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Q&A: Dietitian at heart of hospital’s effort to reduce cardiac readmittance

Nicole Roach, RD at South Nassau Communities Hospital, shares the challenges and triumphs of an educational program that’s changing the way cardiac patients look at food and nutrition.

“I’d love to see you again, but not here—not in a hospital bed.” That’s what Nicole Roach, RD, CDN, dietitian with Sodexo at South Nassau Communities Hospital in Oceanside, N.Y., tells the patients she works with after they’ve been discharged following a cardiac failure.

In order to stay out of the hospital bed, many cardiac patients must consciously change the way they eat. Some are ready and willing, others…not so much. Roach took us through her process for reducing the number of patients who come back as cardiac patients through a wellness program and increasing the number who come back to visit as success stories, having managed this progressive disease.

Nicole_Roach_RD_with_Sodexo.pngPhoto: Nicole Roach, RD, CDN, never thought she’d have so many “favorite patient” stories when she first started, but now her passion for her work is helping keep cardiac patients away from the hospital and living their best lives. To see video of Roach, click here.

Q: How does the cardiac wellness program work?

A: We have a Joint Commission disease specific hospital certification. That’s a tongue twister, but it means that we educate each heart failure patient for one hour minimum on diet and lifestyle. That counts toward the certification, which is great, but more important to our mission is: How do we keep patients from returning to the hospital? Patients can come in for our cardiac wellness program within two weeks of being discharged. Based on statistics, that’s when we start seeing readmissions. They see me, they see a pharmacist and a nurse; we talk to each other and go over what’s been going on since they’ve left the hospital, where do we need to improve and where can we make tweaks to send them off to do well on their own. Our mission is to provide the best care and management of this progressive disease.

Q: So this is all individual to each patient?

A: It’s one on one. Wellness and education is so individual. If there’s someone who cooks at home I can tell them a thousand things they can do at home. Someone who doesn’t cook at home, I can’t tell them the same things. The one-on-one aspect works because the patient bounces around between the nurse, pharmacist and me, so we’re helping multiple patients at a time.

Q: And you’re serving a pretty diverse group, so culture is a factor in nutrition education, right?

A: It’s 100% important to keep in mind. To ignore the cultural aspect would mean you can’t help. Once I asked a patient if they cook with salt, and they said no, but they use adobo, and there’s salt in there. I pulled up the label on my phone, and we found out that there’s a lot of salt, but also cumin and other spices. So, I said, ‘What if you made this spice blend at home and made it minus the salt?’

Q: It seems like most people know excess salt is a no-no for cardiac diets, but what are some of the finer points and other components?

A: In regard to salt, we let people know that it’s in processed food, condiments, canned food…so it’s not oversimplified where they’re thinking, ‘Oh, I just can’t shake the salt shaker over my plate.’ And then we focus on fresh foods, foods that are lower in fat, but also incorporating the good, heart-healthy fats. We talk about different sources of protein and how to work with whole-wheat products. For example, brown rice is rich in fiber, which is not just good for the GI track and blood sugar levels, but whole grains help the heart too. A lot of patients have other things going on too, maybe they’re diabetic or on a renal diet, so we take that into consideration.

Q: For a program like this, where do you start with someone who never cooks at home?

A: People think you have to be a gourmet chef to cook…they think cooking means you need a million ingredients and you’ll be sautéeing and braising for hours. So I try to simplify it. You don’t need a lot of ingredients, and if you can carve out one hour every day, that’s not a lot. This is easy; this is attainable. But I’m not going to start off telling someone they need a three-course meal. That’s a horrible place to start. And sometimes focusing on the health benefits really helps, when they can see they feel better by eating better.

Q: What other tools are you using for education?

A: I made a poster in February for heart failure awareness week with everything I go over with heart patients, and it got so much praise we made a handout—which had to go through our educational board—and it’s been doing so well they’re now translating it to Spanish. Another thing that’s a surprise education tool is the menu. People are wanting to take home [the patient menu] and mirror that at home. And Sodexo has so many resources for us, too, educational material that’s awesome to use as a resource. Plus, our food in the cafeteria follows Sodexo’s Mindful program, so I feel that healthy eating is supported here.

Q: Do you have any success stories about patients you can share?

A: That is my new favorite question! When I first started going on job interviews, they would ask, ‘What’s your favorite patient story?’ And not having much experience, my follow-up question to them was, ‘Why would I have a favorite story?’ although I didn’t say that out loud! I was thinking, why would I? I’m just going to go to work. It hadn’t resonated with me yet how passionate I’d be. Now I’m like, ‘I have so many stories I can’t pick just one!’ But here’s one of my favorites: In addition to the wellness program, I see patients within a certain window while they’re here. In the first 24 to 48 hours, they want to see their doctor obviously, they feel horrible, sometimes they can’t breathe…they don’t necessarily want to see a dietitian. A patient can say ‘No, thank you.’ But this woman was there on a breathing machine and her family was looking at their cell phones. I was sure my spiel was going in one ear and out the other, it seemed like they were ignoring me. But, you win some, you lose some. Then, the net day I was in my morning meeting and they told me this woman needs more education. Usually I wouldn’t go in the day after getting shot down like that, but I went back and she not only listened and thought about it, but she had specific questions. I was taken aback. I expected her to go home and make a couple of changes, but to my surprise she started coming back to the cardiac wellness program every week, just doing great. This was from start to finish, a patient doing so poorly and in so much distress and now doing so much better.

Contact Tara at [email protected]

Follow her on Twitter @Tara_Fitzie

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