So dietitians can now write orders: Denial of rights.

  1. 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 out of my daily curiosity, or more like checking the weekly **** ups I found the dietitian wrote an order by any standard is a denial of rights of the patient. When I asked my house supervisor how? I got an "its a known issue", yet its a known issue for 10 days and no one has done anything.

    The rational is what killed me was "due to infection control". So, what am I missing? Am I in the wrong thinking this is Waaaaaaaa(a^1000)aay outside a dietitians scope of practice? Or am I an uppity nurse that needs to shut up?
    Last edit by Meriwhen on Sep 29, '14 : Reason: Do not partially mask profanity. Thanks.
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  2. 46 Comments

  3. by   MunoRN
    Maybe you could be more specific, I'm not sure what it is you're asking about.
  4. by   livefully
    What was the order?
  5. by   caliotter3
    During a period of turmoil at a sinking ship facility one time, ancillary staff wrote up two page from top to bottom "orders" directing licensed nurses to do various aspects of their jobs. These flowerful edicts were posted in full view at the nurses station and contributed their part to each of the nurses leaving one by one. Usurping of authority only happens if allowed by whoever is in charge.
  6. by   Here.I.Stand
    At my facility/unit (SICU), the MD or NP writes the basic diet order in the case of tubefeedings...basically that the pt may begin TF. The RD writes the order for the formula and rate. Or in the case of dysphagia or non-fixated jaw injuries, the SLP writes the order for dysphagia level/thickened liquids.

    Talking a denial of pt rights and r/t infection control though, I'm guessing it's something like "family may not bring in outside food?" Just a guess. The RD and/or you can advise the pt of their rationale...but remember it's the pt's right whether to "comply" or not. Pt is in a hospital/SNF...not in prison.
  7. by   puravidaLV
    Locked unit mental health. Pt voluntary for addiction. Unit restriction r/t non infectionous skin condition.
  8. by   MunoRN
    Quote from puravidaLV
    Locked unit mental health. Pt voluntary for addiction. Unit restriction r/t non infectionous skin condition.
    I still don't get what you're saying. Did the dietician write a order requiring the patient to stay on the unit?
  9. by   LadyFree28
    Quote from MunoRN
    I still don't get what you're saying. Did the dietician write a order requiring the patient to stay on the unit?
    THIS.

    Is there a way for you to clarify *what* the "order" actually was without revealing too much?
  10. by   firstinfamily
    In the SNF where I worked the Dietician could write orders as a routine which was a policy authorized by the Medical Director. FAmilies were allowed to bring in food from home as long as staff was still maintaining a record of how much the patient was eating. We especially encouraged the families to bring in food when we had problems getting the patient to eat. I don't understand the infection control part. Is the patient on contact isolation because of a skin infection and the dietician is ordering some type of diet based on this infection?? Perhaps she/he is ordering food with increase protein to help the patient heal?? Need more info!!!
  11. by   Spidey's mom
    I agree that your question is still not clear. That makes it difficult to answer.
  12. by   jadelpn
    There are lots of rules in some facilities regarding bringing food from home to patients.

    IF the patient ends up getting sick on some food--from anything to food poisoning to the fact that some food doesn't keep well, it is a compromise to the patient.

    As well as if it is a food that say the room mate is allergic to.....it is like the schools that either require a student to NOT bring in a peanut butter sandwich OR require students to purchase lunch and are not allowed to bring in their own lunch.

    There are some behavioral health patients that intentionally ask for and eat food that they may have a skin reaction to. Then they can manifest inappropriate behaviors ie: skin scratching. Even more that well meaning (or not) relatives, friends are bringing food that has been "supplemented" with just about anything. Further, there are SI patients who will ask for a peanut butter pie....in an attempt to give themselves a fatal reaction.

    You just don't know. And taking home brought food out of the equation can at least give some control over what your patient is consuming.

    Registered dieticians go through some significant education and the registry test is not to be believed in its complexity. Nurses know the basics, however, why not let the RD's do their thing. If a patient has an issue, then by all means you can facilitate a meeting with the RD and the patient.
  13. by   puravidaLV
    I am trying to say without saying to much.
    Figured my last post would have been clear as mud, but from what I see as replies diets should be only thing they should be writing.
    Sounds like a mon day issue for the don and as of right now I won't be following the order. Since as far as I know within my state restrictions of rights with the hospital still falls on providers and nurses
    Last edit by puravidaLV on Sep 28, '14 : Reason: iPhones suck
  14. by   tarotale
    so you are saying they wrote something other than diet orders. unless it's something big like a med order or intervention order, i would just ignore it and maybe talk to charge, but if she wrote something out of her scope, I would ask her what the hell she is doing.

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