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/policies/clinical/uw-health-clinical/med-records/patient-care-orders/341.policy

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Policies,Clinical,UW Health Clinical,Medical Records and Communication,Patient Care Orders

Diet Orders (3.4.1)

Diet Orders (3.4.1) - Policies, Clinical, UW Health Clinical, Medical Records and Communication, Patient Care Orders

3.4.1


UW HEALTH CLINICAL POLICY 1
Policy Title: Diet Orders
Policy Number: 3.4.1
Category: UW Health
Type: Inpatient
Effective Date: October 26, 2015

I. PURPOSE

To establish guidelines for ordering, confirming and processing diet orders for hospitalized patients.

II. POLICY ELEMENTS

All patients, regardless of their nutritional status or need, receive an order for food or other nutritional
product (s), as appropriate. Food and nutritional products are provided only on the order of a medical staff
member w ith clinical privileges, an authorized Graduate Medical Education member, physician assistant w ith
a supervising physician, or healthcare practitioner granted order w riting privileges per physician delegation.
Professionals w riting orders pursuant to delegation from physicians are w ithin the scope of delegation from a
physician authorized by a policy or protocol approved by the Medical Board. The UWHC Administrative
Policy #8.16, Patient Care Orders, specif ies the persons authorized to w rite orders and procedures for
communicating directives for patient care including acceptance and authentication of all verbal orders.

Prescriptions or orders for food and/or nutritional products are consistent w ith guidelines in the approved diet
manual for UWHC – Academy of Nutrition and Dietetics (AND) Adult Nutrition Care Manual (adults), and the
AND Pediatric Nutrition Care. The manuals represent a complete selection of diets, including enteral
nutrition (EN) and parenteral nutrition (PN) typically ordered for adult and pediatric hospitalized patients. All
patient care units, ambulatory clinics, and UWHC healthcare staff have online access to the manuals
through Health Link and U-Connect intranet department site.
The admitting diet order is Nothing Passes Orally (NPO). A physician order for food and/or nutritional
products is in the patient's medical record before any subsequent food is administered to the patient.
Patients’ cultural, religious and ethnic food preferences are honored, w hen possible, unless contraindicated.

Culinary and Clinical Nutrition Services has the authority and responsibility to provide meals and nutrition
care to the patients based on information electronically transmitted through computerized order entry/diet list
and nutrition w ork lists.

Implementation of Health Link
Any provisions of this policy related to paper records and forms shall be superseded by the applicable
electronic processes in all areas w here such electronic process have been implemented. Any signing
required by this policy can be accomplished by electronic signature or by the steps specif ied in other
approved policies and protocols.

III. PROCEDURE

A. NPO - Admit Diet in Effect is the diet order for all patients at the time of admission until a physician diet order
is w ritten. Diet orders as prescribed by the physician or designee in Health Link CPOE are transmitted
through real time interface to the CBORD Room Service System.
B. Physicians or designees order diets consistent w ith guidelines established in the AND Adult Nutrition Care
Manual and the AND Pediatric Nutrition Care.
C. A room service classif ication is automatically assigned w hen the diet is ordered. The classif ications include:
i. Room service eligible (RS1)
ii. Room service eligible w ith assistance (RS2)
iii. Not Eligible Room service non-select (RS3)
D. A diet order of NPO is assigned a RS3. All other diet orders are assigned a RS1. Classif ication is based on
limiting factors but may change at any time during the hospital stay.
E. Nursing personnel confirm admission, subsequent diet orders, and room service classif ication. Nursing also
assess each patent's ability to participate in room service and change the classif ication designation in Health
Link order entry as appropriate.
F. Nursing personnel are responsible for verifying all diet orders including NPOEN, and PN in a timely manner.
i. With the automation of the diet off ice functions, diet orders are transmitted in real time from Health
Link to the CBORD Room Service System through an interface. Therefore, telephone calls to



UW HEALTH CLINICAL POLICY 3
Policy Title: Diet Orders
Policy Number: 3.4.1

Culinary and Clinical Nutrition Services regarding diet order changes are not honored.
ii. Each patient care unit prints a Diet List prior to each meal as a reference for room service staff so
meal trays are delivered compliant w ith the current diet order.
iii. Process during and follow ing dow ntimes:
a. Phone dow ntime:
1. Room Service Clerks receive paper orders from patient units and enter
them in CBORD system to facilitate meal delivery.
2. Room Service Clerks update room service information into CBORD as
needed.
3.
b. Health Link dow ntime:
1. The diet is ordered on Physicians Order Sheet by a physician or by the
designee of the physician to be counter-signed by the physician.
2. When Health Link recovers, Culinary and Clinical Nutrition staff w ill
enter/recover diet/nourishment/supplement orders into Health Link.
3. The American Center: Patient meal orders are called to the kitchen by
patient’s Registered Nurse (RN), culinary staff verif ies the diet order
w ith the RN and documents RN name on meal ticket, also verif ies
correct diet order in CBORD and changes if necessary. Culinary staff
enters meal order into CBORD and delivers to patient f loor.

G. Clinical nutritionists concurrently review the appropriateness of the choice of food and nutritional products for
the patient and the patient's therapeutic regimen, including a review of appropriateness of the route of
administration. Questions or discrepancies are discussed w ith the physician prior to making changes.
H. Clinical nutritionist order protein modulars to be added to foods as needed to ensure patient’s nutrition
needs are met.
I. Culinary and Clinical Nutrition Services prepares and delivers food and nutrition products as appropriate to
patients to provide the care, treatment, and services needed.

IV. FORMS

EMR: Health Link-CPOE, Clinical Documentation, and Reports
Health Link Diet List/Clinical Nutrition System Lists
CBORD Reports
Health Link and Phone Dow ntime Forms

V. COORDINATION

Author(s): Director, Culinary and Clinical Nutrition Services
Senior Management Sponsor: VP, Facilities and Support Services and SVP, Patient Care Services and
CNO
Approval committees: UWHC Medical Board Nutrition Committee; UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: September 21, 2015

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Jeff Grossman, MD
UW Health CEO

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee




UW HEALTH CLINICAL POLICY 3
Policy Title: Diet Orders
Policy Number: 3.4.1

VII. REFERENCES

Medical Staff Bylaw s, Rules and Regulations.
AND Adult Nutrition Care Manual (w eb-based multi-user subscription)
AND Pediatric Nutrition Care Manual (w eb-based multi-user subscription)
Patient Care Protocols – Inpatient Delegation (tube feeding management, diet and nourishment order
w riting, dysphagia diet progression, and parenteral nutrition support).
TJC Accreditation Manual for Healthcare Organization, Provision of Care, Treatment, and Services

VIII. REVIEW DETAILS
Version: Revision
Next Revision Due: February 26, 2018
Formerly Know n as: Hospital Administrative policy 3.10