HospitalInspections.org

Based on Medical Record review, document review and interview, in one (1) of six (6) medical records reviewed, the facility failed to ensure that only staff licensed and privileged to write Diet Orders were writing and changing Diet Orders (Patient #1).

Findings include:

Review of medical record for Patient #7 identified a physician order dated 7/24/21 at 8:34 pm for Cardiac, Low Cholesterol, Low Sodium diet. On 7/26/21 at 4:33 pm, the order was changed by a Dietician, Staff H to a "Moderate Carbohydrate, No Sodium Restricted" diet.

Hospital policy titled "Entering and Confirming Diet Orders" revised on 4/2018 noted "It is the policy of The Food and Nutrition Service Department to accept physician's diet order from the electronic medical record" "The physician must write a diet order in the patient's electronic medical record in order for a patient to receive a meal tray."

Review of the hospital "By-Laws Rules and Regulations of Medical Staff " adopted on 4/30/18 and amended on 11/13/2020 revealed Dieticians have not been granted any privileges by the Medical Staff.

On 7/27/21 at approximately 11:00 AM, Staff E, Dietician, stated that Dieticians can change diet orders. Staff E was then asked if the Physician gives permission or gets notified of the diet change. Staff E replied that Dieticians do not need permission from the Provider and can change the diet order as needed. She stated that if the Physician was present, she will inform the physician of the change in the diet order. Dietitians will not change enteral feeding, total parenteral nutrition, liquid restriction or NPO (nothing by mouth) orders. However, dieticians can change all other orders such as Renal Diet, Sodium Restricted, Pediatric, Diabetic, food consistency and more. Staff E demonstrated how she changed the diet order for Patient #7 from a "Cardiac, Low Cholesterol, Low Sodium" to a "Moderate Carbohydrate Diet, No Sodium Restricted Diet." Staff E also demonstrated how she can change a physician order for a 2-gram Sodium Restricted Diet to a 4-gram Sodium Restricted Diet.

During interview on 7/27/21 at approximately 1:00PM, Staff H, Food Service Director and Staff J, Chief Clinical Dietitian, they confirmed that Dietitians can enter diet order in the Physician orders section of the medical record. Staff H reported the practice began in 2018 and that it was a misunderstanding of the federal and state regulations.

At interview on 7/28/2021 at approximately 12:45 PM, Staff G, Chief Medical Officer stated he became aware on 7/27/21 that Dietitians were prescribing diets. Staff G confirmed that Dieticians were not privileged by Medical Staff to write diet orders.