Registered Dietitians Now Can Write Diet Orders for Patients in Pennsylvania Hospitals
September 24, 2015
Department of Health (DOH) is set to begin implementation of a Centers for
Medicare & Medicaid Services (CMS) rule
allowing registered dietitians to write diet orders for hospitalized patients
if approved by the facility medical staff.
allows registered dietitians to fully function within their scope of practice
and expertise while preserving the ultimate authority of the physician in the
care of the patient.
Pennsylvania Department of Health, the Pennsylvania Academy of Nutrition and
Dietetics, the Pennsylvania Medical Society, and the Pennsylvania Board of
Nursing have worked to align the CMS regulations with state regulations governing
licensed dietitians to allow for implementation of this rule in the
In order to
implement the rule in Pennsylvania, hospitals must apply for an exception for the regulation regarding medical orders (107.61 Written Orders) from DOH.
DOH granted the
first exception during July 2015 under the following conditions:
- A physician member of the medical
staff will have ultimate responsibility for the patient’s care
- A physician member must first order the patient’s
diet; then delegate dietary orders to a registered dietitian who can under this
delegation alter, modify, or change the physician’s original order; and
specifically note in the medical record the delegation to the dietician to
alter, modify, or change the original order
- A registered dietitian issuing an order for a
patient’s diet must act under the direction or supervision of a physician
member of the medical staff
- The medical staff bylaws outline the rules and
regulations, qualifications, status, clinical duties, and responsibilities of
- The medical staff bylaws delineate the responsibilities of the physician members of the medical staff in relation
to registered dietitians
- The registered dietitian issuing an order for a
patient’s diet must act in accordance with the medical staff bylaws and any
rules and regulations, policies and procedures, or hospital bylaws that are
incorporated by reference in the medical staff bylaws
savings are anticipated and documented by CMS for allowing registered dietitians
to write diet orders.
Questions about the rule or applying for the exception may be addressed
to Mary Marshall, HAP’s director for workforce and professional development.