Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA.
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Nutr Clin Pract. 2020 Jun;35(3):377-385. doi: 10.1002/ncp.10467. Epub 2020 Mar 25.
In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States.
A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges.
Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n = 558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting.
PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This paper has been approved by the Academy's Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in the Journal of the Academy of Nutrition and Dietetics. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
2014 年和 2017 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）分别授权注册营养师（RDN）在医院和长期护理环境中进行与营养相关的医嘱。尽管这一实践取得了进步，但缺乏描述当前肠外营养（PN）和肠内营养（EN）医嘱实践的信息。营养支持营养师是营养与饮食学会（Academy of Nutrition and Dietetics）的一个饮食实践小组和肠外与肠内营养学会（American Society of Parenteral and Enteral Nutrition，ASPEN）的饮食实践分会，他们利用一项调查来描述美国 RDN 的 PN 和 EN 医嘱实践。
采用横断面研究设计描述 RDN 的 PN 和 EN 医嘱权限。受访者被要求描述 PN 和 EN 医嘱权限、主要实践环境、主要服务的患者人群、营养专业认证、最高学位、职业年限以及是否有过医嘱权限的拒绝申请或未申请医嘱权限的原因。
702 名 RDN 完成了调查（12%的回复率），其中 664 名 RDN 提供了完整的数据。大多数受访者（n=558）照顾成人/老年患者。在这一组中，47%的人没有 PN 医嘱权限；14%的人可以开具和签署 PN 医嘱；28%的人可以开具 PN 医嘱并由提供者共同签署；10%的人可以开具部分 PN 医嘱并由提供者共同签署。19%的 RDN 没有 EN 医嘱权限；37%的人可以开具和签署 EN 医嘱；44%的人可以开具 EN 医嘱并由提供者共同签署。拥有医嘱权限的 RDN 更有可能获得营养专业认证，并在学术或社区医院工作。
PN 和 EN 医嘱权限因机构和州的要求而有所不同。未来需要研究描述与 RDN 医嘱权限相关的结果。本文已经得到了营养学会的研究、国际和科学事务团队以及理事会的批准，并已在《营养与饮食学会杂志》（Journal of the Academy of Nutrition and Dietetics）上联合发表。两篇文章内容完全一致，只是为了符合每个杂志的风格，在一些细微的风格和拼写方面略有不同。在引用这篇文章时，可以使用任何一篇文章的引文。
