A few years ago, our feeding team implemented a questionnaire to be given to caregivers at check in. It consisted of 6 questions honing in on the Caregiver’s concerns, past interventions, a sensitively worded question about food insecurity, as well as a daily intake recall and tube feeding schedule if applicable.
See here for the short questionnaire:
We developed the questionnaire to gather information before the evaluation in an effort to spend more quality time in the room. We have found the most benefit from having the daily intake log information. This includes foods and liquids the child consumes over the course of the day and volumes accepted. This allows the dietitians to analyze the diet, including accepted food groups, and even begin to assess caloric and nutrient intake ahead of time. As a team, it allows us to enter the assessment with an understanding of eating routines/habits and the parental concerns. Once in the room, we usually just need some clarification.
This was such a success in terms of saving us time that we developed a longer more detailed questionnaire and imbedded it into our electronic charting system. Now, caregivers can fill this out from home as soon as the assessment is scheduled. Our electronic assessments become part of the medical record which means we can access this when needed.
Example of the longer questionnaire:
Feel free to adapt these questionnaires to you and your patients needs and share questionnaires that you have found useful.
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