Guideline text:
(Rev. 137, Issued: 04-01-15, Effective: 03-27-15, Implementation: 03-27-15)

§482.28(b)(2) - All patient diets, including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dietitians and nutrition professionals.

## Interpretive Guidelines §482.28(b)(2)

Patient diets, including therapeutic diets, must be provided in accordance with orders from a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional who is permitted to order diets under State law and authorized to do so by the medical staff.

Diets must be based on an assessment of the patient's nutritional and therapeutic needs and documented in the patient's medical record (including documentation about the patient's tolerance to any therapeutic diet ordered).

The hospital's governing body may choose, when permitted under State law and upon recommendation of the medical staff, to grant qualified dietitians or qualified nutrition professionals diet-ordering privileges.  In many cases State law determines what criteria an individual must satisfy in order to be a 'qualified dietician;' State law may define the term to mean a 'registered dietician' registered with a private organization, such as the Commission on Dietetic Registration, or State law may impose different or additional requirements.   Terms such as 'nutritionists,' 'nutrition professionals,' 'certified clinical nutritionists,' and 'certified nutrition specialists' are also used to refer to individuals who are not dieticians, but who may also be qualified under State law to order patient diets.  It is the responsibility of the hospital to ensure that individuals are qualified under State law before appointing them to the medical staff or granting them privileges to order diets.

If the hospital chooses not to grant diet-ordering privileges to dietitians or other nutrition professionals, even when permitted under State law, the patient's diet must be prescribed by a practitioner responsible for the patient's care. In this situation, a dietitian or nutrition professional who does not have privileges to order diets may nevertheless assess a patient's nutritional needs and provide recommendations or consultations for patients to a practitioner responsible for the care of the patient.

## Survey Procedures §482.28(b)(2)

- Review patient records to verify that diet orders are provided as prescribed by the practitioner(s) responsible for the care of the patient, a qualified dietitian, or qualified nutrition professional.
- If diet orders are prescribed by a dietitian or other nutrition professional, review their records to verify that he or she was appointed to the medical staff with diet-ordering privileges, or was granted diet-ordering privileges without being appointed to the medical staff.
- o Ask the hospital how it determines whether the dietician/nutrition professional is qualified under state law.  Review staff records to verify that dieticians/nutrition professionals demonstrate the required qualifications.

Structured rule (JSON):
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