Registered dietitians cut hospital nutrition order errors

By Ingrid Grasmo

Registered dietitians (RDs) are faster and more accurate than other hospital staff when entering physician-approved nutrition-related orders, show study findings.

"The difference in error rates supports that RDs are qualified and knowledgeable at accurately entering diet orders for the patients they have assessed," say Mary Keith (St Michael's Hospital, Toronto, Ontario, Canada) and colleagues.

For the study, the researchers performed a retrospective chart audit to document the error rate in nutrition-related orders placed before (n=672) and after (n=633) implementation of RD diet order entry in high-risk inpatient units within an acute care teaching hospital in Toronto.

Prior to providing RD access to nonmedication order entry, 377 of 672 orders reviewed contained at least one error, corresponding with an overall error rate of 56%, which decreased to 41% following the change in policy.

Analysis of the individual error types revealed that a significant decrease in the frequency of four of the 10 included error types, including improper terminology (14 to 11%), transcription of orders from the medical chart into the electronic system (25 to 17%), use of the free-text comments box (16 to 12%), and ordering via the message function (8 to 5%).

Following implementation of the new policy, each order entered by an RD contained significantly fewer diet order errors compared with those entered by registered nurses (RNs)and clerical assistants, at 0.25 versus 1.05 and 1.10, respectively.

When the researchers analyzed the time delay of order entry, they found that prior to RD order entry, the median time delay for RNs and clerical assistants was 2.62 hours and 2.17 hours, respectively. No significant difference in this time delay was seen following the policy change, but RDs had a significantly lower median time delay of 0.22 hours.

Overall, a 39% reduction in the average time delay after RD order entry access was observed, from 9.1 to 5.7 hours.

Writing in the Journal of the Academy of Nutrition and Dietetics, the team concludes: "It is imperative that RD access to electronic diet order entry systems be promoted and supported in hospitals where these systems exist or are contemplated, as RDs are critical players in the advancement of patient care."

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