The Parable of the Persistent Widow

For those that read the Bible, there's a parable in Luke of the persistent widow. This woman had been treated unjustly and unfortunately, had to seek out justice from a local magistrate who was, well, unjust. He tries to put her off but, eventually, to save his own sanity, decides to take on her case so that she "won't eventually come and attack me!"

What exactly does any of this have to do with nutrition?

I was following up with a patient this morning. She was a typical patient who, due to various factors, simply wasn't eating well but was agreeable to trying a protein supplement. I had ordered our standard high calorie, high protein supplement and then made her a moderate risk, meaning that I wouldn't see her again for seven days, unless consulted.

Seven days later, I reassessed her and, after asking if she liked the protein supplement, found out that she hadn't actually received any of them. So, we're seven days later with her intake still being poor and her not receiving a source of essential protein and calories. I went and talked to the kitchen and hosts about the problem. The silence was deafening. I wish I could say that this is a rare occurrence but it happens all too often.

But It's Ordered...

Every hospital has a protocol in place for ordering supplements but ours is fairly standard. You add the order for the specific supplement and flavor desired as well as how often it is to be provided. Our system even allows you to order the supplement for a specific meal. This order goes into our meal system and is automatically added onto the menu that prints for each meal. The menu is then passed to the tray line where the supplement is added along with the meal and then taken to the pt's room.

Where and why does the problem occur? The primary reason why patients don't get their supplements or any other ordered item is due to human error. When you have a tray line that's serving 100+ people each meal, time is a factor. It's too easy to miss adding a supplement. The hosts are also supposed to check trays when being delivered. This would be a time to catch anything ordered that didn't make it onto the tray. However, it's easy to miss a supplement or, even if noticed, easy to ignore. Running down to the kitchen to grab one supplement usually isn't a priority with a fast-paced job.

The less common reasons stem from supplements not being ordered correctly, ordering flavors/supplements that are not carried in-house, or running out of that particular supplement. These factors can and do occur but with much less frequency.

Resolving the Problem

I can't follow every patient's tray and make sure they receive supplements I order. I could if I had multiple assistants but I don't think that's in the budget. One of my best assets is a meticulous host. Someone who takes pride in their work and double-checks every tray, fixing even small problems. However, that's hard to find when you don't pay hosts very well. Certainly, it's not a highly skilled position, but when I've had a great host, I notice a huge difference on my floors.

While having an effective solution would be great, I'm working on noticing and addressing each problem that I see in addition to recognizing hosts that do step up and take note of details. The challenge here remains being focused on getting things right without a stream of constant criticism. The malcontent dietitian doesn't make for a great job title, after all! Taking the time to recognize good work as well as correct mistakes takes significant effort.

Finally, I've had to make my peace with being somewhat a malcontent. If I don't recognize that problems exist and mention them, they won't every be addressed. However, I do hope that with every complaint, I motivate people. Probably not to like me or even respect me. But, maybe it will just lead to better patient care. And, I'm directing all the grumbling about this to the passage in Luke.