661 Dietitian Order-writing in a Burn Intensive Care Unit

Abstract

Abstract Introduction Recent changes in Center for Medicare & Medicaid Services guidelines recommend that Registered Dietitians (RD) write nutrition-related orders for hospitalized patients. The goal is to improve patient care and assist other clinical providers. Permitted orders may include diets, enteral nutrition and monitoring along with referrals per hospital policies. RD order-writing started in our intensive care units (ICU) the past year. This study reviewed the type and number of orders written by the RD. Methods The ICU RD prospectively (January 17, 2019 – August 31, 2019) tallied RD orders including: diet and supplement changes, enteral nutrition, calorimetry, nitrogen balance and intake orders (calorie count). Orders that could have been completed by the RD but were completed by a doctor or physician assistant (PA) were also noted. Data was analyzed using descriptive statistics and results reported as percent of patient days and type of order completed. Results Results were collected on a total of 1775 patient day. The majority (1519 = 85.5%) did not require changes in nutritional intervention or monitoring (see Table). Of the 446 nutrition related orders written, the RD completed 347 (77.8%) with 99 (22.2%) completed by the PA. Changes to enteral nutrition, calorie counts and nutrition-related tests (calorimetry and nitrogen balance) the most common. The majority of changes occurred during team rounds. Conclusions Most patients did not require changes in diets, nutrition support or nutritional assessment parameters. The most common changes were stopping/starting calorie counts and adjusting enteral nutrition or nutritional monitoring. RD order-writing decreased the number of orders the MD or PA completed. Applicability of Research to Practice Order-writing protocols can assist the burn medical team with workflow and allow for more timely nutritional interventions when needed.