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F808

(Rev. 173, Issued: 11-22-17, Effective: 11-28-17, Implementation: 11-28-17)

§483.60(e) Therapeutic Diets

§483.60(e)(1) Therapeutic diets must be prescribed by the attending physician.

§483.60(e)(2) The attending physician may delegate to a registered or licensed dietitian the task of prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by State law.

INTENT §483.60(e)(1)-(2) - To assure that residents receive and consume foods in the appropriate form and/or the appropriate nutritive content as prescribed by a physician, and/or assessed by the interdisciplinary team to support the resident’s treatment, plan of care, in accordance with his her goals and preferences.

GUIDANCE §483.60(e)(1)-(2)

If the residents’ attending physician delegates this task he or she must supervise the dietitian and remains responsible for the resident’s care even if the task is delegated. The physician would be able to modify a diet order with a subsequent order, if necessary.

NOTE: The terms “attending physician” or “physician” also includes a non-physician provider (physician assistant, nurse practitioner, or clinical nurse specialist) involved in the management of the resident’s care.

DEFINITIONS §483.60(e)(1)-(2)

“Therapeutic Diet” means a diet ordered by a physician or delegated registered or licensed dietitian as part of treatment for a disease or clinical condition, or to eliminate or decrease specific nutrients in the diet, (e.g., sodium) or to increase specific nutrients in the diet (e.g., potassium), or to provide food the resident is able to eat (e.g., a mechanically altered diet).

“Mechanically altered diet” means one in which the texture of a diet is altered. When the texture is modified, the type of texture modification must be specific and part of the physicians’ or delegated registered or licensed dietitian order.

PROBES §483.60(e)(1)-(2)

  • If a resident is receiving a therapeutic diet, is the diet prescribed by the attending physician or delegated registered or licensed dietitian?
  • If a registered or licensed dietitian has written the order, is this delegation by the physician allowed by State law?
  • If a resident has inadequate nutrition or nutritional deficits that manifest into and/or are a product of weight loss or other medical problems, determine if there is a therapeutic diet that is medically prescribed.

POTENTIAL TAGS FOR FURTHER INVESTIGATION §483.60(e)(1)-(2)

During the investigation of F808, the surveyor may have identified concerns with additional requirements related to outcome, process, and/or structure requirements. The surveyor is advised to investigate these related requirements before determining whether non-compliance may be present at these other tags. Examples of some of the related requirements that may be considered when non-compliance has been identified include, but are not limited to, the following:

  • §483.30(e)(2), F715, Physician Delegation to Dietitians
 
    • Determine if concerns are identified with the physician delegation/supervision of a registered or licensed dietitian
  • §483.25(g)(1)-(3), F692, Assisted Nutrition and Hydration.
    • Determine if concerns are identified regarding a resident’s nutritional status

 

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