Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin-Pierce

Clinical Mentor

Dr. Mark Sloan

Committee Member

Dr. Terry Lennie


PURPOSE: The purpose of this study is to evaluate the effects of enhanced ordering privileges among registered dieticians (RD) on oral nutritional supplement (ONS) ordering frequency and prevalence of oral nutritional supplement use among elderly patients admitted with heart failure (HF).

METHODS: This study was a single facility, retrospective pre-post implementation evaluation of the impact of expanded ONS ordering privileges among elderly patients (age ≥ 65 years old) hospitalized with heart failure at Frankfort Regional Medical Center (FRMC). The sample consisted of 105 patients for the pre-evaluation period and 259 for the post-evaluation period.

RESULTS: There were no differences among groups in age, sex, ethnicity, total comorbidity burden, LOS or BMI. Post group patients received more nutritional assessments (P=.05), but not more ONS. ONS ordering did not differ by provider. Nutritional risk did not predict ONS ordering, but receiving full nutritional assessment did predict ONS ordering.

CONCLUSION: Expanded dietary ONS ordering privileges are consistent with the literature, but it was not effective at improving the use of ONS. The nutritional risk screening and process for full nutritional assessment remains open for improvement. An interdisciplinary team including the advance practice nurse to champion the development of a nutritional risk screening process using a validated assessment tool and then subsequent evidence-based interventions is needed. Nutritional assessment must determine nutritional risk to facilitate ONS ordering, not risk determining assessment.