Answer:
Effective July 1, 2018 the ordering of therapeutic diets is addressed in the Dietetics/Nutrition Practice Act. Under N.C. General Statute § 90-365 a license is required to provide medical nutrition therapy. Medical nutrition therapy is defined under N.C.G.S. § 90-352(3a) as the provision of nutrition care services for the purpose of managing or treating a medical condition. Per section (4) of § 90-352 nutrition care services are defined as:
Further statutory guidance regarding enteral and parenteral nutrition therapy is provided in N.C. General Statute § 90-365.6 where it is stated:
(a) Enteral and parenteral nutrition therapy shall consist of enteral feedings or specialized intravenous solutions and shall only be ordered by an individual licensed under this Article who meets one of the following criteria:
(1) The individual is a Registered Dietitian Nutritionist registered with the Commission on Dietetic Registration.
(2) The individual is a Certified Nutrition Support Clinician certified by the National Board of Nutrition Support Certification.
(3) The individual meets the requirements set forth in the rules adopted by the Board.
(b) Nothing in this Article shall be construed to limit the ability of any other licensed health care practitioner in this State to order therapeutic diets, so long as the ordering of therapeutic diets falls within the scope of the license held by the health care practitioner.
In accord with the amended Practice Act, the NCBDN regulations, found under Title 21, Chapter 17, of the NC Administrative Code, have been updated to provide the following definition for “nutrition assessment.”
"Nutrition assessment" means:
(A) the initial and ongoing, dynamic, and systematic process of obtaining, verifying, and interpreting biochemical, anthropometric, physical, nutrigenomic, clinical, and dietary data to determine nutritional needs and order therapeutic diets, including enteral and parenteral nutrition;
(B) the ordering of laboratory tests related to the practice of nutrition and dietetics; and
(C) the conducting of a swallow screen.
(D) The collection of data does not, by itself, constitute nutrition assessment.
It is important to keep in mind that all licensees of the NCBDN are expected to abide by the Code of Ethics for Professional Practice and Conduct as outlined in 21 NCAC 17.0114. This includes, but is not limited to, assuming responsibility and accountability for personal competence in practice, continuously developing and enhancing expertise through education, and recognizing personal limitations, in addition to recognizing and exercising professional judgment within the limits of the licensee's qualifications and not accepting or performing professional responsibilities which the licensee knows or has reason to know that he or she is not qualified to perform.
With the Code of Ethics in mind, the NCBDN advises that as licensees, if asked to order patient diets independently, without requiring the supervision or approval of a physician or other practitioner, licensees ensure: they are competent to do so, they become part of the medical staff or receive privileges from the hospital or long-term care facility to order therapeutic diets, and that writing such orders is addressed within a clear protocol or policy adopted by facility.
Helpful AND documentation regarding the 2014 CMS order writing regulation changes is found below:
Practice Tips – AND Standards of Practice Document
Practice Tips – RDs and Hospital Privileges 2015
Practice Tips – RDs and Nutrition (Diet) Order Writing 2015
