Quality Assurance Newsletter May 2020

The College has had an increased frequency of questions related specifically to provision of virtual dietetic practice during the COVID-19 pandemic. Please refer to the blog post Virtual Dietetic Practice in the age of COVID-19 and reach out to the College for any support you need.

The Continuing Competence Program is a major component of the CDBC Quality Assurance Program Framework and provides registrants with a platform to inform the College about their continuing competence initiatives throughout their career.

The CDBC Continuing Competence Program (CCP) has changed from a three-year to a yearly cycle.

The CCP section of the new CDBC website provides step-by-step instructions to help registrants complete their CCP.

Q: When is my CCP due?

All registrants will have their CCP due by March 31 yearly. Submissions will be open as of March 1, the same day that registration renewal opens.

Q: Can I simply submit my CCP on March 1 and then proceed to registration renewal? Is anyone at the College reviewing my CCP submission?

You can submit your annual CCP anytime between March 1 and March 31, but remember that you may not renew your registration unless you have first submitted your CCP. If your CCP is sent in after midnight on March 31, you will have to renew late and pay a late fee penalty.

Every year, 10% of CCPs are audited. Audits will now be completed between March 1 and May 31. If you are selected for an audit, your CCP submission will be accepted for renewal and you will receive a detailed letter explaining the audit results and any required follow up actions later in the spring. The Quality Assurance Program Framework is a preventive process (educational and non-punitive) that allows dietitians to keep practising while they provide information to the QA Committee about their practice and/or address aspects of practice that were found to need additional learning to meet the CDBC Standards of Practice. Random selection of audits follows a process of elimination annually, to ensure every registrant is audited over a period of 10 years.

Q: We were all on staggered 3-year CCPs. My last submission was October 31, 2017 while some of my colleagues just submitted in late 2018 and others early 2020. I have attended many education opportunities in the past several years. Can I use them in my next submission?

Your last CCP submission deadline will determine the Learning Activity time period from which you can draw when developing your next Professional Development Report. If you don’t know when your last CCP deadline was, you can sign into your SkilSure profile and find more information about the CCP.

Scroll down to Online Services and select ‘Continuing Competence Program’ twice. Then, select ‘Professional Development Report’. Scroll down to ‘Start Reporting’. Selection of the “year” drop-down menu will display your last CCP submission year. The content of your last report is available in read-only format.

These timelines apply to most registrants. It is possible that you had a different reporting timeline if you recently completed a reinstatement application. In that case, your new CCP reporting timeline begins when you last reinstated to Full registration. 

Q: I am a relatively new registrant. My first time submitting my CCP will be March 2021. How far back can I look in my continuing education for appropriate Learning Activities?

You can use any Learning Activities you have participated in since the time of your initial FULL registration. Once you have submitted your first CCP in March 2021, you will be on a yearly cycle, meaning that for your March 2022 submission, you can use Learning Activities that come from educational opportunities from April 1, 2021 to March 31, 2022.

Q: I just submitted my CCP? How can I have as detailed a goal in my 2021 submission as my colleague who has had several years to work on his/her goals for the same submission? Going forward, am I expected to have large goals completed within one year?

The Quality Assurance Committee carefully considered all comments received during the consultation process and updated the assessment criteria with a one-year CCP in mind that was equitable to all registrants (those with restricted activities and those without).

Although the evaluation criteria have not changed much, the Learning Goals will still follow the SMART format, which means that each of the three goals that registrants report on will have a maximum one-year timeline instead of three years. Registrants will not be expected to complete the same amount of continuing education in 1 year as they were for the 3-year CCP.

Rather, registrants will be expected to distill their learning goals into small, measurable goals that can be attained in their reporting year. Emphasis will be placed on the Learning Outcomes achieved and how these impact registrants’ practice of the standards they report on. This is meaningful to the ongoing practice of Restricted Activities and annual College oversight these higher risk areas of practice.

Q: I often collect a combination of in-person Learning Activities, as well as virtual and informal Learning Activities. I am not able to attend any in-person opportunities for continuing education due to the COVID-19 pandemic. Will the CDBC take this into account for 2020?

The College recognizes the need for you to make changes to your practice and this includes changes to the learning opportunities you may have access to. In-person conferences, meetings, courses and programs are not available to any health professional in the province at present. There are many other ways in which to access continuing education. These can include, but may not be limited to:

  • Self-directed or distance learning programs
  • Research projects with or without article publication
  • Literature searches
  • Professional reading, relevant films, audio or video recordings, webinars
  • Study, journal, or virtual discussion groups
  • Case studies
  • Mentorship/coaching/shadowing with other professionals

These activities must be kept in a Professional Portfolio, which can be via the SkilSure site or any other manner of collection you choose.

Q: Where can I see sample Learning Reports? I find them helpful in preparing my CCP.

CDBC has developed Sample Learning Reports for different areas of dietetics. These are also available on SkilSure. 

Dietitian Type:

Clinical Example 1:

Standard 12: A dietitian provides quality professional services that reflect the unique needs, goals, values and circumstances of the client.

Indicator 5: Monitor client outcomes and adapt the service plan as clients’ needs change.

SMART Goal: This year, I will increase my knowledge level regarding home blenderized tube feeds so as confidently aid appropriate home tube feeding clientele, who use commercially prepared tube feeding formula, but want to transition to blenderized tube feeding due to budgetary constraints.

Learning Activities:

  • PEN access: Reviewed “The Use of Blended Diet with Enteral Feeding Tubes” (published Nov 2019) from BDA, the Association of UK Dietitians. This included considerations on food safety, jejunal vs gastric feeding differences, and involving other members of the healthcare team as well as members of the client’s support team in the blenderized tube feed care plan.
  • Discussion with RD colleagues who have been working with home blenderized tube feeds to glean tips such as recipe modification/development to ensure that clients receive adequate macro/micronutrients and hydration.
  • Attended education session that included pump training, including adjustment of pump settings and feeding bag modification.
  • Literature review. A small example of literature reviewed:
    1. Elizabeth Bobo, Reemergence of Blenderized Tube Feedings. Exploring the Evidence, Nutrition in Clinical Practice, 31,6 (730-735), (2016).
    2. Claire Kariya, Katherine Bell, Celise Bellamy, Jason Lau and Kristy Yee, Blenderized Tube Feeding: A Survey of Dietitians’ Perspectives, Education, and Perceived Competence, Canadian Journal of Dietetic Practice and Research, 10.3148/cjdpr-2019-007, (1-5), (2019).
    3. Teresa W. Johnson, D. L. Milton, Kelly Johnson, Holly Carter, Ryan T. Hurt, Manpreet S. Mundi, Lisa Epp and Amy L. Spurlock, Comparison of Microbial Growth Between Commercial Formula and Blenderized Food for Tube Feeding, Nutrition in Clinical Practice, 34, 2, (257-263), (2018).

Learning Outcome: I am confidently able to speak to the use of blenderized tube feeding as a viable, safe and appropriate alternative to using often expensive and difficult to access commercially prepared formulations. I have become a resource in my community and am able to share my information with other dietitians and healthcare providers in my small community who are looking to reduce the cost and improve the accessibility of appropriate home tube feeding.

Clinical Example 2:

Standard 10: A Dietitian contributes to the provision of quality professional services as a member of the clients’ interprofessional team.

Indicator 4: Engage with team members to plan, coordinate and deliver quality professional services.

SMART Goal: In the coming year, I aim to improve my engagement with the team by increasing collaboration with other healthcare professionals and using best practice principles when transitioning patients from tube feeding to oral intake.

Learning Activities:

  • Reviewed evidence-based processes and guidelines related to transition from EN to PO specific to my hospital setting.
  • Liaised with my unit’s speech language pathologist, other allied health and nursing staff regularly when patients were approaching appropriate timing for a swallowing assessment in order to provide continuity of care and timely service.
  • PEN Access: Read “An Inter-professional approach to Malnutrition in Hospitalized Adults” (published June 2014 and accessed this past year) and discussed with colleagues at a Lunch and Learn session.

Learning Outcome: I improved my collaboration skills with staff on my unit while increasing my profile as the expert in nutrition intervention and transition to oral intake. I am confidently using best practice to ensure that my patients are transitioning to oral intake from enteral nutrition appropriately.

Clinical Example 3:

Standard 14: A Dietitian uses critical thinking to obtain assessment data, determine practice problems, plan, implement and evaluate professional services.

Indicator 3: Analyze/interpret data using critical thinking, professional judgement and best practice knowledge

SMART goal: Now that Soybean oil-Medium Chain Triglyceride (MCT oil)-Olive oil-Fish Oil (SMOF) lipids are available as an alternative lipid at my worksite, I will become comfortable within the next six months in assessing each appropriate nutrition support patient to determine whether SMOF can be implemented as the lipid formulation of my parenteral nutrition (PN) recommendations.

Learning Activities:

  • Reviewed site-specific policies and procedures that were recently updated with information about SMOF lipid availability for nutrition support plans that include PN.
  • Attended a lunch and learned hosted by a healthcare company regarding the literature available supporting the use of SMOF lipid products. Presentation included discussion of the benefit of transition to a 3-in-1 PN bag for potential future use at my worksite.
  • Consulted a member of the PN resource dietitians in the first several PN nutrition assessments since undertaking the SMOF implementation to ensure that SMOF was appropriate, especially in circumstances where complex medical diagnoses and food allergies were present.

Learning Outcome: I am now able to write PN recommended orders with the knowledge and skill set to determine when SMOF lipid should be used versus when it is best to use Intralipid (the other lipid emulsion available to my worksite). I find I am now able to confidently advise other dietitians and dietetic students in my workplace who are looking for PN guidance in their practices.

Clinical Example 4:

Standard 3: A Dietitian maintains competence in their practice area.

Indicator 3: Determine new or anticipated areas of dietetic practice and acquire knowledge and/or skills needed to practice competently.

SMART goal: Now that I have begun working in a new clinical area, I anticipate the benefit of becoming registered with Restricted Activities. This year, I will undertake learning opportunities in order to be able to select the competencies that are required to become registered with Restricted Activity B in the next CCP cycle at the time of my next renewal.

Learning Activities:

  • Completed site specific training on policies and procedures, including review of the formulary related to completing nutrition assessments and recommending PN by completing site-specific pre-printed orders.
  • During my training at my new work location, I was able to shadow dietitians who work with patients requiring PN. I completed mock assessments and recommendations and was able to compare them to my preceptors’ assessments and recommended orders.
  • Completed the in-house dietitian developed PN course (and/or Basic 5 PN course) available, which included recommendations related to macro and micronutrient additions as well as lab work monitoring and tolerance follow-up.
  • Learning Outcome: At the end of this CCP cycle, I am now ready to confidently apply for registration with Restricted Activity B.

Public Health Dietitian

Standard 9: A Dietitian communicates in a clear, concise and respectful manner.

Indicator 4: Adapt communications to the clients’ level of understanding and cultural/ language needs, incorporating supports as needed to reduce comprehension barriers (interpreters, visual aids, etc.)

Standard 9.4 Learning Report

Goal: By the end of this CCP cycle, I would like to develop communication strategies to provide simpler and clearer information to my clients who have mental health and impaired communication capabilities, resulting in increased client satisfaction.

Learning Activities:

  • Community Workshop: Vancouver Coastal Health Mental Health and Addiction (date: within the current CCP year)
  • Lunch and Learn: SLP Strategies and Tools: Effective Communication with post stroke patients with comprehension and speech impairment (date: within the current CCP year)
  • Collaboration with community SLP in my health unit to facilitate use of appropriate materials and strategies for communication, while also doing joint visits, where appropriate.
  • Reading: Compensatory Behavioral Strategies in Brain Injury (date: within the current CCP year)
  • Tracked statistics to demonstrate time spent on repeat visits for ongoing/static issues.

Learning Outcome:

Successfully developed Nutrition Care Plans for adult clients in home health, mental health and addictions outreach including those with impaired cognition and comprehension, hearing deficits, impaired speech. This was achieved by using simplified, practical and clear interventions developed from the resources in available in the learning activities and resulted in measurable changes in behaviour and satisfaction of RD services. I was able to demonstrate a reduced need to provide repeat education/intervention, based on my statistics.

Food Service Manager

Standard 16: A dietitian leads and organizes effective and timely delivery of services.

Indicator 3: Incorporate principles of financial management relevant to the organization, including cost awareness and service delivery budgeting, feeds and payment arrangements.

Standard 16.3: Learning Report

Goal: During this fiscal year, be able to successfully collaborate with the Health Authority in order to develop operational plans and terms of contracts that are patient-focused while being financially operationally responsible, by reducing costs by 2% as compared to last year.

Learning Activities:

  • On the job training with site managers/supervisors to facilitate survey among residents, which provides insight into which recipes and “Pace Changers” are most enjoyed and accepted.
  • Attended annual Canadian Society of Nutrition Management (CSNM) conference, specific topics included using technology to promote efficiency and cost reduction
  • Review quarterly CSNM magazine
  • BC Spring Workshop – Dietitians of Canada Gerontology Network
  • Work with suppliers to procure cost-effective ingredients for lower cost and most enjoyed “Pace changers”.
  • Attend monthly resident council meetings to gain perspective on resident food preferences.

Learning Outcome:

Learned strategies and developed relationships with colleagues to be able to reduce budgetary spending by 2% while providing culturally appropriate and acceptable meals that met the Health Authority and resident requirements.

Private Practice Dietitian

Standard 9: A Dietitian communicates in a clear, concise and respectful manner.

Indicator 5: Write client/client group education materials in an organized manner, using plain language.

Standard 9.5: Learning Report

Goal: My goal is to expand my private practice by the end of my fiscal year. By improving my social media content and thereby increasing traffic to my website and social media platforms, I will be able to expand my reach as a knowledgeable, evidence-informed private practice dietitian.

Learning Activities:

  • Joined the DC Consulting Dietitians Network in the spring of this year and have been accessing collaborative dietitians’ practice resources such as infographics and patient education for use and adaptation for my practice area.
  • Completed “Counseling Tips for Nutrition Therapists: Practice Workbook Series”, on my own time, over the course of the past six months, which provided examples of wording, expressions and dialogue for use in my practice and in my social media posts.
  • Review of and connection with other local private practice dietitians and their social media content. This is ongoing as I find it useful to follow the trends in what dietitians are being asked about and what they are researching.
  • Attended online workshop “Dietitian as a Writer: a workshop exploring words, health and connection” led by CDBC registrant in April of this past year.
  • Review of College resources, bylaws and policies related to marketing and product endorsements.

Learning Outcome:

Traffic to my website and social media accounts increased by 20% as compared to last year. My business has grown by 8% over the same time period. I am feeling more confident in the nutrition information I put out in the public sphere and find I have the support to continue to grow my business.

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