Pt.s Ordering Food from Outside Hospital?

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Are patients allowed to order food from outside places and have it delivered to their rooms if they are on anything but a regular diet?

Right now we have a morbidly obese pt. who is a raging diabetic. He's on a diabetic diet. He can not even move himself around in the bed independently. All of us have been stressing our backs lifting his legs, pannus, arms, etc. so that he can turn and reposition. Getting him to sitting position on the edge of the bed is a real back buster. Don't even get me started on the two hour long dressing changes.

Just about every night he orders large amounts of food from the local fast food delivery places.

I understand that food is an addiction and free will and all of that but he is not complying w/ his prescribed diet which is affecting his ability to heal.

We had a another situation w/ a diabetic dialysis pt. who the doctors allowed to be on a regular diet. He needed to have his gallbladder taken out but refused. He would order burgers and fries and nibble on them all night while at the same time getting Phenergan q6hr and Dilaudid q3hr for his nausea and stomach pain. He'd refuse his Carafate, Reglan and Pepcid. And dialysis for days at a time.

Both of these pt.s could be verbally abusive and demanding to the staff. It is so frustrating that the doctors don't put their foot down and tell them that they cannot have a regular diet. Why can't the docs discharge them for non-compliance? We are basically just boarding these folks

b/c they refuse everything that will make them better.

I've been a nurse for a long time and I know the answer...customer satisfaction. But it feels good to vent.

I'm still curious about the ordering food from outside places, though. And, do you all see any docs that will stand up to these pt.s and not allow them things that are hindering their healing? Or will discharge them if they are refusing all tx. that will make them better?

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We discharge them if they're refusing treatment ...if we can find someone to take them! I'm not sure there's a way to stop them from ordering food, though.

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You could tell them that unit/hospital policy doesn't allow outside food for infection control reasons. You can't stop them from ordering it, but you don't have to allow delivery men on your unit.

Gallbladder guy needed to be discharged for noncompliance. Sounds like that MD (granted, I don't have all the information) needed to grow a pair.

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Yes, they do it all the time, or did when I worked in the hospital.

No doctor EVER said no.

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You could tell them that unit/hospital policy doesn't allow outside food for infection control reasons. You can't stop them from ordering it, but you don't have to allow delivery men on your unit.

Gallbladder guy needed to be discharged for noncompliance. Sounds like that MD (granted, I don't have all the information) needed to grow a pair.

A good move if it is true. But unless the hospital also forbids visitors from bringing outside food, and prohibits pt's from eating healthy outside food, then it is lying.

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Specializes in ICU, LTACH, Internal Medicine.

Gallbladder guy got to be sent home ASAP for non-compliance.

Diabetic cookie is more difficult. Whatever our good intentions might be, we just cannot break the "bad" habits these patients nursed for decades in a few days, leaving alone that these few days in unit will not make any difference on the long run. For some reason, very few people realize that 500+ pounds human being needs about 3000 kcal to just sustain itself with very little mobility, and that 1800 ADA does not offer enough protein for a 400 pounds patient requiring 2.5 grams of it per kilo/24 hours to support anabolism and wound healing. Ridiculously, I found many RDs to be at complete lack of basic clinical critical thinking and just physically unable to get the fact that it is not possible to convert someone who existed on junk food diet for years into a healthy foodie in 24 hours. This is even before we get to the questions of money, time, planning and lack of cooking skills.

What I would do is to ask the patient what exactly he wants (cafeteria food is pretty often either disgusting or just not enough in quantity for huge guys like that one) and assist in choosing a little bit more "healthier" alternative. If he is dying to eat pizza, fine with me if he at least gets not double-cheese, triple-pepperoni and with some veggies on it.

Infection control issue can hardly be applied because everybody else including visitors and staff are allowed to bring food from whereabouts. A smart patient will be very quick to point on it.

I often deal with anorectic patients or those who refuse hospital food (which I personally will eat only if alternatively facing death by starvation) by allowing them to bring their own, whatever patient might be tempted to try. I only emphasize necessity to absolutely comply with structure ordered by SLP, and with necessary restrictions (no milkshakes if calcium/phosphorus restrictions for renal failure). It almost always works great, and brings more comfort and eventually more trust and compliance in my relationship with these patients. My unit owns a small library of books about cooking in "special situations" just for such cases.

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Document that you've educated them about the risks and they say they understand, and stand back and let 'em eat themselves to death. I do wish we'd quit admitting people to the hospital that don't want to help themselves or cooperate with their care.

My position has always been that I'm not going to (not allowed to) obtain or serve people something contrary to their diet order, but I'm not going to get involved in trying to wrestle the cheeseburger out of their hands, either. If they can independently get their hands on food that's contrary to their ordered diet, not my problem.

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Thanks for all the replies so far. I agree about not being able to change habits during a few days of hospitalization and I usually don't sweat the diet stuff too much but these two cases annoyed me b/c they were directly making themselves ill by what they were eating.

It was infuriating to be in that guy's room pushing Dilaudid q3 and Phenergan q6 while he was simultaneously munching down on a burger and fries. And he was vomiting and having the foulest diarrhea. You could practically taste the poo smell in the air. Sorry, gross, but true. I tried to educate him on cause and effect but no go. After all his GI stuff settled down for the night he turned around and ordered SIX carne asada breakfast burritos for his bkfst. He wouldn't be able to order all that if the doc would put his foot down and have him on a renal/diabetic diet.

He had no means to get food from the outside so the doctor changing his diet would have put an end to it. But the pt. was a squeaky wheel and we all know that they get the grease. In his case, lots of it :-)

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For some reason, very few people realize that 500+ pounds human being needs about 3000 kcal to just sustain itself with very little mobility, and that 1800 ADA does not offer enough protein for a 400 pounds patient requiring 2.5 grams of it per kilo/24 hours to support anabolism and wound healing. /QUOTE]

Good point. I didn't think of that but you are right. I'll have to see how many calories he's on and recommend a change if he's getting too little food.

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Specializes in Med/Surg, Academics.

We get one of those about once a month from one of the nursing homes. Morbidly obese, bed bound, on dialysis, wounds, noncompliant, and usually quite young (in their 50s). When we don't see them for about six to nine months, we figure they died.

Honestly, I'm glad the docs don't fight about the diet order with them. If the docs put their foot down, who do you think would be bearing the brunt of the abuse?

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Quote feature isn't working right but this is from KatieMI:

For some reason, very few people realize that 500+ pounds human being needs about 3000 kcal to just sustain itself with very little mobility, and that 1800 ADA does not offer enough protein for a 400 pounds patient requiring 2.5 grams of it per kilo/24 hours to support anabolism and wound healing. /QUOTE]

Good point. I didn't think of that but you are right. I'll have to see how many calories he's on and recommend a change if he's getting too little food.

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We get one of those about once a month from one of the nursing homes. Morbidly obese, bed bound, on dialysis, wounds, noncompliant, and usually quite young (in their 50s). When we don't see them for about six to nine months, we figure they died.

Honestly, I'm glad the docs don't fight about the diet order with them. If the docs put their foot down, who do you think would be bearing the brunt of the abuse?

Very true. But this particular guy is super abusive as it is so it couldn't get much worse :-)

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