Do we really need a MD's order for this?

[Plagueis]

I understand that resident's need a physician's order to apply ice, heat, or even for Vaseline, for instance. However, recently I've seen orders to D/C particular food items from a resident's diet.

For example, one order was to D/C waffles with breakfast (the resident doesn't like waffles), and the nurse had to get permission from the MD to do so. Another was to D/C jelly with the resident's afternoon snack, as the resident only wanted peanut butter sandwiches. I always thought that a diet slip would be the only thing to fill out for changes such as these, as these aren't orders to change the diet (i.e. from puree to mech. soft), or to add fluids to a fluid-restricted diet.

To require a MD's permission for this seems odd to me (my previous facility didn't require that), but I was wondering: is this a common practice in other LTC facilities?

[OldNurseEducator]

My guess would be that the patient is still getting foods they don't like despite the fact that someone filled out the proper request. So the doctor probably felt that his order might make this happen. Sounds like a breakdown in communication between dietary and the unit you work on. Just my !

[INLPN93]

No.

I laughed a good one reading this, oh for cripe's sake.

Though I will say, after all the silliness of the past few years in LTC I can see this over the top kinda stuff being the normal for what requires a MD order.

[merlee]

I am allergic to eggs. Despite this, when I was hospitalized for cardiac issues, on the cardiac floor, I GOT EGGS EVERY MORNING. And not the fake ones, either.

Yes, there are breakdowns in communication everywhere. No, orders aren't needed, but may be a last resort.

[vald96]

you don't need an order from physician because it falls to likes and dislikes category so you need to let your dietary manager or RD to talk with the patient.Now if the problem is food consistency then there should be an order due to several issues like chewing or swallowing.Whats your policy about this?

[morte, LPN, LVN]

My only thought would be cost....perhaps dietary will send whatever is the cheapest that fits the ordered dietary regimen, and will not change it to the more expensive w/o a doc's order.

[BabyLady, BSN, RN]

I see this competely different.

Unless the MD has a MEDICAL reason for omitting certain foods, to me, he is treading on the patient's rights to choose their own food and their right to some level of enjoyment.

I would question and ask for the rationale for these orders.

[morte, LPN, LVN]

I see this competely different.

Unless the MD has a MEDICAL reason for omitting certain foods, to me, he is treading on the patient's rights to choose their own food and their right to some level of enjoyment.

I would question and ask for the rationale for these orders.

reread the OP, these are foods the patient is refusing...

[Ahhphoey]

Sounds crazy to me. I've never heard of such except in situations as previous posters have mentioned-different consistencies, allowing certain items to an otherwise restricted diet, etc. In places where I've worked, this has always just been an issue resolved by communicating with dietary. To me this is equal to some of those frivolous orders that docs sometimes write like give patient a bath daily (and not for a particular medical reason), or clean patient after each incontinent episode (and yes docs have written such orders)...

[steelydanfan]

My guess would be that the patient is still getting foods they don't like despite the fact that someone filled out the proper request. So the doctor probably felt that his order might make this happen. Sounds like a breakdown in communication between dietary and the unit you work on. Just my !

I agree. The doc just got tired of listening to food complaints. But, hey, if that's all your resident is complaining about, things are good.

[JenniferSews]

I agree. The doc just got tired of listening to food complaints. But, hey, if that's all your resident is complaining about, things are good.

Yup, it's a CYA. The next time the pt complains the doc can say "I wrote an order for you to never get X food again." They never think about the bind that puts the facility in, but they did something and that's all that matters. Unless of course it's an actual food allergy or something that the patient shouldn't have but asks for often.

[caliotter3]

Heavens.