Nutrition Fundamentals and Medical Nutrition Therapy

Implement Physician’s Dietary Orders

Corresponds with LEARNING PLAN 12Copyright 2016 Association of Nutrition and Foodservice Professionals

12

Objectives

Recognize medical and nutrition terminology

Provide ordered diets

Include patient input on diet prescribed by physician

Recognize appropriateness of diet order for diagnosis

Explain importance of adhering to physician diet order

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Facility Diet Manual

Purpose» To establish a common resource with practice guidelines to

guide all healthcare professionals

Diet manual customization» Must be current, based upon research» Customize to individual facility» Record signatures of approval of IDT and physician» Make available at all nursing stations and in foodservice

department as a reference

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Physician’s Diet Order

Follow facility policy for being notified of a physician’s diet order

Review medical record for written documentation

Interpret diet order and implement for clients» Ensure knowledge of standard medical terminology such as

tid, CHF, NPO

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Interpreting the Diet Order

CDM must exhibit sensitivity and understanding

Person-centered care (CMS guidelines)» Supported by Academy of Nutrition and Dietetics

- Education for clients, family members and staff- Follow-up with clients

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Interpreting the Diet Order

Interpreting the diet order» Is it appropriate for the long-term care client» Determine in the interview if the client understands

his/her diet» Menu development- Add menu extensions as needed

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Brain Break

What response might be given to a client who doesn’t want to follow their diet order?

» First, review the reason for the diet order with the client» Second, determine how the diet can be individualized to

include client food preferences

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Individualized Nutrition Approaches

Quality of life and nutritional status of older adults in healthcare communities can be enhanced by individualization to less restrictive diets

Determine risks vs. benefits of therapeutic diets

Food is an essential component of quality of life

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Individualized Nutrition Approaches

Unpalatable or unacceptable diet can lead to poor food and fluid intake resulting in negative health effects

New Dining Practice Standards should be adopted to enhance person-centered care at mealtime in long-term care

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Implementing the Diet Order

Liberalized diets should be the norm; restricted diets the exception» Minimize restrictions before using supplementation

Most long-term clients are at risk for malnutrition; a regular or liberalized diet which allows for client choice may be the preferred initial choice

Medically prescribed diets should be continually monitored, be consistent with the client’s goals for care, and not decrease quality of life.

Talk with the RDN to determine if the diet order is appropriate for the diagnosis

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

Documenting Choice

When Clients Request a Food Not on Their Prescribed Diet

MEET with the client and briefly discuss what their diet is and why, and listen to their request

COMMUNICATE the information to the RDN and the RN

DISCUSS liberalizing the diet order with the physician- and follow up with the client

DOCUMENT conversation and response in the medical record, include client input on the diet, and what was discussed/decided by the MD. Make changes as ordered by physician

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Brain Break

» If they request a food not on their diet, provide the client with more information about the diet order

» If they still request the food, provide them with the requested food

» Document your conversation with the client and the menu choice in the medical record

Nutrition Fundamentals and Medical Nutrition Therapy • Implement Physician’s Dietary Orders • Learning Plan 12

What steps should the Certified Dietary Manager take to comply with a client’s diet order of 2-gram sodium diet?