[Dysphagia] writing orders

[RingoCC at comcast.net (Carol Ringo)]

At our acute care hospital we instituted "post swallow evaluation
pre-printed orders for diet recommendations."  The SLP checks off the
recommended diet texture, liquid consistency, aspiration precautions, and
recommendations for oral med administration.  There is also a check box for
recommending a VFSS.  The orders state "These orders take effect
immediately," or words to that effect.  At the bottom of the order sheet,
the physician checks off either "Continue with above recommendations" or
"Change above recommendations as follows __________," and is supposed to
sign within 24 hours.  The physician also may check off a box to order VFSS.
When we originally presented this to a group of the physicians, they
uniformly stated that they would never wish to change the recommended diet
consistency, having ordered the SLP evaluation for precisely that purpose.
However, it was dictated from the powers on high that no one except
physicians, ARNPs, PACs, etc. could write in the orders section, despite the
fact that the physicians had been encouraging us to do it for years.  This
new system works well.  Of course, the docs don't always sign the orders,
any more than they always sign off on VOs and TOs, but that's someone else's
problem!

Carol Ringo, Ph.D., CCC-SLP
Concord Hospital
Concord, New Hampshire



-----Original Message-----
From: dysphagia-bounces@b9.com [mailto:dysphagia-bounces@b9.com] On Behalf
Of Patti Larghi
Sent: Tuesday, May 09, 2006 7:45 PM
To: Dysphagia@b9.com
Subject: [Dysphagia] writing orders 

I think this topic has been addressed on this list serve before but I would 
like to reviist it.  I work in an acute care hospital setting. I am often 
faced with the problem of making a simple diet texture and or liquid 
consistency adjustment by obtaining a telephone order from a difficult to 
reach physician. It has always been my understanding that this can only be 
done with a physician's order and physicians are the only ones allowed to 
write orders.That being said our dietary department recently wrote a policy 
stating that a registered dietician could adjust diet texture or write 
orders for supplements. This was approved by the Pharmacy and Therapeutics 
Comittee and then by the Medical Review Board.
Orders are now written by dietician to adjust diet textures, po supplements 
etc. This is only after a diet has been intiated by the physician.
I would like to do something similiar to this which would allow the Speech 
Pathologists to write orders to change the texture of an existing diet and 
the viscosity level of  liquids. This would be referenced to the national 
dysphagia diet standards.
Now for the question. Has any one had success with implementing this type of

protocal?  I realize we all  have physicans  that we work with regularly 
which give us blanket telephone orders priviledges,but I would like to make 
this avaliable as a protocal which pertains specifically to the SLP staff to

make this change independently.
Thanks in advance for any feed back.
Patti Larghi
Speech Pathologist
Memomrial Health Care System


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