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Can Increasing RDs Privileges Improve Patient Care?

Is It a Realistic Battle in California? . Can Increasing RDs Privileges Improve Patient Care?. Overview. Importance of RD recommendations Research giving RDs privileges Obstacles of achieving privileges. After you will be able to…. Give one reason why RD recommendations are important

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Can Increasing RDs Privileges Improve Patient Care?

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  1. Is It a Realistic Battle in California? Can Increasing RDs Privileges Improve Patient Care?

  2. Overview • Importance of RD recommendations • Research giving RDs privileges • Obstacles of achieving privileges

  3. After you will be able to… • Give one reason why RD recommendations are important • Give one reason supporting privileges • State one obstacle

  4. Ice Breaker Turn to your neighbor and tell them how often MDs take your recommendations and if the system in place is efficient

  5. RDs Recommendations • Specialists • Article- Implementation of Dietitian Recommendations for Enteral Nutrition Results in Improved Outcomes - accepted RD recommendations vs. non accepted • Malnutrition • Decrease length of stay • Wound healing • Decrease infection

  6. RDs Recommendations Continued • How often are they taken? • Article – Physicians implementation of dietitian’s recommendations -Lack of knowledge of RDs role

  7. One Way to Improve this situation is to….. Expand RD privileges

  8. Expanding RD privileges • Verbal Orders • Research – Diet Order Entry by Registered Dietitians Results in a Reduction in Error Rates and Time Delays Compared to Other Health Professionals - reduced error rates and time delays with RD order entry privileges

  9. Expanding RD privileges • Order Writing Privileges • Research – Assessing the Influence of Registered Dietitian Order-Writing Privileges on Parental Nutrition Use -decreased inappropriate PN use • Research – The Role of Dietitian Order-Writing Privileges in Improving Parental Nutrition Utilization in Neonatal Intensive Care Unit - Faster achievement of calorie, protein, and lipid goals with presence of RD and order writing privileges in NICU

  10. Obstacles • Regulations • Clinical privileging vs. prescriptive authority Must obtain license, relevant training and experience, demonstration under observance by practitioner and competencies • Medicare State Operations Manual Appendix A - Survey Protocol, Regulations and Interpretive Guidelines for Hospitals - LIPs - Dependent on hospital facility and state dietetics and nutrition licensure law - States that do not license or give statutory certification to RDs: CA, AZ, CO, NJ, WY • California’s current law

  11. Obstacles • Liability and malpractice insurance • Academy accused of monopolizing field Alliance for Natural Health USA “nutritionists” Homeopathic nutrition Alternative nutrition Those with higher degree but did not pursue RD • Opposition from American Nurses Association of California and California Nurses Association

  12. What does this mean? Conclusions….

  13. Conclusions • RDs have the knowledge and skills – reduce error and hospital costs • More research needs to be done • Very complex issue with many obstacles

  14. Review • RD recommendations: Decrease length of stay, decrease infection, wound healing, malnutrition- SAVE HOSPITAL MONEY  • Research says RD privileges can reduce diet entry error and time delays, decrease PN use and decrease cost, help achieve goals faster • Obstacles: state licensure, opposing groups, liability

  15. Who Can…. Give one reason supporting RD recommendations? Give one reason supporting RD privileging? State one obstacle hindering the achievement of RD privileging?

  16. What We Can Do • Educate others -Medical staff on RDs role -Issue of licensure -Difference of MNT and nutrition advice • Stay informed -Contact legislators -Be involved with the CDA

  17. Questions??

  18. Thank you 

  19. References • Braga J, Hunt A, Pope J, Molaison E. Implementation of dietitian recommendations for enteral nutrition results in improved outcomes. J Am Diet Assoc. 2006; 106:281-284. • Skipper A, Young M, Rotman N, Nagl H. Physician’s implementation of dietitians’ recommendations: a study of the effectiveness of dietitians. J Am Diet Assoc. 1994; 94:45-49. • Imfeld K, Keith M, Stoyanoff L, et al. Diet order entry by registered dietitians results a reduction in error rates and time delays compared with other health professionals. J AcadNutr Diet. 2012; 112:1656-1661. • Peterson A, Chen Y, Sullivan C, et al. Assessing the influence of registered dietitian order-writing privileges on parenteral nutrition use. J Am Diet Assoc. 2010; 110:1703-1711. • Witowich G, Fogelman M, Tupesis S, et al. The role of dietitian order-writing privileges in improving parenteral nutrition utilization in the neonatal intensive care unit. J Am Diet Assoc. 2009; 109:A30. • History of licensure for RDs in California. http://blog.shopwell.com/files/history_of_licensure_in_california_feb2011-1.pdf • Hager M, McCauley S. Clinical privileging: what it is.. And isn’t. J Am Diet Assoc. 2009;109:400-402. • Hager M, McCauley S. Why are therapeutic diet orders an issue now and what does it have to do with legal scope of practice? J Am Diet Assoc. 2009; 109:1515-1519. • House of Delegates: Licensure initiatives. http://www.reallyeatright.org/wp-content/uploads/2012/05/HOD-Licensure-Backgrounder-2011-07-22-11.pdf

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