Diet Order Entry by Registered Dietitians Results in a Reduction in Error Rates and Time Delays Compared with Other Health Professionals


      In January 2009, registered dietitians (RDs) at St Michael's Hospital (Toronto, Ontario, Canada) were granted approval for nonmedication order entry of physician-approved nutrition-related orders for the patients to whom RDs provided care. The aim of this project was to document any changes in the numbers and types of diet order errors and time delays that were associated with this policy change. A retrospective chart audit was conducted to document the error rate in 672 nutrition-related orders placed before, and in 633 orders placed after, implementation of RD diet order entry on high-risk inpatient units. Error rates for all nutrition-related orders decreased by 15% after RD order entry access (P<0.01). Error rates for diet orders entered by RDs were significantly lower in comparison with those entered by clerical assistants or registered nurses (P<0.001). Time delays for orders electronically entered were reduced by 39% (from 9.1 to 5.7 hours; P<0.01). Allowing RDs access to the electronic order entry system has improved overall timeliness of nonmedication order entries and improved patient safety by decreasing error rates in diet orders. This study supports this institutional policy change and provides evidence that RDs have the knowledge and skills to accurately process nonmedication order entries for the patients they have assessed. Finally, the current findings support the need for ongoing education and training of all health professionals in nonmedication order entry to reduce errors and improve safety.


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      K. Imfeld is a clinical dietitian, Trillium Health Centre, Mississauga, Ontario, Canada; at the time of the study, she was a clinical dietitian, St Michael's Hospital, Toronto, Ontario, Canada.


      M. Keith is the coordinator of nutrition and dietetic education/research and an associate scientist, Keenan Research Centre in the Li Ka Shing Knowledge Institute, St Michael's Hospital, and an assistant professor, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.


      L. Stoyanoff is a interim CBORD coordinator, St Michael's Hospital, Toronto, Ontario, Canada.


      H. Fletcher is manager of patient food services, St Michael's Hospital, Toronto, Ontario, Canada.


      S. Miles is manager of academic affairs and a clinical dietitian, St Michael's Hospital, Toronto, Ontario, Canada; at the time of the study, she was an interim professional practice leader−dietetics, St Michael's Hospital, Toronto, Ontario, Canada.


      J. McLaughlin is retired; at the time of the study, she was chief supply chain officer and director of support services, St Michael's Hospital, Toronto, Ontario, Canada.