Quality Assurance Program

Quality Assurance Standards, Policies and Guidelines

The CDBC Quality Assurance Program is founded on the Health Professions Act requirement for Continuing Competency, the CDBC Bylaws, Code of Ethics and Standards of Practice, and evidence of QA initiatives that promote high standards of practice in health regulated professionals.

The Quality Assurance Framework outlines the various steps the CDBC may take to ensure dietitians provide ethical, safe and competent services throughout their career.

Quality Assurance Policies and Guidelines

Quality Assurance Framework

Authority

Health Professions Act, sections 16(2)(e), 26.1, 26.2, and CDBC bylaws, s. 56-59.

Background

According to section 16(2)(e) of Health Professions Act [the Act], one of the CDBC’s main objectives is to: “establish and maintain a continuing competency program to promote high practice standards amongst registrants”. The CDBC Quality Assurance Program fulfills this legislative requirement and supports the College’s mandate to serve and protect the public.

Quality Assurance Program

1. Continuing Competence Program (CCP)

The CCP is an annual registration requirement that begins when a Dietitian registers as a Full registrant.

By working through the CCP, Dietitians reflect on their performance relative to the CDBC Standards of Practice, and based on this assessment, determine at least two learning goals at the start of each registration year.

Standards of Practice form Schedule B of the CDBC bylaws and are founded on the national Integrated Competencies for Dietetic Education and Practice. The Standards of Practice describe safe, ethical and competent dietetic practice [professional practice] in British Columbia.

Professional practice is defined as “competent, skillful, responsible and confident performance of responsibilities related to the provision of dietetic services.”

In BC, Dietitians must:

  • Meet educational requirements
  • Pass national and/or provincial exam(s) to test their skills and abilities; and review legal, professional, and ethical practice
  • Meet standards of practice
  • Maintain a code of ethics
  • Use their professional title in accordance to the Health Professions Act and the CDBC bylaws
  • Consent to a criminal record check every five years
  • Be publicly registered within their regulatory college and renew their registration annually
  • Keep their knowledge and skills up-to-date
  • Practice within their individual and profession-specific scope of practice
  • Abide by the Health Professions Act’s complaint process if standards are not met.

Guiding Principles

The Quality Assurance Program Framework:

  • Contributes to protection of the public by ensuring registrants comply with the standards of practice
  • Provides resources (e.g., Professional Development Plan Guidelines, Jurisprudence Examination) that are easily understood and time efficient for registrants to use
  • Values and encourages lifelong evidence-informed learning and development that is meaningful and relevant to dietetic practice
  • Is legally defensible (methods used are evidence-informed, fair, and designed to have sufficient detail and procedures.)
  • Values formal and informal learning opportunities related to dietetics
  • Uses a fair and transparent process of document review and assessment and,
  • Evaluates the components of the QAP on a regular basis.

Dietitians work on their Professional Development Plan annually. Through this process, Dietitians demonstrate ongoing growth and development of their professional knowledge and skills and have a systematic way to document how their learning/development activities impact their practice.

Dietitians submit their Professional Development Plan (PDP) online annually to the CDBC. Each PDP must meet the Quality Assurance Committee (QAC)’s Assessment Criteria. Dietitians receive a general assessment letter to confirm completion of the CCP requirement or alert them to any errors or omissions. Dietitians have two attempts to satisfy the QAC’s Assessment Criteria. Missing entries or other technical errors will not count as failed attempts.

Random Audit Selection Process

Each year, ten percent (10%) of all submissions undergo review. Selection for audit is determined by a randomization software. Dietitians are not selected for audit if they:

  • have already been audited in the previous CCP cycle
  • notify the CDBC they have moved to another jurisdiction or
  • notify the CDBC they are retiring with no plans to submit a Professional Development Plan nor renew their registration

Dietitians selected for an audit receive a general assessment letter as well as individualized detailed feedback. Incomplete Professional Development Plans after a second attempt will be forwarded to the QAC for review.

2. Review by the Quality Assurance Committee

Second Failed Attempt

The QAC will review and provide direction on second missed attempts of the Professional Development Plan. The QAC may ask the registrant to:

  • explain their difficulty in meeting the Assessment Criteria and,
  • provide documentary evidence of the continuing education reported in the Professional Development Report.

Documentary evidence of continuing education consists of a Professional Portfolio as defined in the CCP Self-assessment Guidelines. The Portfolio will be reviewed by an assessor appointed by the QAC for accuracy, currency and completeness to support the continuing education reported in the Professional Development Plan.

During that time, registrants remain registered in Full while completing a third Professional Development Plan submission. The QAC will provide the registrant with a written evaluation of the third Professional Development Plan submission and Portfolio review.

Third Failed Attempt

After a failed third attempt, the registrant will meet with the QAC or a panel of the QAC to review challenges in meeting the Assessment Criteria and documentary evidence requirements.

The Quality Assurance Committee may:

  • appoint an assessor to evaluate the registrant’s professional ability during an interview and review of workplace documentation or
  • require the completion of the CDBC Self-assessment Process (CSAP) to identify gaps in knowledge and skills. The CSAP consists of:
    • a competence self-assessment questionnaire and scored case studies and/or,
    • a practical competence assessment (scored case-based panel interview)

The CSAP is administered on a cost-recovery basis at the expense of the registrant, in accordance with Schedule D, Fees.

Upon review of the assessor’s report and/or the competence assessment results, the QAC will provide the registrant with written recommendations for remediation, if necessary.

3. Remediation

Remediation will consist of recommended course work and/or practical training. The registrant will have an opportunity to discuss the QAC’s recommendation for remediation, completion timeline and need for competence re-assessment.

The registrant will remain registered in Full while completing remediation.

4. Notice to Inquiry Committee

In accordance with s. 26.2 of the Health Professions Act and s. 59 of the CDBC bylaws, the Quality Assurance Committee may notify the Inquiry Committee if it has reasonable grounds to believe a registrant has committed an act of professional misconduct, demonstrated incompetence, has a physical/mental condition that impairs their ability to practice or poses a threat to the public.

Definitions

Learning activity

Learning activities may be formal such as a university or self-directed course or informal such as a discussion with colleagues or creating a new resource for your clients.

Learning goal

A learning goal is an outcome statement that captures specifically what knowledge, skills and attitudes learners should be able to exhibit after completing learning activities. A learning goal should relate to one topic or one area of practice and be SMART = Specific, Measurable, Attainable, Relevant and Time-bound.

Learning Report

A Learning Report is composed of the following elements:

  • one Learning Goal that is specific to a standard and indicator of practice
  • at least two Learning Activities that are relevant to the achievement and measurement of the leaning goal and,
  • a statement describing how the achievement of the learning outcomes will enhance/maintain the standard and indicator of practice

Professional Development Report

A collection of three or more Learning Reports. Learning Reports are founded on a specific standard and indicator of practice.

Self-assessment

An annual self-evaluation relative to the CDBC Standards of Practice to determine aspects of dietetic practice that would benefit from continuing education.

Standards and Indicators of Practice

Standards and Indicators of Practice describe minimal acceptable levels of safety and competence. CDBC’s Standards of Practice are founded on the Integrated Competencies for Dietetic Education and Practice by the Partnership for Dietetic Education and Practice (PDEP). The Standards of Practice form Schedule B of the CDBC bylaws and were enacted in 2016.

References

  1. BC College of Nursing Professionals (formerly CRNBC). Engaging British Columbia Nurses and Nurse Practitioners through Evidence-Informed Quality Assurance Programs https://www.bccnp.ca/PracticeSupport/RN_NP/QA/Documents/CRNBC_QA_MyProfessionalPlan.pdf; accessed January 15, 2019.
  2. BC Health Regulators. August 2017. Environmental Scan on Quality Assurance Programs (not published).
  3. BC Laws. Health Professions Act. Sections 26.1 and 26.2; accessed January 12, 2018.
  4. CDBC Bylaws. Sections 56-59 and Schedules A and B; accessed January 12, 2018.
  5. Continuing Competence Program. Assessment Criteria; accessed January 12, 2018.
  6. College of Occupational Therapists of BC. Quality Assurance Program Framework. March 2016; accessed January 15, 2018.
  7. Partnership for Dietetic Education and Practice. Integrated Competencies for Dietetic Education and Practice. 2013; accessed January 15, 2018.
  8. College of Occupational Therapists of BC. Developing the Continuing Competence Program for the College of Occupational Therapists of British Columbia: From Ideas to Design. 2009. https://cotbc.org/wp-content/uploads/COTBC_QAP_IdeastoDesign_FINAL1.pdf; accessed July 9, 2018.
  9. College of Occupational Therapists of BC. Continuing Competence Program. Blueprint Development & Validation Report. 2010. https://cotbc.org/wp-content/uploads/COTBC_QAP_BlueprintDevelopment_FINAL.pdf; accessed July 9, 2018.
  10. College of Physical Therapists of BC. Quality Assurance Program. 2013. https://cptbc.org/wp-content/uploads/2013/11/Quality-Assurance-Program-Backgrounder.pdf; accessed July 9, 2018.

Conflict of Interest and Sales Policy

Authority

Health Professions Act, sections 16(2)(g), 19(1)(l) and (s); Cannabis Act, Dietitians Regulation, Definitions and section 4, scope of practice, CDBC bylaws, section 74, Marketing, Schedule A, Code of Ethics, principles 1, 3 and 4, and Schedule B, Standards of Practice 1, 4, 7, 8 and 17.

Background

This policy supports dietitians in every practice environment where they are employed and connect directly or indirectly with members of the public. The policy is meant to be interpreted in combination with CDBC Bylaws, Marketing Standards and Social Media Guidelines. It is the College’s aim that the Marketing Standards will help to mitigate much of the risk of conflict of interest by providing clear guidance on marketing and endorsement expectations, and that this policy provides more detail about the expectations of conflict of interest management stated in the Standard of Practice 8, including when selling products to the BC public.

Research has found that transparency can help a patient and their families make informed choices when selecting a… health plan,… or choosing among alternative treatments” (American College of Physicians. Healthcare Transparency). Transparency can facilitate the development of a trusting client-dietitian professional relationship, while benefitting members of the public by upholding safe standards of care and empowering informed, impartial client decision making.

Definitions

A conflict of interest occurs when  a dietitian’s personal, business, commercial, political, academic or financial interests, or the interests of the dietitian’s family or friends, interfere with the dietitian’s professional responsibilities or a client’s best interests. A conflict of interest may exist whether or not a dietitian is actually influenced by the competing interest. The conflict of interest may affect dietitians in any practice setting. A conflict of interest can be actual, potential, or perceived and may or may not lead to negative clients’ outcomes and service delivery. An actual conflict of interest is one that has already occurred or currently exists. A potential conflict of interest is one that could possibly develop in the future. A perceived conflict of interest occurs when others perceive that a conflict of interest may influence a dietitian’s judgment. *Adapted with thanks from BC College of Nurses and Midwives’ Practice Standard on Conflict of Interest.

Conflict of interest in dietetic practice can diminish the confidence and trust of a client in his/her therapeutic relationship. It is therefore important for the registrants of CDBC to be honest and transparent with their clientele, so as to uphold the standards of the profession.

A client can be defined as “a patient or resident” and is extrapolated to all instances where there is a therapeutic relationship during the nutrition care process.

Dietetic practice, including business practice for dietitians who are self-employed, follow the CDBC Code of Ethics and are consistent with CDBC Standards of Practice.

Policy

1. Dietitians disclose and mitigate any potential, real, or perceived conflict of interest.

Dietitians must abide by Standard of Practice 8: “A Dietitian identifies and manages any real, perceived or potential conflict of interest”. Refer to the CDBC Patient Relations Program nd Chapter 4 of the Jurisprudence Guide for Dietitians.

a. Dietitians should recognize situations where a conflict of interest could arise and have an impact on professional judgement. Dietitians can refer to the Decision Tool for New Aspects of Dietetic Practice and the CDBC Code of Ethics for support in a conflict of interest situation. These could include professional relationships in practice, education, or research and may impact services, product endorsement/sales, and client referrals.

b. Where a conflict of interest exists, and when it cannot be avoided:

  • Dietitians disclose to the client in advance any financial interest they, or a person related to the dietitian, may have in another practice, to which they may refer the client.
  • Dietitians disclose any industry relationships that exist between him/her and the product or product line being endorsed/recommended.
  • Dietitians disclose the conflict of interest to manager/employer, as applicable.
  • Dietitians avoid provision of dietetic services where conflict of interest cannot be managed. Appropriate referral should be made to another healthcare professional.
  • Per Standard of Practice 8.3, options for alternative products and services must be offered.

c. Dietitians should understand and be able to communicate the difference between making a “recommendation” and “endorsing” a product or service for sale, as defined in CDBC Marketing Standards (1e).

d. When a dietitian is in a position to profit or gain from a personal incentive related to their practice and services (gift/donation), they should avoid accepting the incentive.

e. Dietitians document discussions about conflict of interest in the client record, and per CDBC Standards for Record Keeping, and also be prepared to provide information about conflict of interest when called upon by the Inquiry Committee, Discipline Committee or Board.

2. Dietitians practice objectively and provide evidence-based nutrition information.

Dietitians must abide by CDBC Standard of Practice 13: “A Dietitian seeks information and incorporates an evidence-informed approach to their practice”.

a. Assessment of a client’s nutritional needs and determining that a product sold, or a service recommended or endorsed to the client is based on current nutrition evidence and practice guidelines and are client-centered (take into consideration client’s financial means, personal and cultural preferences).

b. No client or colleague testimonial, as defined in the CDBC Marketing Standards, is permitted. For more information, CDBC has a position statement on testimonials (includes before/after photos).

c. Dietitians follow Social Media Guidelines in their online practices.

3. Dietitians practice transparently when providing services and in the provision of sales of dietetic products and services.

a. Client-dietitian therapeutic relationship and subsequent dietetic service provision is not dependent on the sale or use of a certain product/service, whether recommended/endorsed by the dietitian or purchased by a client independently.

b. Wherever possible, dietitians ensure the separation of sales from provision of nutrition services. Selling dietetic-related products/services should be separated from healthcare functions, such as counselling in the context of a therapeutic relationship.

c. Dietitians must sell a product at fair market value. The cost may include reasonable handling, shipping and storage cost. Dietitians must adhere to the CDBC Standards for Record Keeping while including documentation for the following for each sale:

  • Actual cost of product, including any rebate/ price reduction,
  • Name(s) of manufacturer and supplier of product,
  • Date the product was supplied to dietitian,
  • Expiry date of product if applicable,
  • Any additional costs incurred by the dietitian, including any formula/ calculation used by the dietitian to determine the total price of the product charged to the client.

d. Dietitians must offer clients at least one alternative to a specific product or brand. (CDBC Standard of Practice 8: “A Dietitian identifies and manages any real, perceived or potential conflict of interest”, specifically Indicator 3: “Provide options for the sale of dietetic products”; Marketing Standard 2f).

e. Dietitians inform their clients in regard to a service and product, that clients have the right to:

  • Decide not to purchase.
  • Seek a second opinion.
  • Compare the cost, brand, and other service and product characteristics with alternative options.
  • Delay the purchase to a time convenient to the client without any additional requirements (e.g., asking the client to book another appointment to complete the purchase).

4. Dietitians separate their professional practice from personal lifestyle endeavours.

a. Dietitians must use clear statement of title when practicing dietetics (Marketing Standard 3c)

b. Dietitians must avoid use of title in a non-professional role or selling/recommending products/services that are unrelated to dietetic practice (when not practicing dietetics). Refer to the Social Media Guidelines for more detail.

  • Dietitians must separate physical places of business from personal endeavour/lifestyle-related practices, and refrain from referring (linking) from personal to professional social media accounts, in a manner that compromises professional boundaries.
  • Dietitians must separate online professional presence from online personal presence, and refrain from connecting the two, whether by link, hashtag, or by any other identifiable manner.

References

American College of Physicians. Healthcare Transparency. A Position Paper. 2010. https://www.acponline.org/acp_policy/policies/healthcare_transparency_2010.pdf; accessed November 10, 2020.

BC College of Nursing and Midwives. Conflict of Interest. Practice Standard.  https://www.bccnm.ca/RN/PracticeStandards/Lists/GeneralResources/RN_PS_ConflictOfInterest.pdf; accessed January 4, 2021.

College of Dietitians of BC. Bylaws.

College of Dietitians of BC. Code of Ethics.

College of Dietitians of BC. Decision Support Tool for New Aspects of Dietetic Practice.

College of Dietitians of BC. Have a Practice Question? Conflict of Interest and Sales Q&A.

College of Dietitians of BC. Have a Practice Question? Managing Risk in Dietetic Practice.

College of Dietitians of BC. Social Media Guidelines.

College of Dietitians of BC. Jurisprudence Guide.

College of Dietitians of BC. Marketing Standards.

College of Dietitians of BC. Patient Relations Guide. Professional Boundaries: Where’s the Line?

College of Dietitians of BC. Standards of Practice.

College of Dietitians of BC. Standards for Record Keeping

College of Dietitians of Ontario. Standards of Practice for Professional Practice. Conflict of Interest. https://www.collegeofdietitians.org/Resources/Standards/Standards-and-Guidelines-COI.aspx; accessed November 10, 2020.

College of Physicians and Surgeons of BC. Practice Standard: Conflict of Interest. https://www.cpsbc.ca/files/pdf/PSG-Conflict-of-Interest.pdf; accessed February 3, 2021.

Nova Scotia Dietetic Association. Standards of Practice 2019. https://www.nsdassoc.ca/images/media/documents/NSDA_Standards_of_Practice_Draft_September_2019_.pdf; accessed February 3, 2021.

Consent to Nutrition Care Policy

Authority

Health Professions Act, section 16(2)(g); Health Care (Consent) and Care Facilities (Admission) Act, Infants Act, Mental Health Act, Patients Property Act and Representation Agreement Act.

Background

One of the duties and objectives of a college legislated under the Health Professions Act is to inform individuals of their legal rights, including consent to health care legislation.

 Policy

1. Dietitians have a legal obligation to understand rights and elements of consent to nutrition care. Key legislation concerning consent to nutrition care: Health Care (Consent) and Care Facilities (Admission) Act, Infants Act, Mental Health Act and Representation Agreement Act. Other pertinent legislation regarding consent to nutrition care: Adoption Act, Adult Guardianship Act, Child, Family and Community Service Act, Patients Property Act, and Public Health Act and Communicable Disease Regulation.

2. The ethical obligations of Dietitians to obtain consent are outlined in Principles 4 and 5 of the CDBC Code of Ethics.

 3. The Dietitian must inform the client or substitute decision maker on the nature, purpose and risk of the nutrition care, alternatives and the consequences of refusing nutrition care (risks, benefits, and side effects to help the client make an informed decision).

4. Consent may be granted for a course of treatment or nutrition care plan (e.g. overall parenteral or enteral feed; modified texture diet; diabetic diet, etc.) If there is a change in the nutrition care plan (e.g. transitioning from enteral nutrition to oral intake; minced texture diet to regular food, etc.), consent to the new nutrition care is required.

5. The Dietitian may need to determine the client’s ability to consent to/refuse nutrition care based on the client’s understanding of the information discussed in point 3. If the client is incapable of giving consent, the Dietitian must refer to the client’s substitute decision maker to obtain consent.

6. The Dietitian must communicate in a manner appropriate for the client’s skills and abilities and provide opportunities for the client to ask questions.

7. Consent/refusal may be obtained in writing, verbally or may be implied from the client’s words or actions (e.g. a nod of the head).

8. Consent/refusal must be documented in the patient’s clinical record, according to facility policy.

9. Consent/refusal to nutrition care is a dynamic process that requires renewal (re-confirmation) as the client’s treatment changes. Consent should be renewed if more than 12 months have passed since the last consent was given (e.g. client seen in private practice).

 10. Consent is not required:

    1. for preliminary examination, treatment or diagnosis
    2. for urgent or emergency health care
    3. when the health care that was consented to is in progress
    4. when the client is unconscious or semi-conscious, and
    5. when additional or alternative health care is medically necessary to deal with conditions that were unforeseen when consent was given.

References

Consent to Nutrition Care Guidelines

CCP Requirement for Reinstatement Within 3 Years Policy

Authority

CDBC bylaws, sections 50(1)(c)(iii) and 56.

Background

In accordance with section 50(1)(c)(iii) of the bylaws, “…the registration of a former full or non- practicing registrant, who ceased to be registered under section 48(6) for less than three (3) years, may be reinstated by the registration committee if the former registrant… submits to the registrar proof of completion of all requirements of the quality assurance program required under section 56, as though the applicant had not ceased to be registered under section 48(6)…

The CDBC’s Continuing Competence Program (CCP) was approved by the Board in November 2006 and implemented on April 1, 2007 for all registrants. The program’s purpose is to ensure currency and promote high practice standards in support of the College’s mandate to serve and protect the public.

Policy

1. Reinstatement applicants are informed that the preparation of required documents, approval of the continuing competence requirement and Registration Committee approval of the application for reinstatement may take a minimum of one month. Applicants may not practice dietetics or use the protected title “dietitian” until approved.

2. Applicants out of practice for less than 3 years who are applying for reinstatement to the register under section 50 the bylaws can only be reinstated within the 3-year period. After 3 years, they are considered under sections 51 (reinstatement within 6 years) or 52 (reinstatement after more than 6 years) of the bylaw.

3. Former registrants not participating in the CCP who are applying for reinstatement must:

  • Complete the Professional Portfolio and Self-assessment relative to the Standards of Practice
  • Complete the Professional Development Plan according to the Quality Assurance Committee assessment criteria, and
  • Submit all CCP documents to the CDBC for review and approval.

4. Reinstatement applicants with a compliant CCP participation record less than 3 years old must submit an updated Professional Development Plan. In accordance with bylaw 56(3)(c), the Quality Assurance Committee appoints the Registrar/Deputy Registrar-Quality Assurance to assess CCP submissions.

5. Applicants whose submissions are complete are informed that they have met the continuing competence requirement for reinstatement. The Registration Committee is informed that the requirement has been met.

6. Applicants whose submissions are not complete on the third (3rd) attempt are referred to the Quality Assurance Committee for further assessment.

Co-signing Students’ Records Policy

Authority

Health Professions Act, section 16(2)(d); CDBC bylaws Schedule A, Code of Ethics, Principle 2.

Background

The College is required to “establish, monitor and enforce standards of practice to enhance the quality of practice and reduce incompetent, impaired or unethical practice amongst registrants.”

In addition, Principle 2 of the CDBC Code of Ethics states “A Registered Dietitian assumes responsibility and holds her/himself personally accountable for all actions taken in the delivery of dietetic services by: … assuming responsibility for services provided by those under their supervision.”

Dietetic students are not registrants of the CDBC. Registrants who agree to supervise dietetic students are therefore accountable to the client and responsible for the care the dietetic students provide. These supervisory actions enhance the dietetic student’s practice and protect the public from harm.

Policy

The supervising Registered Dietitian (RD) reviews the dietetic student’s care and entry in the client’s record (after client care is provided) and co-signs the entry with explanatory notes or corrective actions, as necessary. Co-signing is required whether or not client care is observed.

References

Co-signing Students’ Records - Practice Guideline

Introduction

Under the Health Professions Act, the College is required to set standards for competent practice to ensure public safety.1 Ethical standards for professional behaviour are outlined in the Code of Ethics, Schedule A of the CDBC bylaws. Principle 2 states: “A Registered Dietitian assumes responsibility and holds her/himself personally accountable for all actions taken in the delivery of dietetic services by: … assuming responsibility for services provided by those under their supervision.”2

Registrants who agree to supervise dietetic students are responsible for the care the student provides and accountable to the client. Accountability is confirmed by the Registered Dietitian (RD) co-signing a student’s entries in a client’s record.

Co-signing Guidelines for RDs Supervising Dietetic Students

1. Supervisory preparation

Before supervising a dietetic student, the RD obtains information about a dietetic student’s knowledge, skill and ability level.

2. Supervisory level

The RD sets his/her supervision level on a case-by-case basis, depending on the dietetic student’s education and experience and the client’s medical and nutritional complexity.

3. Observation of client care

When the dietetic student or client case requires direct observation, the RD supervisor ensures s/he is present during the dietetic student’s session with the client. The RD intervenes and corrects the care being provided if necessary and appropriate for client safety.

4. Co-signing the dietetic student’s entry in the client record

Whether or not client care is observed, the supervising RD discusses the care provided to the client and reviews the dietetic student client record entry to ensure appropriate care is provided.

  • If the RD supervisor observes the dietetic student providing care and agrees with the care provided and the dietetic student’s signed record entry, the RD co-signs the record.
  • If the RD doesn’t see the care provided, s/he reviews the record entry and if both the stated care provided and the record entry are appropriate and accurate, the RD co-signs the record.
  • Whether or not the RD sees the care provided, if s/he determines the record entry is incomplete/ unsigned, the RD adds, or observes the dietetic student adding, an explanatory or corrective entry and/ or signature, and then co-signs the record.

5. Co-signer’s name and designation

    A co-signer signs their full name or initials and “RD” in accordance with facility protocol.

    References

    Privacy Guide

    Professional Practice Guidelines

    Authority

    Health Professions Act (HPA), section 16(2); CDBC Bylaws, Schedules A and B.

    Background

    The intent of the Professional Practice Guidelines is to describe principal elements of competent, safe and ethical dietetic practice [professional practice]. These guidelines apply to all areas of dietetic practice and provide dietitians with links to CDBC resources that support practice in the interest of the public.

    Standards and principles of competent, safe and ethical practice are found in the CDBC bylaws’ Schedule A: Code of Ethics and Schedule B: Standards of Practice and supported by Quality Assurance and Registration Committee policies.

    Professional Practice Guidelines

    When providing dietetic services, a Dietitian must:

    1. Be competent and practice ready

    a. Have the necessary knowledge, skills, abilities and judgement, to perform dietitian roles and responsibilities without direct supervision

    b. Recognize limits of individual practice readiness and provide services within individual level of competence

    c. Take steps to achieve practice readiness in new areas of practice and maintain practice readiness in areas of current practice

    Resources

    2. Have appropriate information

      a. Have full knowledge of facts to provide client-centered services.

      Resources

      • Standards of Practice 12 to 14 describe practice expectations regarding client-centered services
      • Section 70 of the CDBC bylaws describes information categories dietitians must consider when providing client-centered services.

      3. Consult and collaborate

        a. Consult and collaborate with the client and relevant stakeholders (e.g., interprofessional health care team, caregiver, business partners), as needed.

        Resources

        • Standards of Practice 9 to 11 describe practice expectations regarding communication and collaboration
        • Code of Ethics Principles 3, 4 and 5 describe collaborative behaviour expected of dietitians

        4. Obtain consent

          a. Obtain the client’s informed consent following appropriate legislation and guidelines.

          Resources

          5. Meet standards, limits and conditions

          a. Ensure nutrition services are congruent with any standards, limits and conditions associated with the service being provided and consistent with work place policies and protocols.

          Resources

          6. Document and notify

          a. Document nutrition services following appropriate legislation.

          b. Notify appropriate stakeholders about services as soon as reasonably possible.

          Resources

          Definitions

           Client: an individual and/ or their substitute decision maker, or a group of individuals, who is a potential or an actual recipient of nutrition care services.

          Practice Readiness: confidence in the dietitian’s ability to independently fulfill the duties and responsibilities required in the assigned area of dietetic practice – the dietitian is ready to practice independently. This confidence can be the dietitian’s own self-confidence in her/his ability to practice independently, or the employer’s confidence in the dietitian’s ability for independent practice.

          Professional Practice: Competent, skillful, responsible and confident performance of responsibilities related to the provision of dietetic services. In BC, Dietitians must:

          • Meet educational requirements
          • Pass national and/or provincial exam(s) to test their skills and abilities; and review legal, professional, and ethical practice
          • Meet standards of practice
          • Maintain a code of ethics
          • Use their professional title in accordance to the Health Professions Act and the CDBC bylaws
          • Consent to a criminal record check every five years
          • Be publicly registered within their regulatory college and renew their registration annually
          • Keep their knowledge and skills up-to-date
          • Practice within their individual and profession-specific scope of practice
          • Abide by the Health Professions Act’s complaint process if standards are not met

          Adapted from BC Health Regulators. accessed March 3, 2020.

           

          Right to Refuse Treatment Policy

          Authority

          BC Human Rights Code; CDBC Bylaws, Schedule A: Code of Ethics and Schedule B: Standards of Practice.

          Background

          Registered Dietitians are legally entitled to use discretion when accepting or refusing clients. Refusal cannot be based on reasons that contravene the BC Human Rights Code (age, gender, race, ancestry, religion, marital/family status, physical or mental disability, sex or sexual orientation, etc.).

          Policy

          Registered Dietitians may encounter circumstances where they find themselves unable to provide competent, safe and ethical dietetic services because of stress or discomfort, threatening or inappropriate client behaviour, or non-compliance of a client with treatment or payment of services.

          When a dietitian is unable to provide safe, competent and ethical treatment, the dietitian has an obligation to:

          • inform the client of his or her concerns
          • give reasonable notice of termination of treatment and,
          • offer alternative options to ensure that the client’s nutritional care needs are met.

          A dietitian has an ethical duty to provide treatment if refusal to treat or delaying care might result in serious harm to that client.

          NOTE: The general principles of this policy are covered in Chapter 4 of the CDBC Jurisprudence Guide and Examination.

          References

          Social Media Guidelines

          Testimonial Position Statement

          Virtual Dietetic Practice Policy

          Authority

          Health Professions Act, sections 16(2)(a) and (k)(iii) and CDBC Standards of Practice and Code of Ethics.

          Definitions

          • Client: an individual and/or their substitute decision maker, or a group of individuals, with whom a dietitian has an established professional relationship with the intent to deliver dietetic services.
          • Virtual Dietetic Practice: provision of dietetic services (e.g. counseling, consultation, monitoring, teaching, etc.) which involves any type of intervention with a client who is remotely located from the dietitian providing the service. It may include telephone, videoconferencing, email, apps, web-based communication and wearable technology (excludes social media and public appearances where advice is provided to the public at large). Virtual dietetic practice can occur within a jurisdiction and across provincial, territorial or national borders.

          Background

          The duties and objectives for a college legislated under the Health Professions Act include superintending the practice and promoting the ability of its registrants to respond and adapt to changes in practice environments and advances in technology such as virtual dietetic practice.

           The CDBC is responsible for advising dietitians providing dietetic care in BC to comply with its registration requirements and to get informed about practice requirements if their client resides in BC (e.g., standards of practice, scope of practice, restricted activities and liability insurance).

          No provincial dietetic regulatory body in Canada prohibits virtual dietetic practice. However, each regulatory body may identify their own registration requirements and standards specific to virtual dietetic practice to clients residing in their province.

          Registration Requirements

          In all provinces, dietitians providing “cross-border” in-person dietetic services must be licensed in the province where the client resides. Registration requirements for services provided through virtual dietetic practice vary as indicated in the following table.

          The information in the following table only applies to dietitians who are currently fully registered and in good standing with a Canadian dietetic regulatory body. The table information is accurate to the date of publication of this policy and is subject to change. Dietitians are advised to confirm registration requirements in the jurisdiction where the client resides.

          The regulatory College in the province where the client resides may request the registrant’s College in another province to complete and submit a “Verification of Registration” form. The completion of the form has an associated cost, which can be viewed on Schedule D, Fees.

          Provincial Registration Requirements for Dietitians providing Virtual Care in Canada

          Regulatory Body

          Required to register in client’s province?

          (Yes or No)

          Other Regulatory Requirements
          College of Dietitians of British Columbia (CDBC) Yes A dietitian registered in another province who provides virtual dietetic services to BC residents must be registered in BC.
          College of Dietitians of Alberta (CDA) Yes A dietitian registered in another province who provides virtual dietetic services to AB residents must be registered in AB.
          Saskatchewan Dietitians Association (SDA) Yes A dietitian registered in another province who provides virtual dietetic services to SK residents must be registered in SK.
          College of Dietitians of Manitoba (CDM) No

          A dietitian registered in another province who provides virtual dietetic services to MB residents must:

          a. be fully registered in good standing with another Canadian dietetic regulatory body

          b. request completion of a Verification of Registration form by their provincial regulator(s)

          c. contact CDM prior to providing services and

          d. disclose where they are registered to the MB client.

          College of Dietitians of Ontario (CDO) Yes A dietitian registered in another province who provides virtual dietetic services to ON residents must be registered in ON.
          Ordre professionnel des diététistes du Québec (OPDQ) Yes A dietitian registered in another province who provides virtual dietetic services to QC residents must be registered in QC.
          New Brunswick Association of Dietitians (NBAD)/ Association des diététistes du Nouveau-Brunswick (ADNB) No

          A dietitian registered in another province who provides virtual dietetic services to NB residents must:

          a.  disclose where they are registered to the NB client,

          b.  inform NBAD prior to providing virtual dietetic services in NB, and

          c.  adhere to NBAD laws, regulations, standards and code of ethics.

          Nova Scotia Dietetic Association (NSDA) No

          If a dietitian is physically located outside of Nova Scotia and providing virtual dietetic services to Nova Scotia residents, the NSDA advises the dietitian:

          a.  disclose to their client they are not registered as a dietitian in NS, and

          b.  become familiar with Nova Scotia laws, regulations, standards and guidelines.

          Prince Edward Island Dietitians Registration Board (PEIDRB) Yes A dietitian registered in another province who provides virtual dietetic services to PEI residents must be registered in PEI.
          Newfoundland and Labrador College of Dietitians (NLCD) No

          If a dietitian is physically located outside of NL and providing virtual dietetic services to NL residents, the NLCD advises the dietitian:

          a.  disclose to their client they are not registered as a dietitian in NL, and

          b.  become familiar with NL laws, regulations, standards and guidelines.

          Policy

          The use of information technology does not alter the ethical, professional and legal requirements around the provision of appropriate nutrition care. Dietitians follow the CDBC Virtual Dietetic Practice Guidelines when they provide virtual dietetic care to clients. In providing nutrition care services, Dietitians engaged in virtual dietetic practice must:

          1. Deliver virtual dietetic services in accordance with the CDBC Bylaws and other standards, including but not limited to: Code of Ethics, Marketing bylaws, Standards of Practice, and Standards for Record Keeping, as though the dietetic services were delivered in person.

          If Standards of Practice cannot be met virtually, the dietitian must refer the client elsewhere.  Dietitians may not exempt themselves from the obligation of complying with the Standards of Practice and the Code of Ethics by obtaining releases from or publishing disclaimers to the client.

          2. Be aware of and comply with restricted activities in the province where the client resides and each province where the dietitian is registered.

          3. Be aware of additional authority mechanisms that must legally be in place for some activities to be carried out in BC and in other jurisdictions (e.g., ordering lab tests and vitamins and minerals).

          4. Disclose where they are registered to the client.

          5. Ensure professional liability coverage includes virtual dietetic practice within the province of registration as well as other jurisdictions where they provide virtual dietetic services (e.g., Canadian provinces, USA or other countries where client may reside).

          6. Deliver competent dietetic practice by assessing their own competence, identifying areas for learning, and addressing knowledge gaps in relation to relevant software and information technology processes needed for effective virtual care.

          7. Be satisfied that the standard of care is reasonable and can lead to outcomes that are equivalent to any other type of care that can be delivered to the client, considering the specific context, location, timing and relative availability of in-person care.

          8. Have a process to explain benefits and limitations of virtual dietetic care, collect and record informed client consent to virtual services.

          9. Have a process to ensure client information confidentiality, access to information and safety of records.

          10. Have a process for emergency response to address any health emergencies that may occur during a virtual consultation (must be cross jurisdictional, if applicable).

          11. Provide interprofessional practice and have a process to refer the client to other health professionals, as necessary.

          12. Provide evidence-informed assessments, interventions and recommendations.

          Dietitians who provide virtual consultation to other Dietitians or other health professionals are not considered to establish a direct therapeutic relationship with the client. The client in these situations remains under the care of the Dietitian or health professional requesting the consultation.

          References

          Virtual Practice Guideline

          Resources

          Decision Tool for New Aspects of Dietetic Practice

          Private Practice Resource

          Webinar: Navigating Marketing, Conflict of Interest/Sales, Testimonial Position Statement, Social Media Guidelines