Are South African registered dietitians ready to take responsibility for prescription of parenteral nutrition and intravenous nutrients?
Abstract
Objective: To assess registered dietitians’ (RDs’) knowledge of their right to prescribe parenteral nutrition (PN) and intravenous nutrients (IVN) to adults, while exploring associated attitudes and practices.
Design: A mixed-methods approach included a descriptive study design and semi-structured interviews.
Setting: Dietitians registered with the Health Professions Council of South Africa, working in government and private sectors.
Subjects: Registered dietitians (n = 145), mostly female (95%), participated in an online self-administered questionnaire and semi-structured interviews (n = 6).
Results: Most participants (64%, n = 93/145) actively recommend PN/IV nutrients and felt RDs should have the authority to prescribe (77%, n = 108/140). Only 11% (n = 11/104) had a good knowledge score > 65%. Those practising for ≥ 7 years or with additional training demonstrated significantly better knowledge scores (p < 0.001 and p = 0.002), emphasising the need for additional training (PN: p = 0.019; IV nutrients: p = 0.018). Qualitative and quantitative findings underscored RDs’ pivotal role in PN/IV nutrients prescription. It also revealed knowledge gaps pertaining to pharmaceutical aspects, IV nutrients, and prescribing rights. Participants agreed that prescription of IV nutrients remains the doctor’s responsibility but emphasised the importance of multidisciplinary nutrition support teams.
Conclusion and implication: There was a disparity between RDs’ perceived competence and their actual knowledge of PN and IV nutrients. Registered dietitians need more education and training to ensure their competency and confidence in the discussion, recommendation, and management of PN and IV nutrients for adults. The research suggests a need for clarity on legal responsibilities in prescribing rights to ensure consistency in prescription practices between healthcare professionals and health sectors in South Africa.
Keywords: attitudes, dietitians and prescription, intravenous nutrients, knowledge, parenteral nutrition, practices
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