So dietitians can now write orders: Denial of rights.

[puravidaLV]

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?

[yesterday]

This thread makes me smile. Twenty seven responses to sketchy information.

We don't even know what the question or the concern is.

I've seen perfectly worded and thought out threads die after 6 posts. This one is clear as mud, and it's developed a life of it's own.

Look at me. I'm the 30th post and I don't have a clue about what exactly the OP is asking.

I love, love, love this response! It really made me laugh!

I hardly ever post any more due to concern about being recognized, so I do appreciate the OP's attempts at writing in garbled code to elicit feedback.

[ktwlpn, LPN]

I think the OP is concerned over some orders her dietitian wrote which she believes are not within the scope of practice. First I encourage the OP to actually look at the dietitian's scope of practice in her state, it may surprise her(recommending vitamins,labs etc,are well within their scope) Secondly any resident has the right to refuse any recommendation.We have a big problem with speech therapy making recommendations we consider inappropriate although they are well within the scope of their practice. We educate staff, resident and family and provide a waiver.

[canoehead, BSN, RN]

I'd call the dietician first, and find out her logic behind the order. It might be logical. If not I'd call the doc and say "I have an order for.....and it doesn't make sense to me because......" Ask the doc for the final decision, and document.

[puravidaLV]

I think there is confusion on the mass of diet replies. I had a vitamin post which has disappeared. In any case she hates me now. Looks as if she got pulled into a morning meeting and we crossed paths in the back of the hospital. I think a little to much gets " over looked" and swept under.

I have zero problems with vitamin orders, neither does our medical director, yet state law does not permit those type of orders.

More to the issue is the wording "unit restriction" which falls under a denial of rights. Which is outside scope of practice.

Also the restrictions rationale is due to a medical diagnosis which according to state law, in bold letters, is way way out side the scope. Even more that the hx of the dx is not infectious as per the rationale

if anything I know more now than before.

[Spidey's mom, ADN, BSN, RN]

I'm really sorry . . . .but I'm even more confused.

[Esme12, ASN, BSN, RN]

I think there is confusion on the mass of diet replies. I had a vitamin post which has disappeared. In any case she hates me now. Looks as if she got pulled into a morning meeting and we crossed paths in the back of the hospital. I think a little to much gets " over looked" and swept under.

I have zero problems with vitamin orders, neither does our medical director, yet state law does not permit those type of orders.

More to the issue is the wording "unit restriction" which falls under a denial of rights. Which is outside scope of practice.

Also the restrictions rationale is due to a medical diagnosis which according to state law, in bold letters, is way way out side the scope. Even more that the hx of the dx is not infectious as per the rationale

if anything I know more now than before.

I have access to all removed posts...there have been none.

Well at least you know more for I am more confused than ever.

My only advice is chose your battles carefully.

[Spidey's mom, ADN, BSN, RN]

Maybe you started another thread about this subject on a different forum here on AN?

Sometimes posters make more than one thread in different areas?

I guess I could search and see . . . . . . .

Edited to add . . . I found nothing.

[psu_213, BSN, RN]

Maybe you started another thread about this subject on a different forum here on AN?

Sometimes posters make more than one thread in different areas?

I guess I could search and see . . . . . . .

Edited to add . . . I found nothing.

That was nice of you to look. However, I don't think we will ever get to the bottom of this without more specifics. I realize the OP can't post everything that happened here, but we need a bit more help on this!

[dudette10, MSN, RN]

I have an issue with RDs or speech therapists writing actionable orders. They need to be recommendations. Why? Just had a patient with a swallow eval ordered on admission over the weekend. Speech did the swallow eval on Monday and wrote a rec for a dysphasia diet. The pt remained NPO for a developing acute abdomen. If speech or RD were allowed to write orders, they would need to know the bigger picture, when they don't ever know the bigger picture.

I also was indoctrinated to how much medicine/nursing the therapy team is privy too. I love our speech therapists, but I walked in on one saying to the patient that there wasn't a whole lot of difference being on a tele floor as opposed to a regular floor. From her perspective, maybe... I was a little annoyed that she was "educating" the patient on that.

[jadelpn, LPN, EMT-B]

I think there is confusion on the mass of diet replies. I had a vitamin post which has disappeared. In any case she hates me now. Looks as if she got pulled into a morning meeting and we crossed paths in the back of the hospital. I think a little to much gets " over looked" and swept under.

I have zero problems with vitamin orders, neither does our medical director, yet state law does not permit those type of orders.

More to the issue is the wording "unit restriction" which falls under a denial of rights. Which is outside scope of practice.

Also the restrictions rationale is due to a medical diagnosis which according to state law, in bold letters, is way way out side the scope. Even more that the hx of the dx is not infectious as per the rationale

if anything I know more now than before.

Could be wayyyy off base here, but...I could assume that this is patient with disordered eating as part of their diagnosis. Lots of depends as far as policies/procedures and patient rights.

There are many patients who, as part of their mental illness are manipulative. Even more who are pros at it. People with disordered eating issues are prone to strange behaviors regarding what they put in their mouths. If one is "force feeding" (including vitamins) a patient, if they are restrictive in a unit due to behaviors--any "typical" thinking person would find this a huge violation of someone's rights.

We can't hold patients against their will if in fact they are in a facility under their own accord, and don't have a section. Even with a section, there's a limit. Sometimes patients are just not in a place where wellness or lack thereof is a motivating factor.

The dietician is a main discipline in the process of doing what they can to ensure wellness. Because they are registered, they have obligations like nurses do to ensure proper care. Should the patient decline, there needs to come a time that other disciplines are called into play to decide on a plan going forward for this patient.

I am all for advocating. I am all for educating patients. But when one starts looking at the legalities and scopes and other issues regarding a patient communication, that is something that needs more than just you, OP. I would discuss with social work, ethics....use your resources. And no matter how well meaning, it is never a great idea to get into a lively rights debate with a patient. It can also feed itself and take on a life of its own should this patient's mental illness manifest itself by perceived denial of rights.

[banterings]

According to the OP:

I have zero problems with vitamin orders, neither does our medical director, yet state law does not permit those type of orders.

More to the issue is the wording "unit restriction" which falls under a denial of rights. Which is outside scope of practice.

Also the restrictions rationale is due to a medical diagnosis which according to state law, in bold letters, is way way out side the scope. Even more that the hx of the dx is not infectious as per the rationale

So puravidaLV,

Is this the situation?: The dietician has seen the Hx and Dx of the patient and added vitamins to the diet due to the Hx and/or Dx. The dietician has also added "unit restriction" for the purposes of infection control for a condition that normally does not require any restrictions, theoretically like Hep C or HIV.