Marty’s Corner: Empowering Dietitians to Improve Patient Health
I remember it well from my years as a clinical dietitian - a physician modifies the patient’s existing diet order to, for example, add a texture modification, but all that is written is that single modification. So...the patient incorrectly moves from a carbohydrate- and sodium-controlled diet to a mechanical soft diet with no other restrictions. Usually a meal or two is served to the patient, or trays are wasted, until someone discovers the mistake and alerts the physician to re-write the order to include all the necessary modifications. If the above scenario happened in reverse, where a necessary texture modification is omitted, the consequences to the patient could range from inconvenience to significant harm. I'm sure you're thinking, "Well, that was back when everything was written on paper."
Even with automation, the above scenario can continue, and some electronic health record systems lack the needed alerts that would help the issue. Fast-forward to this past July, when the Centers for Medicare and Medicaid Services (CMS) gave dietitians order-writing privileges, pending the granting of appropriate privileges by their hospital, and with consideration of applicable state laws. Per the Academy of Nutrition and Dietetics, this privileging can happen in one of two ways: 1) a hospital has the regulatory flexibility to appoint RDs/RDNs to the medical staff and grant them specific nutrition ordering privileges, or 2) the hospital can authorize the ordering privileges without appointment to the medical staff. Once privileges are granted, dietitians would also have the ability to order lab tests to “monitor the effectiveness of dietary plans and orders,” as well as order nutritional supplements. This requires all dietitians to practice at a high level, using each and every skill gleaned from their extensive training.
These relatively new regulations aren't just a boost for the dietitian's role on the healthcare team. CMS predicts this action could save up to $459 million per year in hospital costs, from wasted trays to unnecessary complications to the patient's treatment. It's time for every clinical dietitian to step up to the plate, review all the necessary resources such as the Academy's "State Status and Regulation" map and its practice tips documents related to hospital regulation and implementation, and begin moving forward. I realize that in some states, changes to existing dietetics statutes are required, so obtaining privileges may be easier in Illinois than Indiana, for example. The result of these efforts? Significant cost savings, enhanced patient safety, and diet orders that are complete and appropriate.
Article by: Marty Yadrick, MBI, MS, RDN, FAND - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 1st Quarter, 2015