Are patients allowed to order food from outside places and have it delivered to their rooms if they are on anything but a regular diet?
Right now we have a morbidly obese pt. who is a raging diabetic. He's on a diabetic diet. He can not even move himself around in the bed independently. All of us have been stressing our backs lifting his legs, pannus, arms, etc. so that he can turn and reposition. Getting him to sitting position on the edge of the bed is a real back buster. Don't even get me started on the two hour long dressing changes.
Just about every night he orders large amounts of food from the local fast food delivery places.
I understand that food is an addiction and free will and all of that but he is not complying w/ his prescribed diet which is affecting his ability to heal.
We had a another situation w/ a diabetic dialysis pt. who the doctors allowed to be on a regular diet. He needed to have his gallbladder taken out but refused. He would order burgers and fries and nibble on them all night while at the same time getting Phenergan q6hr and Dilaudid q3hr for his nausea and stomach pain. He'd refuse his Carafate, Reglan and Pepcid. And dialysis for days at a time.
Both of these pt.s could be verbally abusive and demanding to the staff. It is so frustrating that the doctors don't put their foot down and tell them that they cannot have a regular diet. Why can't the docs discharge them for non-compliance? We are basically just boarding these folks
b/c they refuse everything that will make them better.
I've been a nurse for a long time and I know the answer...customer satisfaction. But it feels good to vent.
I'm still curious about the ordering food from outside places, though. And, do you all see any docs that will stand up to these pt.s and not allow them things that are hindering their healing? Or will discharge them if they are refusing all tx. that will make them better?
If people are non-compliant with the treatment plan (wanting to go outside and smoke, eating food after just having bowel surgery) I ask them to sign an AMA form ( against medical advice) stating they are aware of the complications of not following doctors orders, but choose to ignore the treatment plan. Regardless, I keep educating and documenting until I am blue in the face. Is administration aware of this situation? I am not sure what the policy is at your facility but you could have your nurse manager go speak to this patient as well.
A diet order is like any other order, a competent patient is free to refuse the order, which is probably better described as a suggestion.
Providing the patient with the ideal diet isn't going to work for a patient who's patient is that far off of ideal, you have to be willing to accept the reality of the patient's poor dietary habits and do what you can to make realistic movement towards better habits.
When I worked as a substitute teacher, students ordered food to be delivered to the school. It was disruptive and inappropriate, to say the least. For some reason the admin allowed it.
Patients in a hospital and students in a school should not be ordering food. Food is provided for them. It is counterproductive to all of the work you are trying to do. Outside of the hospital is one matter, but it should not be happening right under your nose.
Specializes in OR, Nursing Professional Development.
It's all about patient autonomy. They can refuse anything that is prescribed, including a diet. As long as you CYA with documentation, there is nothing you can do.
Specializes in Med nurse in med-surg., float, HH, and PDN.
My first year in nursing, the unit I worked on admitted a morbidly obese patient who had skin breakdowns everywhere there was a fold of flesh. It took four people to do dsg changes! (She also required two side-by-side beds, pushed together and secured by the Maintenance Dept.)
I think my wrist problems may have started then, as two of us were required to push up or pull up whatever was drooped over whatever spot the other nurses were working on.
She had Dr's orders for milk-shakes and egg-nogs made fresh and sent up from the dietary kitchen between her high calorie meals. That's when I learned a very large person can actually be malnourished! I was floored!
When I worked as a substitute teacher, students ordered food to be delivered to the school. It was disruptive and inappropriate, to say the least. For some reason the admin allowed it.
Patients in a hospital and students in a school should not be ordering food. Food is provided for them. It is counterproductive to all of the work you are trying to do. Outside of the hospital is one matter, but it should not be happening right under your nose.
I disagree. Patients can choose to accept or decline any medical intervention, up to and including dietary orders (the student thing though- that's crazy! Unless I guess during lunch? Even then i can't imagine the logistics).
What if, instead of ordering food, the diabetic patient refuses their metformin or insulin? That is even more counterproductive than eating pizza and hohos. All you can do is educate, encourage, and document.
And also, if this is what the patient is doing while inpatient, imagine his diet when he is at home. It's all well and good to keep someone's blood sugar regulated while they are on a controlled, hospital administered diet, but that 3-4 days of good control is not going to translate to the home environment very well. Better to work with the patient's actual diet and hopefully help them maintain decent levels- meet the patient where he/she is at, as the saying goes.
Hospital food is gross and unappetizing, as a general rule. Maybe we'd have less patients refuse to follow their prescribed diet if the options we presented were more appetizing. But that's a topic for another thread I guess.
Family members bring in their garbage food all the time. It isn't really that different if it is a delivery from a company.
Some people are never going to follow a dietary order. You can't really force those people to follow a dietary order. Once they're out of the hospital, they are going back to their habits. If you are certain of non-compliance, plan for the non-compliance.
Are patients allowed to order food from outside places and have it delivered to their rooms if they are on anything but a regular diet?
Right now we have a morbidly obese pt. who is a raging diabetic. He's on a diabetic diet. He can not even move himself around in the bed independently. All of us have been stressing our backs lifting his legs, pannus, arms, etc. so that he can turn and reposition. Getting him to sitting position on the edge of the bed is a real back buster. Don't even get me started on the two hour long dressing changes.
Just about every night he orders large amounts of food from the local fast food delivery places.
I understand that food is an addiction and free will and all of that but he is not complying w/ his prescribed diet which is affecting his ability to heal.
We had a another situation w/ a diabetic dialysis pt. who the doctors allowed to be on a regular diet. He needed to have his gallbladder taken out but refused. He would order burgers and fries and nibble on them all night while at the same time getting Phenergan q6hr and Dilaudid q3hr for his nausea and stomach pain. He'd refuse his Carafate, Reglan and Pepcid. And dialysis for days at a time.
Both of these pt.s could be verbally abusive and demanding to the staff. It is so frustrating that the doctors don't put their foot down and tell them that they cannot have a regular diet. Why can't the docs discharge them for non-compliance? We are basically just boarding these folks
b/c they refuse everything that will make them better.
I've been a nurse for a long time and I know the answer...customer satisfaction. But it feels good to vent.
I'm still curious about the ordering food from outside places, though. And, do you all see any docs that will stand up to these pt.s and not allow them things that are hindering their healing? Or will discharge them if they are refusing all tx. that will make them better?
I've had the same situation. Obese very unhealthy man would order food every night. Chinese food night was my favourite as he would have explosive diarrhea the whole next day.
Gallbladder guy got to be sent home ASAP for non-compliance.
Diabetic cookie is more difficult. Whatever our good intentions might be, we just cannot break the "bad" habits these patients nursed for decades in a few days, leaving alone that these few days in unit will not make any difference on the long run. For some reason, very few people realize that 500+ pounds human being needs about 3000 kcal to just sustain itself with very little mobility, and that 1800 ADA does not offer enough protein for a 400 pounds patient requiring 2.5 grams of it per kilo/24 hours to support anabolism and wound healing. Ridiculously, I found many RDs to be at complete lack of basic clinical critical thinking and just physically unable to get the fact that it is not possible to convert someone who existed on junk food diet for years into a healthy foodie in 24 hours. This is even before we get to the questions of money, time, planning and lack of cooking skills.
What I would do is to ask the patient what exactly he wants (cafeteria food is pretty often either disgusting or just not enough in quantity for huge guys like that one) and assist in choosing a little bit more "healthier" alternative. If he is dying to eat pizza, fine with me if he at least gets not double-cheese, triple-pepperoni and with some veggies on it.
Infection control issue can hardly be applied because everybody else including visitors and staff are allowed to bring food from whereabouts. A smart patient will be very quick to point on it.
I often deal with anorectic patients or those who refuse hospital food (which I personally will eat only if alternatively facing death by starvation) by allowing them to bring their own, whatever patient might be tempted to try. I only emphasize necessity to absolutely comply with structure ordered by SLP, and with necessary restrictions (no milkshakes if calcium/phosphorus restrictions for renal failure). It almost always works great, and brings more comfort and eventually more trust and compliance in my relationship with these patients. My unit owns a small library of books about cooking in "special situations" just for such cases.
You may not be able to call it an infection control issue, but the unit/hospital is not obligated in any way shape or form to allow food delivery on their unit. You can't stop a patient from going down to the lobby/outside to pick up delivery, but you are also under no obligation to assist a person down there if they aren't capable themselves. The best solution is, as has been suggested, to ensure that the patient is getting adequate calories from the diet provided.
Been there,done that, ASN, RN
7,241 Posts
Patients can decline any doctor's order. The nurse informs the physician of the non-compliance and the doctor takes it from there.