Order Writing Privileges: How To Make It Happen
Let Sara’s Success Story Inspire You To Take Action
In 2014, a magical moment happened for all of us dietitians. The Centers for Medicare & Medicaid Services (CMS) finally recognized Registered Dietitians as qualified healthcare personnel to order therapeutic diets. But wait … then why are so many of us still leaving tube feeding recommendations on sticky notes or chasing docs down the hallways shouting, “Order that supplement three times a day!”
So far in my short career, I have worked in six states — both as a traveler and a traditional full-timer. I have worked in facilities where I ordered everything and others where I was expected to be seen, but not heard. During my full-time days, I implemented order-writing privileges at my facility. Although it may seem like a daunting task, YOU (yes, you) can achieve order-writing privileges at your facility. Read on to find out how it can be done.
Familiarize yourself with the CMS ruling and your state’s specific rules.
Even though the federal government gave us a huge green light to move forward with order-writing privileges, there are state- and facility-specific rules that still must be followed. Educate yourself to find out how you can operate within the rules without jeopardizing your license. The Academy of Nutrition and Dietetics has put together a handy list of state-specific issues to obtaining order-writing privileges; access it here.
Build rapport with your staff … especially your physicians.
Coming from an internship where dietitians managed all of the nutrition support orders, that was my expectation as I started my career. Unfortunately, the site of my first full-time job only allowed me to order oral nutrition supplements. Within the first week, I was asking my manager when we could start the process to change this. Always patient and wise, she urged me build rapport with my physicians and “prove myself.” So, I did. I talked to them all the time. Shared my recommendations and expertise. Asked questions of them. Learned. Charted at the nurses’ stations so I was always available and approachable. My efforts paid off big time — when my manager and I presented a preliminary policy for dietitian order-writing privileges to the surgeons less than six months later, we were met with enthusiasm and pleas to approve the policy right then and there.
Consider the logistics.
Taking on order-writing is a big responsibility. Patients need diet orders 365 days a year. Do you have enough staff to commit to providing this level of care? If not, you may need to set boundaries or make it understood that dietitians will not be the sole providers to order diets or nutrition support. (i.e., If a patient is admitted on Saturday at midnight, s/he should not be diet-less for two days because there is no dietitian weekend coverage.) Another consideration is competency. If you wish to take on nutrition support order writing, are all members of your staff confident and competent to accurately manage these orders? How do you know? Perhaps you should require regularly scheduled trainings or competency checks to ensure patient safety.
Have some data on your side.
Data doesn’t lie. Can you prove that the providers who are currently managing nutrition support orders aren’t meeting patients’ calorie needs? What is your facility’s rate of inappropriate parenteral nutrition? What about blood glucose or electrolyte management? Or the timeliness of diet advancement after surgery? Or how quickly or accurately providers follow dietitians’ recommendations? It never hurts to have some data to show that #DietitiansDoItBetter.
Don’t give up.
This is a process…sometimes a long one. If you are declined the first time around, don’t wave your white flag just yet. Repeat steps 2-4, tweak your policy, and give it another go. Maybe you will be successful in achieving a trial period or delegated order writing (which allows dietitians to write orders under the direction of a physician and with a physician co-signature). If so, make sure you are collecting data that show you are doing an amazing job.
I am a huge believer in dietitians doing more and becoming more involved in patient care. Writing and managing orders is a big step towards that. So if you haven’t yet achieved order-writing privileges at your facility, there’s no time like the present to get started.
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