Diet Ordering Privileges
by Karen Sheffler, MS, CCC-SLP, BCS-S
As a clinician who specializes in dysphagia, haven’t you always wanted the control of diet ordering for the safety of patients with dysphagia? Your recommendations for a diet upgrade or downgrade are extremely time sensitive.
How many times have you performed a Modified Barium Swallow Study (Video Swallow Study) at 11 am and needed to get a diet changed by lunch time? As you are in the radiology suite finishing with other patients, you are worrying about that lunch tray coming soon. Will my patient choke on that regular diet when the swallow study showed that he would be safest with a pureed texture?
How many times have you come back to your facility the following day and noticed that the diet order did not get changed or was changed to the wrong solid or liquid consistency?
We have the patient’s comfort and safety in mind when we want to see the diet changed immediately and the meal trays accurate. We have likely all witnessed the dangers of a patient receiving the wrong diet. We may have had to place incident reports. We may have even heard about a sentinel event (which is an unexpected occurrence causing a serious adverse reaction or death, per the Joint Commission).
After years of performing root cause analysis for patients receiving the wrong meal trays, I determined that one main root cause was in the communication of the diet order from the SLP to the MD. Is this done face to face, through a text page, or over the phone? We are all busy and some of this order writing gets delayed or miscommunicated. Through a patient safety committee at one hospital, the best solution we created at that time was for the SLP have privileges to write diet orders. The Nutritionist (Registered Dietitian/RD) also created a policy to adjust orders.
- Our policy stated that we could upgrade or downgrade a patient who already had a diet order.
- The SLP did NOT take a patient off of NPO or place them onto NPO; that was still done by the MD/PA/NP.
- The SLP also did not take the patient off a “clear liquid” diet, but could change from thin liquid clears to thickened liquid clears.
This drastically decreased tray errors.
The SLP enters the order into the computer system immediately after the evaluation is completed. The order was sent electronically directly to the kitchen. No delays and no “middle-man.” Of course, the medical team could still tweak the orders as needed.
Click on this link below for the policy I had created at my hospital:
Feel free to use it.
Our #1 Priority is Patient safety!
By Karen Sheffler