can dieticians write physician order?

[Ms.RN]

i work at ltc but maybe hospitals are the same. a physician ordered protein supplement for my patient and he forgot to write down how much and often so i told dietician about it and she told me that " i have to write a physician order". i told her that at my every jobs i had dieticians wrote physician orders related to patient's diet and log in doctors book to sign the physician order. she insisted that she cannot write physician order and that i have to write physician order. do dieticians where you guys work write dietary physician order? i mean why on earth would i write dietary order when i know nothing about nutrition? why does she think she cant write an order but i can?

[ONCRN84]

Our dieticians write recommendations. The MD then comes behind them and writes something like "tube feed per RD recommendation". The RDs don't write the order, just they're suggestion. The MD can modify it if they want (rate, H20 flushes, etc). We had one recently where the RD recommended the goal of 60ml/hr with q6hr H20 flushes, but the surgeon wanted no flushes and a goal of 30ml/hr because of the patient's abdominal issues.

[Rainmaker RN]

No, RDs can't write orders and can't take telephone orders from a physician (even for diets).

[core0]

No, RDs can't write orders and can't take telephone orders from a physician (even for diets).

Ours do orders all the time. We write an order consult dietary (TF or dietary preferences) and then they write orders under protocol. Same way that pharmacy can change medication doses for antibiotics. It probably varies by institution and state.

David Carpenter, PA-C

[NurseKatie08, MSN]

Our RD writes reccomendations in a separate dietary log book and makes nursing aware. We then call the reccs into the MD and get new orders.

[Plagueis]

Dieticians where I work make recommendations, and the nurses inform the MD of the recommendations. If they are approved, the LPNs write out the orders. (I work in LTC.)

[blondy2061h, MSN, RN]

It varies by facility policy. At my facility the physician has to write the order for the dietician to write the order, then the dietician writes the order. If that makes sense. For example physician will write "RD to write TPN orders" and then the RD writes the actual detailed order.

[Tweety, BSN, RN]

I was recently at a meeting where it was clarified that dieticians can not write orders, or change diets without an order, but they can follow a protocol that has been approved by the medical staff. I'm pretty sure it's not a facility policy but a licensure limitation.

I feel this is a horrible waste of talent. The dieticians know the patients labs, medical condition, history, etc. and have the knowledge to know what's best nutritionally for the patient.

[Tweety, BSN, RN]

It varies by facility policy. At my facility the physician has to write the order for the dietician to write the order, then the dietician writes the order. If that makes sense. For example physician will write "RD to write TPN orders" and then the RD writes the actual detailed order.

Interesting. Where I work the RD is part of the TPN team, but it's actually the PharmD that writes the order every day when an MD writes "Pharmacy to provide/manage/write/whatever TPN".

While I just praised the RD's knowledge in the post above, often TPN contains medication such as Insulin, H2 blockers, and electrolytes IV and I'm not to sure I'd be comfortable with RD writing TPN.

[cardiacmadeline, RN]

I work in a hospital. The MD will write something like "start tube feeding through PEG tube" The RD will then write tube feeding orders (type, rate, flushes etc). Same with supplements. The MD will write a consult for nutrition, and the RD will order supplements if appropriate for the patient. But with our esophagogastrectomy patients, I believe the surgeons are a little more involved with the tube feeding orders because their tube feedings are initiated a little more slowly than other patients.

[mappers]

At our hospital, the RD writes a recommendation and the MD writes the order. The MD might consult RD and write to follow recommendations all at once or might wait for the actual recommendation before writing the order.