So dietitians can now write orders: Denial of rights. - page 2

Well first I had no clue that dietitians can now writes orders and take verbal orders from physicians (depending on state) but it was put forward by CMS and practiced. I don't get many memos. Yet,now... Read More

  1. by   JustBeachyNurse
    Sounds like the dietician didn't write a dietary order or recommendation but an activity restriction which is a medical/nursing order or even PT/OT. I'm guessing if the OP writes specifics it will be pretty identifiable.

    No if the registered dietician writes an order such as patient to remain in locked unit due to infection risk I'm deferring to the MD/APN and not following. If the RD writes no outside food only facility prepared food or 2100 Kcal ADA diet, lactose free, controlled K++ & Na+ I will follow it.
  2. by   Esme12
    are you saying the dietician wrote an activity order that restricted the patient freedom of movement? What was the infections condition?
  3. by   KelRN215
    Dieticians could not write orders at all when I worked in the hospital. They wrote "recommendations" but the providers were the ones who actually wrote the orders.

    And if the dietician wrote such an order, can't you just tell the MD/NP/PA/whoever is in charge of the patient to d/c it and to ask the dietician who she thinks she is?
  4. by   withasmilelpn
    So my best guess is it's a question about whether it's in her scope of practice to write what she wrote as an order. It seems that the order pertains to a skin issue and being restricted to the unit from what I gathered. The answer to that would be no in my opinion. Her education and scope does not give her the right to give orders concerning these issues. She can collaborate with the physician - persuade him to give the order. (I am wondering if perhaps it's food allergy related and that's what led to the order, understand if you can't elaborate.) At any rate, look up your state practice act. In Pa dieticians are actually regulated by the board of nursing. If you don't find it in the legislation you can try directing it to the agency in your state that regulates them. And I would also question the patient's physician. If the MD supports the dietician's order, then it will obviously stand. Good luck.
  5. by   nurse4ever08
    RD can write diet and some vitamin orders. They cannot write other orders no matter what state.
  6. by   Junebug903
    Where I have worked previously, dietitians wrote recommendations on order sheets, then were signed off by MD/NP and then nurse taking off orders.
  7. by   LTCNS
    Quote from Junebug903
    Where I have worked previously, dietitians wrote recommendations on order sheets, then were signed off by MD/NP and then nurse taking off orders.
    Same here in every LTC I have worked in. RD writes recommendation, MD/NP signs it, nurse notes order and documents.
  8. by   puravidaLV
    the vitamin came up today on another patient. So far in my research there is nothing allowing this or policy at the facility. I've caught her stepping over the line previous in forcing patients to accept their diet. Pt has the right to refuse treatment no matter what it is. She told me a diabetic cant refuse a diabetic meal ordered for them that the ADA diet is "LAW". I looked at her and handed a copy of the patient rights given to every patient.

    I was checking state law in regards to this and saw little to nothing. Matter fact its specific that dietitians can not dx anything according to state law, which was a rational for the reason of this original post.

    Sorry I might work in mental health, but I give a damn about my patients.
  9. by   MunoRN
    Quote from puravidaLV
    the vitamin came up today on another patient. So far in my research there is nothing allowing this or policy at the facility. I've caught her stepping over the line previous in forcing patients to accept their diet. Pt has the right to refuse treatment no matter what it is. She told me a diabetic cant refuse a diabetic meal ordered for them that the ADA diet is "LAW". I looked at her and handed a copy of the patient rights given to every patient.

    I was checking state law in regards to this and saw little to nothing. Matter fact its specific that dietitians can not dx anything according to state law, which was a rational for the reason of this original post.

    Sorry I might work in mental health, but I give a damn about my patients.
    I'm not quite following the vitamin part, but ordering an ADA diet is within the scope of the RD, just like ordering a dysphagia diet is within the scope of a speech therapist, although technically both are writing those orders under the MD.

    A patient has the right to food and water, regardless of NPO orders, fluid restrictions, etc. They are free to refuse those orders and eat/drink whatever they want. The degree to which a facility feels they need to assist the patient in obtaining food that falls outside of their dietary orders varies however. I'm sure many patients would prefer lobster to shepherd's pie, but the patient doesn't have a "right" to lobster, only to food, which shepherd's pie counts as (although I might argue differently).
  10. by   puravidaLV
    Quote from MunoRN
    I'm not quite following the vitamin part, but ordering an ADA diet is within the scope of the RD, just like ordering a dysphagia diet is within the scope of a speech therapist, although technically both are writing those orders under the MD.

    A patient has the right to food and water, regardless of NPO orders, fluid restrictions, etc. They are free to refuse those orders and eat/drink whatever they want. The degree to which a facility feels they need to assist the patient in obtaining food that falls outside of their dietary orders varies however. I'm sure many patients would prefer lobster to shepherd's pie, but the patient doesn't have a "right" to lobster, only to food, which shepherd's pie counts as (although I might argue differently).
    there was a post a few back. Gotta follow with me or you'll get left behind. It's no the ordering of the diet that is an issue. It's the enforcement. I give enough forced medications by court order to know what enforcement is. If someone doesn't want insulin well although I might educate them to the reason and do everything I can they still have the right to refuse the diet as treatment.
    Last edit by puravidaLV on Sep 29, '14 : Reason: Much nicer of a reply. I rolled around in puppies
  11. by   Esme12
    Quote from puravidaLV
    the vitamin came up today on another patient. So far in my research there is nothing allowing this or policy at the facility. I've caught her stepping over the line previous in forcing patients to accept their diet. Pt has the right to refuse treatment no matter what it is. She told me a diabetic cant refuse a diabetic meal ordered for them that the ADA diet is "LAW". I looked at her and handed a copy of the patient rights given to every patient.

    I was checking state law in regards to this and saw little to nothing. Matter fact its specific that dietitians can not dx anything according to state law, which was a rational for the reason of this original post.

    Sorry I might work in mental health, but I give a damn about my patients.
    In your effort to respect the patient information....your questions are very difficult to answer.

    The dietician can order the diet for the patient. Whether the patient eats or not is entirely up to them. If they refuse and demand another diet be ordered...the dietician is under no obligation to comply. Patients can be discharged for non compliance/adherence to the medical plan.

    The vitamin...what vitamin?
  12. by   Esme12
    Quote from puravidaLV
    there was a post a few back. Gotta follow with me or you'll get left behind. It's no the ordering of the diet that is an issue. It's the enforcement. I give enough forced medications by court order to know what enforcement is. If someone doesn't want insulin well although I might educate them to the reason and do everything I can they still have the right to refuse the diet as treatment.
    Could you reference that post....I am still not following.

    Yes they can refuse the diet but the dietician is not under any obligation to change the order. They can choose whether to refuse and go hungry....or eat it and do what they want when they go home.
  13. by   JustBeachyNurse
    Is the dietician ordering a diet such as 2100 kcal ADA patient refusing the diet and dietician insisting patient be forced to consume ADA meal "as per the "law"" or starve? Does the patient want a regular diet?

    The physician can override a dietician order.

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