Abstract
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Will electronic order entry reduce health care costs?.Eff Clin Pract. 2002; 5: 67-74
- To Err is Human: Building a Safer Health System.National Academies Press, Washington, DC2000
- Immediate benefits realized following implementation of physician order entry at an academic medical center.J Am Med Inform Assoc. 2002; 9: 529-539
- The state of the evidence for computerized provider order entry: A systematic review and analysis of the quality of the literature.Int J Med Inform. 2009; 78: 365-374
- The impact of computerized provider order entry systems on in patient clinical workflow: A literature review.J Am Med Inform Assoc. 2009; 16: 539-549
- Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals.J Med Syst. 2012; 36: 241-277
- Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system.J Am Med Inform Assoc. 1999; 6: 234-244
- The impact of computerized physician order entry on medication error prevention.J Am Med Inform Assoc. 1999; 6: 313-321
- Role of computerized physician order entry systems in facilitating medication errors.JAMA. 2005; 293: 1197-1203
- Medication administration technologies and patient safety: A mixed-method systematic review.J Adv Nurs. 2011; 67: 2080-2095
- Development and implementation of the Clinical Privileges for Dietitian Nutrition Order Writing program at a long-term acute-care hospital.J Am Diet Assoc. 2002; 102 (79-81): 72-74
- Nutrition informatics.J Am Diet Assoc. 2006; 106: 134-139
- Design and implementation of a computerized diet order entry system for a hospital.J Am Diet Assoc. 1990; 90: 93-95
- Types of unintended consequences related to computerized provider order entry.J Am Med Inform Assoc. 2006; 13: 547-556
- 2009 Canadian Health Accreditation Report: A Focus on Patient Safety, Using Qmentum to Enhance Quality and Strengthen Patient Safety.Accreditation Canada, Ottawa, ON2009
- The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition.JPEN J Parenter Enteral Nutr. 2011; 35: 209-216
- Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients.Am J Clin Nutr. 2005; 82: 1082-1089
- Early and sufficient feeding reduces length of stay and charges in surgical patients.J Surg Res. 2001; 95: 73-77
- Implementation of dietitian recommendations for enteral nutrition results in improved outcomes.J Am Diet Assoc. 2006; 106: 281-284
- Exploring patient satisfaction with foodservice through focus groups and meal rounds.J Am Diet Assoc. 2003; 103: 1347-1349
- Measurement of patient satisfaction in a public hospital in Ankara.Health Serv Manage Res. 2001; 14: 27-35
Biography
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.
Biography
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.
Biography
L. Stoyanoff is a interim CBORD coordinator, St Michael's Hospital, Toronto, Ontario, Canada.
Biography
H. Fletcher is manager of patient food services, St Michael's Hospital, Toronto, Ontario, Canada.
Biography
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.
Biography
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.
Article info
Publication history
Published online: July 11, 2012
Accepted:
May 7,
2012
Available online 11 July 2012Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There was no funding for this project. The project was supported by the Chief Supply Chain Officer and Director of Support Services at St Michael's Hospital.
Identification
Copyright
© 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
