu ada la 4org cm2.

IPD kes bergantung pd ward..
cm medical 2 bnyk la..kitorg 1 dietitian jaga few ward..
so agak cmpur2 jg la kes..
n kitorg da msk ICU n NICU sb dietitian yg in charge 2 jg ctu, so kitorg kna ikut la..
em berdebar first msk NICU 2, ye la I/O chart die besar n xpernah tgk..pas 2 baby2 2 menangis..trus rasa dup dap dup dap..

ICU pun cm2, tp ok ckit sume diam je.
xde yg nangis le sb majority xsedarkan diri, kalu ada yg jg pun cume kelip2 mata n immobile..
pengalaman la dpt msk ICU ni, kena blaja regime intermittent n sama cm tmpt len product2 2 kna master..huhu..

em lupa nk ckp kt cni pun sistem komputer gak..tp not 100% la, admission note n biochem ada, nursing n doc note kna bc kt BHT..but depend on ward jg la..
dulu alif n amad pernah prktl kt cni..kitorg batch ke 4 praktkal kt cni..

em kitorg lmbt ckit mula counseling, last week baru mula, first 3 week 2 tgk dietitian dulu..ye la sb dietitian len2 kn..n kt cni specialized sal hemato~ kt cni ada neutropenic diet (diet rendah bakteria)..hehe..ni u pt yg undergo/will undergo BMT (bone marrow transplant)..

adui pnjg lak crite xlarat korang nk bc e..hehe..ye la da sebulan..
k la stop dulu, hope to hear from Jb n Kuantan..
smoga terus bersemangat u 4weeks to go ~

All the way from HSNZ, na na na tranung kite~

Wah KT musti tanak kalah ngn Sg Petani! huahua
here we go HSNZ!

aha, 1st day, ktorng start hari ahad, walopn surat start isnin.. tgk la betapa semangat merah menyalanya ktrng keskes =) (sbnrnye ade salah fhm sket haha)

Kt sini ade 7 org dietitian; 1 U52, 1 U48, 1 U44, 4U41. Sume baik2 n mengajar dgn komited sekali w!nk*
Start je hari 1st, ktrng diberi jadual. Suma ikut dietitian msg2.. bersedirian tanpamu~~
Sal dkt ward medical, Ida OPD, n me myself kt surgical/ortho. By the way, kt sini 1 ward 1 dietitian yg jg, so dietitian mmg dikenali d setiap ward..best kn? xdela kompius..

Plus, ramai la pulak snr2 medic wat housemnt kt cni...ayai.....

Since dietitian2 kt sni suma tau we all ni pektikel tuk kali ke-2, they have a high expectation on us...which is rsnya amat berat sekali...huhu

1st day: "okeyh mimi, amik case ni, g clark skrng, lg 15 mnt sy dtg pstu nnt awk trus bg counseling ya!"
haru biru......
tp xpe, dgn semangt waja, trus g ward then bg counseling dgn trketar2 waa~

komen diorng:
-> "eh awk x blaja ke cr tuk tulis dlm BHT? lect x bg templte ye?"...... agagaga. Moral of the story: Ngaku cpt2 klo x tau, jgn buat2 tau. pstu cpt2 tgk cne dietitn tlis dlm BHT, ingt on d spot!
-> "mimi, ape BKA? PVD? EDD? POA?... ha xsure? kt HTAA xde ke?".... Moral: sila kumpul abbreviation dgn rakusnya! compile dlm handbook
-> "mm mimi, sy rs suara awk td lembut sgt, x tegas, t pt tanak ikut" Moral: sile bg kaunseling dgn kuat & bertenaga, bg satu ward dgr lg bagus! (dietitian ckp tau!)
-> "sy rs mcm x ajar awak ape2 pn.., tanak tanya pape ke?" Moral: tanya dietitian byk2, time ni la nk cari ilmu yg x diajar dlm notes
-> "klau sorng pt awk amik ms 1 jam nk manage, cne klau ade 15 pt nnt?" Moral: tulis laju2! pikir laju2! igt formula harris benedict, xbleh belek2 note!

stakat ni tu je la komen dr diorng...
ha lg 1 soklan yg dietitn tny, selain knee ht, arm span, ape lg cara nk estimate ht pt?
.....ni mmg xtau langsung..
jwp: Ulna legth, lebih sng n lebih precise drp knee ht.

Okes...tu je la stakat ni..
By the way, Ampang, Kuantan n JB banyak btol cuti hari jumaat ye, jeles btul! huhu
Tp xpe, sbb hari Jumaat ktrng abes kol 3.30pm! yiieha!

Looking forward to see u guys, mishhh u alot.. T_T

Khabar dari Sungai Petani

Assalamualaikum w.b.t.

Apa khabar sahabat2 semua? Alhamdulillah kami di SP sihat sejahtera. Cuaca kat sini agak panas, berbeza sikit dari Kuantan yg selalu hujan hujung2 tahun. Alhamdulillah wa syukurillah, minggu pertama kami di sini berjaya diharungi dengan beberapa assignment yang mesti disiapkan weekend ni :)

Hospital Sultan abdul Halim, Sungai Petani antara hospital di Malaysia yang menggunakan e-HIS (Hospital Information System), jadi semua data memang kena access dalam sistem. Kena mahir la jugak nak guna sistem nih, kalau tak susah la nanti. Kat sini cuma ada 3 orang dietitian- Pn Balqis (U48)~HOD, Pn Hanee (U44) & Pn Norzaila (U41), patient lebih kurang dalam 500 orang. Refer memang agak banyak, lebih kurang hampir 15-20 orang dalam 1 hari utk IPD.

Oleh sebab klinik diet kat sini buka setiap hari (8.30 pg-1.00 ptg), jadi kami buat OPD masa tu dengan bimbingan Pn Zaila. Patient OPD tak la terlalu ramai, bergantung pada keadaan. Ada walk in, ada by appointment. Lebih kurang 3-4 orang jugak la 1 hari, kadang2 boleh sampai 8-10 orang jugak. cuma kalau Ahad tu ramai la sebab cuti Jumaat dgn Sabtu kan... Kat sini banyak jugak kes peads (FTT / Childhood obesity) selain kes2 DM / HPT / CVD & Renal.

Lepas zohor, baru ward round. Kami dibahagikan kepada 2- Su ikut Pn Hanee, Nadirah & Yat ikut Pn Zaila. Attachment selama sebulan utk 2 dietitian ni, nanti tukar la antara kami. InsyaAllah 21hb ni kami akan dapat kawan baru dari UKM, jadi 6 orang la yg akan buat klinikal kat sini.

Suasana kat hospital ni agak tenang juga, mungkin hospital baru, so design ward lebih teratur.. Doktor & Nurse pun baik, sangat menghargai kedatangan dietitian ke ward [diorg sgt faham peranan dietitian tu sendiri- bila perkenalkan diri sebagai dietitian terus je bagi BHT patient yang dirujuk...tak payah susah2 nak cari BHT tu :) kalau tak pun BHT memang da tersusun kat kaunter nurse, tak payah pening2. Kadang2 nurse siap tolong carikan lagi BHT..baik tak??]

Sepanjang seminggu di sini, kebanyakan patient yang direfer untuk IPD kes2 lebih kurang IPD 1 dulu [DM / HPT / Gout / CVD / CKD]. cuma ada 1 kes 'baru' - wheat allergy, peads 11 months. Ha..masa tu baru la kami kelam-kabut cari food list yg baby to kena elak. utk bagi pada parents & doctor [sbb doktor pun mintak juga]. Inilah padahnye tak hafal betul2 masa dulu..Huhu, jangan ikut contoh tak baik nih!

Kes RTF pun agak banyak juga, mostly to start feeding or review to increase feeding. Ada 1 kes RTF, patient has non-stop diarrhea. Patient nak transfer Hospital Baling, so kena review jugak pagi tu. Saya & Pn Zaila review this patient, bila tengok notes dalam BHT dr. plan nak tukar Ensure ke Jevity. Tapi kena consider jugak sama ada Hospital Baling ada produk tu atau tak & macam mana pulak management bila patient discharge nanti. Hmm...last2 dapat jugak detect, patient tu on antibiotics so mungkin antibiotics tu yg sebabkan diarrhea..[baru teringat knp Sr Aishah tekankan sangat management diarrhea dlm MNT tu]. So proceed with Ensure as previous plan, but added with probiotics (HEXBIO) to resolve diarrhea. Probiotic tu diambil 2 paket sehari, tambah masa flushing [tak kisah sama ada sebelum atau selepas feeding] & kena ambil sekurang2nya 4 jam sebelum atau selepas ambil antibiotics. Explain kat caregiver about the feeding & use of probiotics. ~satu pengetahuan & pengalaman baru bagi saya~

Pengalaman yang baru lagi~ tulis SOAP notes dalam BHT... [You can imagine how's our feelings right].

Apa yang perlu kami improve, based on comments from dietitians:

1. Familiar with food here - of course kat mana2 pun sama jugakkan?! kat sini ramai patient Melayu & India, so restoran nasi kandaq, nature food kat sini kena tau la apa yang ada. hehe..

2. Characteristics setiap enteral product kena hafal & faham, tak boleh hafal ikut disease tapi based on the product itself =)

3. Build rapport with patient- jadikan sesi kaunseling macam sembang, jangan formal sangat. Put ourselves in patient's situation. Ingat tuh!!

4. Improve how to write notes in BHT- cara dah betul, cuma ayat yang banyak kena improve. Baca ayat2 dalam MNT tu, terms yg digunakan...

Rasanya setakat ni dulu untuk kali ni, Insya-Allah ada kelapangan kami sambung lagi... Harapnya kawan2 lain di JB, KT, Ampang, Kuantan pun sudi berkongsi dengan dengan kami juga ye! Rindu kalian semua...^_^

Kami yang kejauhan; Nadirah, Su & Yat, Sungai Petani Kedah

IPD2 & OPD2 Placement

Hospital Tengku Ampuan Afzan, Kuantan / Poliklinik Komuniti Beserah / Klinik Kesihatan Bandar Kuantan

1. Mohd Firdaus b Nazri Shaharuddin

2. Ilman Hadree b Idris

3. Shariah Hussenbocus

4. Ayat bt Ibrahim

5. Syarifah Aisyah bt Syed Mohd Kamil

6. Nurul Farhanah bt Md Fozi

Hospital Sultanah Nur Zahirah, Kuala Terengganu

1. Noor Salihah bt Zakaria

2. Nursyamimi bt Ahmad

3. Norzairunida bt Mohd Razali

Hospital Sultanah Aminah, Johor Bahru

1. Mazuin bt Kamarul Zaman

2. Nor Syahiza bt Abdul Kadir

3. Nawwarul Huda bi Zulkefli

4. Nur Amirah bt Abdul Alam

Hospital Sultan Abdul Halim, Sungai Petani

1. Nur Nadirah bt Khairuddin

2. Siti Suhaili bt Ismail

3. Siti Nurhayati bt Ali

Hospital Ampang, Kuala Lumpur

1. Nurulhidayah bt Nazri

2. Nurul Hazirah bt Jaafar

A love letter from Sr Fathin:

Dear students, 

A very big congratulations for finally able to finish your thesis presentation and I hope the write up will be good as well.

As for OPD2, IPD2 and Special Units will start soon, I would like to take this opportunity to wish you the best of luck. A few advices from me as a teacher and a mother to all of you:

1. Bring up the best quality in you as you are now bearing the Kulliyyah's and IIUM's name to the outside world.

2. Respect the one who you are going to work with at the hospital; the dietitians, catering officers, nurses, doctors, clerks, etc.

3. Watch your attitude- as the bad ones may impact people's impression on you.

4. Learn a lot! Learning does not always meant creating novelty, but what's more important is that you learn from mistake and not repeating the same mistake again.

5. Polish your ability in critical thinking, reasoning and skills- these mean you have to practice and read a lot!

6. Keep your discipline scale at the higest of the barometer! Never miss the session unnecessarily, never late, never disobey and be punctual!

7. Do not procrastinate!

Last but not least, take care of yourselves. Manage your stress (mainly stress is due to procrastinating tasks!), eat healthily, get enough sleep and talk to your friends and families if you have problems!

Again, good luck and have a good time exploring dietetic world!

Regards,

Sr. fathin

1st Dec 2009

* Biggest hope from teacher is never ending, but how about us??*