May 16, 2014

Be Careful of Your Food If In the Hospital

One of the members of our support group and another friend are both in the hospital this week. Our member, A.J. is recovering from an auto accident in which he had both arms broken and other injuries. The other friend was working in his yard and being near the street, had a motorcycle hit him when the operator lost control. Most of his injuries were internal, but the operator of the motorcycle was less fortunate and lost his life.

What is surprising is both were visited by the hospital dietitian and put on high carb/low fat meal plans. Both have complained that this is not good for them, as the internal injuries have created a need for a liquid diet for my friend as he was being fed through a tube for the first three days and his doctor wants him to remain on a liquid diet for several more days. He got his diet changed by the doctor, but the doctor had a battle with the dietitian.

A.J. had the problem that he is used to a low carb/high fat diet meal plan and had to refuse food until he was able to have a nurse call Tim and Barry and tell them that he was in the hospital. When more of us were notified once Tim arrived at the hospital, we arrived and there were eight of us in his room. Since it was Saturday, we were surprised to have the dietitian walk in and start ordering that he eat the food from the hospital.

Tim stepped out of the room and called Dr. Tom. We were fortunate that he was in the hospital and came quickly. The dietitian started informing Dr. Tom that she was in charge of nutrition and the patients would eat what she prepared. Tim and Allen were entering the information for the food on the tray and both could only guess at the weight, but both arrived at over 130 grams of carbohydrates. Dr. Tom said A.J. is a person with type 2 diabetes and that his food plan should be allowed.

At that point, the dietitian informed us that a new rule issued by the Centers for Medicare and Medicaid Services gave registered dietitian nutritionists the ability to now work more independently in hospitals, providing patients with more effective and efficient nutrition care thanks to the final rule on therapeutic diet orders. She said she would be filing a complaint that her nutritional expertise was being ignored by patients and doctors.

No one had noticed Allen and Barry leaving and when they returned about 40 minutes later, they had prepared a meal for A.J.  A.J. had asked Dr. Tom for a prescription of metformin while he would be in the hospital, as he would not be able to exercise and wanted to keep his blood glucose managed. A.J. took one 500 mg of metformin and asked to be fed. Allen said that the meal had 30 grams of carbohydrates and A.J. said he had guessed about 35 grams.

Since Tim had his laptop, I asked him to go to this article and after he found it, he started reading it aloud. When he read this, “Allowing registered dietitian nutritionists to independently order therapeutic diets and monitor and manage dietary plans for their hospital patients will save the country hundreds of millions of dollars and also help hospitals provide better multidisciplinary care,” we all laughed.

Jason said this could cost more and do more health damage than what the patients needed, especially those with diabetes. When Tim finished reading the article, Dr. Tom commented that her filing a complaint could create problems. At that point, Barry had finished feeding A.J. and he said this does not sound good for patients that do not eat high carb/low fat.

I commented that when a dietitian orders solid food for a patient on a liquid diet, this is very troubling. Dr. Tom said you know about this happening. I told Dr. Tom to talk to and gave him the name of the doctor, and he could get what happened. Dr. Tom said that he had heard this, but was not sure about the details. I said the person is a friend of mine and was visiting him before receiving Tim’s call about A.J.

Barry said he would bring A.J. meals with Allen’s help. The rest of us offered money to defray the costs and A.J. said if we could do this, he would repay people when he was out of the hospital. Barry said that was not necessary, as by spreading the cost over several people should not cause a burden. Dr. Tom told us to call him if any problems arose because of our actions, as he needed to leave to see the rest of his patients.

We all looked at the time and A.J. thanked us for coming and said he needed to sleep if he could with the nurses and others coming and going all evening and night. We wished him well and Barry asked what time he wanted breakfast. We all left A.J. then. I headed for my friend’s room, said good night to him, and told him I would be back the next day.

1 comment:

alfred said...

great post. thanks