Is It a Realistic Battle in California?

 Importance of RD recommendations  Research giving RDs privileges  Obstacles of achieving privileges

 Give one reason why RD recommendations are important  Give one reason supporting privileges  State one obstacle

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

 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

 How often are they taken?  Article – Physicians implementation of dietitian’s recommendations -Lack of knowledge of RDs role

Expand 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

 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

 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

 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

Conclusions….

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

 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

Give one reason supporting RD recommendations? Give one reason supporting RD privileging? State one obstacle hindering the achievement of RD privileging?

 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

1. 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: 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: 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 Acad Nutr Diet. 2012; 112: 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: 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:A History of licensure for RDs in California Hager M, McCauley S. Clinical privileging: what it is.. And isn’t. J Am Diet Assoc. 2009;109: 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: House of Delegates: Licensure initiatives. content/uploads/2012/05/HOD-Licensure-Backgrounder pdfhttp:// content/uploads/2012/05/HOD-Licensure-Backgrounder pdf