Dietetics in Health Care Communities
of New Jersey (DHCC of NJ)
 

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  • 18 Nov 2016 8:51 AM | Sarah Blozen

    Please contact Terri Rufo at trufo@care-one.com.

  • 05 Oct 2016 7:52 AM | Mary Piciocco (Administrator)

    CMS has released the adoption of revisions to the SOP Appendix PP.  Among the changes is the ability for RD/RDNs to attain order writing privileges as delegated by the physicians.  Our colleagues in the acute care setting have been establishing policy for credentialing and writing orders for almost 1 year. There is some useful information available for RDs in the LTC/Sub-acute setting.

     The following article was written by Aimee Crant-Oksa, the Clinical Nutrition Manager at CentraState Medical Center. Aimee was one of the first Clinical Managers to initiate RD privileges in the state of New Jersey in her hospital.

    Registered Dietitian Order Writing Privileges – One Institution’s Journey

    by Aimee Crant-Oksa MS, RD

    In May 2014 The Center for Medicare and Medicaid’s (CMS) proposal allowing Registered Dietitians the authority to manage a patient’s diet in the inpatient hospital setting.  It was passed and went into effect in July of that year.  As a Registered Dietitian (RD) for close to 20 years, and dreaming about this privilege since I was first a dietitian, I knew I wanted to pursue this in my facility.  After the ruling came into effect, The Academy of Nutrition and Dietetics released a state by state guide stating who had a green light for ordering privileges, who had a red light and those that fell in between.  In New Jersey, we fell in between in the yellow area.

    In the fall of 2014, I contacted the dietitian from the New Jersey Department of Health (NJDOH) for guidance.  She advised me that we needed a waiver to have the state regulation amended to allow ordering privileges for the RD.  I met with the Chief Medical Officer (CMO) , the Director of Nursing and the AVP of Quality for support, guidance and permission to move forward with the process. I am very lucky to have had the support from these people.  The CMO worked with me on every step of the project, and we had his and many other physicians wanting us to have ordering privileges.  This was vital in having the privileges granted.

    Initially I created a proposal and submitted it to the CMO.  In it I stated the CMS ruling, why it was important for patient care, the outline of the privileges I was asking for and credentialing requirements.  This document served as the basis for the Dietitian Order Writing Policy.  I debated having a policy that allowed the dietitians to write orders without restrictions, but decided that there needed to be some guidelines.  This is a new process for all of the medical staff, nursing staff and dietetic staff.  I wanted the dietitians to be comfortable in their new role, but also have communication to the physician when necessary to make the decisions as a team.

    I decided on the following as the outline of our policy:

      After initial RD consult and evaluation:

    • ·         RD’s can change existing po diets, order nutrition supplements and nourishments

    • ·         RD’s can only advance from NPO or a liquid diet to a solid food diet with a conversation with the attending physician and documentation in the progress note

    • ·         RD’s can write Enteral tube feeding orders if an order is written by the physician stating NGT/PEG/PEJ/GT/JT can be used

    • ·         Total Parenteral Nutrition (TPN) orders can only be written by a Certified Nutrition Support Clinician (CNSC)

    • ·         RD’s can order modified consistency diets based on Speech Language Pathologists recommendations

    • ·         RD’s may order diet related laboratory tests

    The policy successfully passed through The Medical Executive Committee (MEC) and The Governing Board.  We submitted our application to NJDOH in December 2014.  In June 2015, NJDOH after many applications were submitted from hospitals throughout the state, sent out a memo stating that “as a general waiver, licensed hospitals may allow a physician or an RD to write a specific dietary order for each patient; and patient nutrition needs for food and food supplements shall be met in accordance with physician or RD orders.”  Upon receiving the memo, I contacted the CMO for our next steps.  We created a privileging application for the dietitians to apply to the medical staff and a credentialing checklist to ensure we had all the necessary documentation.  We are the only non-medical staff to have been privileged in our facility.

    This is an example of our checklist:

    Personnel file monitored and maintained in Human Resources Department

          Meets all employment criteria for Registered Dietitian

             Personnel file up-to-date

             Employee in good standing

             Professional Portfolio for 75 CE credits every 5 years (current and on file)

             Medical Nutrition Therapy goal related to area of hospital practice with a

             minimum of 5 CE credits annually (current and on file)

             Registered Dietitian, verified by the Commission on Dietetic Registration - copy attached

             Malpractice insurance for independent diet and TPN ordering - copy of current COI attached

               Certified Nutrition Support Clinician (required for TPN order entry) – copy   Attached

    The dietitians are employed by the hospital so it was decided that Human Resources would sign off on the credentialing piece, and the privileging part would be signed off by the chairperson of the Credentialing Committee.  I initially presented all of the applications at this meeting as the forms needed to be approved.  After the chairperson and the committee approved the applications, they went to MEC and The Governing Board for final approval.  All of the dietitians have been approved and are now placing orders for diets, supplements, etc.

    This is a wonderful enhancement to our profession, and our role in the hospital setting.  There is improvement in timeliness, accuracy and provision of nutrition care.  I look forward to seeing the dietitians role continue to grow and change as we become a more valued member of the healthcare team.

    References

    http://www.eatrightpro.org/resource/advocacy/quality-health-care/consumer-protection-and-licensure/faqs-cms-final-rule-related-to-therapeutic-diet-orders

    http://www.eatrightpro.org/resource/advocacy/quality-health-care/consumer-protection-and-licensure/therapeutic-diet-orders-state-status-and-regulation

    https://www.federalregister.gov/articles/2014/05/12/2014-10687/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and

     

  • 19 Mar 2016 11:49 PM | Anonymous

    Are you an RD/RDN interested in advancing your career and obtaining an advanced degree?

    The Master of Science in Clinical Nutrition (MSCN) program at Rutgers School of Health Related Professions is an advanced practice degree in Clinical Nutrition designed for the Registered Dietitian Nutritionist (RDN). It is a web based, 31 credit degree program that focuses on advanced clinical knowledge, practice and research needed for innovative and inter-professional practice and leadership in the dynamic health care environment.

    Click HERE for more information

  • 20 Feb 2016 6:48 AM | Nancy McMahon

    Good morning!

    We are in need of nominations of members for the following positions: Chair-Elect, Treasurer-Elect, Secretary, By Laws, Awards, and Nominating committee.

    If you would like to nominate a member, including yourself, please contact Paula Hopkins or Nancy McMahon.

    Thank you.




  • 08 Dec 2015 12:53 PM | Pat Finnerty

    Does anyone have a good menu program that you use in your facilities?  We have one from US Foods that is not that good.

    Thanks!

  • 09 Oct 2015 2:23 PM | Cheryl Ann Macellaro

    Hello. Does anyone know of any New Jersey RDN who has diet prescription writing priveleges in their facility. Please send their name and contact number to my cell or email: macelc57@yahoo.com. Thanks. Cheryl Macellaro, RDN

     

     

  • 06 Oct 2015 9:02 PM | Mary Chambers

    I'm interested in talking with the present RD or former RD from either of these LTCF. One of my accounts is being bought by Marquis Health Services . I am aware that Burnt Tavern nursing Home in Brick and Oakland Care were also bought out by this group. Just wanted to get heads up to my future.

    Thank you,

    Mary Chambers, RDN

    908-902-7069

    Mchambersrd@verizon.net

     

     

  • 16 Sep 2015 10:15 PM | Mary Lou Bialon

    Contact Mary Lou Bialon,MS,RD,CSG, if you are interested in working approximately 16 hours per week in South Jersey area at a LTC/ Sub-acute facility.  Hours are flexible . A wonderful opportunity to grow your consulting business.  856-905-0221. 

  • 22 May 2015 10:22 PM | Anonymous

    Click on the "Legislation" tab to learn more about NJDA's Advocacy Day on 6/22/15.

  • 22 May 2015 1:31 PM | Barbara Spencer

    Virtua Berlin rehab and Long term care willbe having an opening.


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