QOTW – QUESTION OF THE WEEK: CMS Regulations and Dietitians Ordering Therapeutic Diets

Has the final rule been published regarding CMS allowing dieticians to order diets independently?

The Centers for Medicare & Medicaid services (CMS) issued a final rule on May 2, 2014, that reforms Medicare regulations and certain regulations under the Clinical Laboratory Improvement Amendments of 1988 (CLIA)  identified as unnecessary, obsolete, or excessively burdensome on hospitals and other health care providers.

As a part of this final rule, CMS is permitting registered dietitians and other clinically qualified nutrition professionals to be privileged to order patient diets under the hospital Conditions of Participation (482.28).

This Final Rule became effective 60 days after the date of its publication in the Federal Register on May 12, 2012 ( Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction; Part II).

Related Products from MCN:
Nutritional Services Policy and Procedure Manual

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FDA warns Consumers about Fraudulent Ebola Treatment Products

Miracle DrugThe U.S. Food and Drug Administration (FDA) is advising consumers to be aware of products sold online claiming to prevent or treat the Ebola virus. Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection.

There are currently no FDA-approved vaccines or drugs to prevent or treat Ebola. Although there are experimental Ebola vaccines and treatments under development, these investigational products are in the early stages of product development, have not yet been fully tested for safety or effectiveness, and the supply is very limited. There are no approved vaccines, drugs, or investigational products specifically for Ebola available for purchase on the Internet. By law, dietary supplements cannot claim to prevent or cure disease.

Individuals promoting these unapproved and fraudulent products must take immediate action to correct or remove these claims or face potential FDA action.

Individuals who have seen these fraudulent products or false claims are encouraged to report them to the FDA.

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MCN Learning: A New Perspective

I am sure that many nurses have had individuals seek them out to discuss health problems. At times the sharing of information by individuals with whom I see sporadically is limited to pleasantries however recently I’m finding that more individuals want to talk with me about their ailments.

These conversations are occurring in places where the sharing of personal information is less than optimal, such as while attending a car show or waiting to cross the street. When the most recent episode occurred I asked the individual why they felt the need at this particular time to talk with me about their health problems. The response was not what I expected…

One individual had just been released from the hospital after having symptoms of an aneurysm. This older lady was nearly shaking as she explained her symptoms and the treatment she received. After listening to her she simply thanked me for taking the time to hear her story. She was getting teary-eyed and apologized for the emotion but she just wanted to talk with someone in healthcare who understood what she had just gone through. She stated that her doctor didn’t have the time to answer any questions or explain what was going on. The nurses were overworked and because her situation was not dire, she was quickly discharged with minimal information as to what had just transpired.

This situation caused me to reflect on one of the greatest skills that nurses possess – communication. Communication is a complicated concept and has many stages, characteristics, and approaches however nurses are as a group, expert communicators. Because of this I was confused as to why this older lady felt that no one had the time to communicate what was going on with her health.

This older person made an observation about nurses that is becoming more and more of an obstacle in patient care – nurses are overworked. Nurses have always been juggling more than desirable numbers of patients when providing care. For decades, nurses have been expected to perform treatments, change dressings, monitor intravenous fluids, and provide medications all while teaching the patient about the care being delivered. And then, nurses sit down to document everything that had just transpired in any particular period of time. I believe the use of the term overworked is an understatement…

Yes nurses perform technical skills and somehow just know what do when a patient situation takes a turn for the worse however as a profession, we sell ourselves short. We do much more than implement the physicians’ orders. We assess the patient’s status, we determine what problems the patient is experiencing, we plan interventions to address these problems, and we evaluate if the interventions worked. If they did then the problem is solved. It the interventions didn’t work, we plan new ones and try again. Anyone with minimal observational skills can see that this is a tremendous amount of work to do for one patient let alone a group of possibly 6 or 10.

As I related to the older lady who shared her most recent medical experience, the nurse did not want to send her away without some type of explanation or support. The nurse had to make a decision as to which patient needed the most care at that particular time. And since the patient was stable and actually received good news, the other patient who possibly wasn’t breathing or whose heart stopped beating needed attention first.

For years the profession of nursing has been sitting in the shadow of the medical profession and I believe that it is time that this behavior stops. Nurses are unique individuals who tend to place everyone else’s needs before their own. Nurses don’t take lunch most of the time, forget breaks, and neglect natural bodily functions because patient care comes first. Nurses have to synthesize data to come up with plans and solutions to problems all while walking down the hall to answer yet another call light. I’ve never seen another healthcare professional do that and I know I never will.

Even though National Nurses Day occurred months ago, I felt it was important to reiterate the importance of nurses in today’s healthcare arena. Yes most nurses have too much to do however they will always make time to listen or help someone else. This is selflessness in action.

So as we each travel our respective journeys in healthcare, may we all know that we are appreciated and needed – even when waiting for a light to change to cross a busy intersection. And just for today, embrace a nurse while you embrace the day!

Check out this and other articles at the MCN Learning blog.

Contributed by
Dawna Martich, MSN, RN
Director of Education

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