Marty’s Corner: Order Writing Privileges for Registered Dietitians
The ability of “qualified dietitians” to write nutrition-related orders in hospital health records varies widely by state and by facility. The Centers for Medicare and Medicaid Services (CMS) issued a revised rule a few years ago that opened the door for dietitians to assume this important task. The Academy of Nutrition and Dietetics maintains a map on its member website that uses stoplight colors to reflect the current status of regulations affecting order writing by dietitians in each state. Two factors are involved; first, the state must have no “statutory or regulatory impediments” to allowing dietitians to write patient diet orders. A state colored red, for example, may have statutes that include language precludes dietitians from writing orders. Second, the medical staff of a hospital must approve order writing by dietitians and declare so in their policies and procedures.
The benefits of this practice not only include the ability of the clinical dietitian to use her or his expertise to ensure that the patient’s diet is appropriate in all aspects, but it also can result in reduction in costs for the hospital. Some examples include when malnutrition is quickly identified and appropriately treated, thereby improving outcomes and avoiding costly readmissions, reducing inappropriate parenteral nutrition orders, or simply ensuring that inappropriate trays are not sent and subsequently wasted. 1 These examples, along with other information regarding the current state of malnutrition, are covered in one of our recent eBooks. Also, many of us who have worked as clinical dietitians can recall many times when a diet order came through that inadvertently omitted a patient’s previously-ordered texture modification, resulting in a tray sent that, at the least, would be wasted or more seriously, could result in the patient aspirating and all the consequences that can result from it. The combination of automation in food & nutrition services, along with granting order writing privileges to dietitians, can help ensure that the patient’s diet is always appropriate.
- Phillips W, Doley J. Granting order writing privileges to registered dietitian nutritionists can decrease costs in acute care hospitals. J Acad Nutr Diet; in press.
Article by: Marty Yadrick, MBI, MS, RDN, FAND - Director of Nutrition Informatics and former President of the Academy of Nutrition and Dietetics; Fusion, 2nd Quarter, 2017