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Consult to Nutrition - Adult/Pediatric ‐ Ambulatory [155]

Consult to Nutrition - Adult/Pediatric ‐ Ambulatory [155] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols




Delegation Protocol Number: 155

Delegation Protocol Title: Consult to Nutrition - Adult/Pediatric - Ambulatory

Delegation Protocol Applies To:
UW Health Primary Care and Specialty Clinics

Target Patient Population:
Adult and pediatric patients requiring or requesting nutrition counseling or education.

Delegation Protocol Champions:
Elizabeth Trowbridge, MD – Department of Medicine – Internal Medicine
Sandra Kamnetz, MD – Department of Medicine – Family Medicine
Megan Waltz – Director, Culinary and Clinical Nutrition Services

Delegation Protocol Reviewer:
Melody Cole, MS, RDN, CD, CDE – Clinical Staff Education

Responsible Departments:
Department of Culinary and Clinical Nutrition Services

Purpose Statement:
This protocol delegates authority from the patient’s UW Health Primary Care Provider to Registered
Nurses (RNs) and Pharmacists (RPhs) to place Consult to Nutrition orders for nutrition counseling or
education.

Who May Carry Out This Delegation Protocol:
RNs and RPhs trained in the use of this delegation protocol.

Guidelines for Implementation:
1. This protocol is initiated when patient requests nutrition counseling or education or the RN/RPh
determines the patient could benefit from a consult to nutrition. Indications for the consult
include but are not limited to:
1.1. Prediabetes
1.2. Hypertension
1.3. Hyperlipidemia
1.4. Newly or previously diagnosed patients with heart disease
1.5. Food allergies
1.6. Gastroenterology related diseases such as Celiac, Irritable Bowel Syndrome
1.7. Hypothyroid
2. When a qualifying patient has been identified the RN/RPh will place the consult order in Health
Link. If there is no diagnosis for indication the RN/RPh will consult with the provider.
3. RN/RPh will inform patient to check with insurance provider for coverage.

Order Mode: Protocol/Policy, Without Cosign

Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org




References:
1. Medical Nutrition Therapy (MNT) (2009). (n.d.). Retrieved August 02, 2016, from
https://www.andeal.org/topic.cfm?menu=3949
2. Medical Nutrition Therapy Effectiveness (MNT) (2013-2015). (n.d.). Retrieved August 02, 2016
from https://www.andeal/org/topic.cfm?menu=3808
3. Standards of Medical Care in Diabetes—2013. (2012). Diabetes Care,36(Supplement_1).
doi:10.2337/dc13-s011. http://care.diabetesjournals.org/content/34/Supplement_1S11.full

Collateral Documents/Tools: NA

Approved By:
UW Health Ambulatory Protocol Committee: September 2016
UW Health Nutrition Committee: September 2016
UW Health Center for Clinical Knowledge Management Council: January 2017
UWHC Medical Board: March 2017
UW Health Chief Medical Officer: March 2017

Effective Date: March 2017

Scheduled for Review: March 2020


Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
12/2017CCKM@uwhealth.org