Nutrition diagnosing and order writing: value for practitioners, quality for clients.

h w a b l u c ( lthough the words have changed today from recognition to value, the issue for our profession continues to be one of respect—and indispensability (1). Recent articles in this ournal have addressed the need to increase the value of the rofession (1,2). Some have discussed expanding clinical privleges, including nutrition diagnosing and order writing. Similar iscussions go back years as part of the general theme of imroving professional status and the scope of dietetics practice. n 1988, Koteski and McKinney (3) suggested expanding ealth-related tasks to increase understanding and respect for he contributions of dietitians. To be truly valued, and thus indispensable, dietitians must ontinuously demonstrate that nutrition services are critical to he process and delivery of quality health care. Both Braunchweig and colleagues (4) and Weddle and colleagues (5) emonstrated better patient outcomes, including improved nuritional status, when dietitian recommendations were folowed. Yet, nutrition care today too often relies on implemenation by other health care providers. Skipper and colleagues 6) showed that physicians implemented only 42% of 865 writen dietitian recommendations in Greater Philadelphia area ospitals. Even more concerning, Hagan and colleagues (7) ound that, after dietitians wrote recommendations for dietary hanges to physician-written nutrition orders in a teaching hosital, physicians revised only 39% of these orders. Thus, at imes, current practice fosters barriers to efficacious nutrition are and diminishes professional respect for dietitians. Without utrition diagnosing and order writing, nothing much will