Medical directive: authorizing dietitians to write diet and tube-feeding orders.

Dietitians working with patients in hospital settings are recognized experts in clinical nutrition. However, the diet and tube-feeding ordering process varies among hospitals and can present barriers to expeditious, effective patient care. When dietitians are granted full authority to implement their nutritional recommendations, they can write diet and tube-feeding orders on the physicians order sheets, change existing physician orders, and implement orders immediately, without a physician s co-signature. This article describes the process whereby the dietitian team at the Toronto Rehabilitation Institute became authorized through a medical directive to write diet and tube-feeding orders. Full authorization to write diet and tube-feeding orders is groundbreaking for the dietetic profession because it expedites patient-centred care and expands the dietitian s responsibilities beyond the traditional sphere of clinical dietetic practice.