Quality Assurance Program

Quality Assurance Policies

Professional Practice Guidelines

Professional Practice Guidelines

Date created: September 20, 2017
Date approved by the QAC: January 19, 2018
Date approved by the Board: March 19, 2018
Category: QAC
File code: Qac20/Policies/Prof-Practice-Guidelines-Final-Jun-09-20

 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
    1. Have the necessary knowledge, skills, abilities and judgement, to perform dietitian roles and responsibilities without direct supervision
    2. Recognize limits of individual practice readiness and provide services within individual level of competence
    3. Take steps to achieve practice readiness in new areas of practice and maintain practice readiness in areas of current practice

Resources

  1. Have appropriate information
  2. 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.
  1. Consult and collaborate
  2. 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
  1. Obtain consent
  2. Obtain the client’s informed consent following appropriate legislation and guidelines.

Resources

  1. Meet standards, limits and conditions
  2. 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

  1. Document and notify
  2. Document nutrition services following appropriate legislation.
  3. 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.

 

Quality Assurance Framework

Date created: January 12, 2018
Date last approved by the QAC: January 19, 2018 and January 25, 2019
Date last approved by the Board: March 12, 2018
Date last reviewed by the Board: March 12, 2018 and March 1, 2019
Category: QAC
File code: Qac18/Policies/Quality-Assurance-Program-Framework-Final-Mar-01-19

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.

QA-02 Continuing Competence Requirement for Reinstatement Within 3 Years

Date created: January 30, 2007
Date last approved by the QAC: January 25, 2019
Date last approved by the Board: October 14, 2016
Date last reviewed by the Board: March 1, 2019
Category: QAC
File code: Qac18/Policies/Qac-02-CCP-Req-Reinstate-Final-Jan-25-19
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
  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
  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
  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 Assnce 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 receive feedback on their submission and instructions to submit further specified documentation until completion is Applicants whose submissions are not complete on the third (3rd) attempt are referred to the Quality Assurance Committee for further.

QA-03 Privacy Legislation for Private Practitioners

Date created: January 4, 2007
Date approved: March 3/07, January 18/10, October 26/12, September 22/14
Date last reviewed (QAC): October 7, 2019
Date last reviewed (Board): March 5/10, October 26/12, September 22/14, November 4/19
Category: Quality Assurance Committee
File code: Qac20/Policies/Qac-03-Priv-Leg-Priv-Practs-FINAL-9-Jun-2020
Authority:  Health Professions Act, section 16(2)(i) and CDBC Bylaws, ss. 70-71.

Background:

One of the duties and objectives for a college legislated under the Health Professions Act is to inform individuals of their legal rights, including privacy legislation. In accordance with privacy legislation, sections 70 and 71 in CDBC bylaws outline provincial and federal privacy requirements of registrants who have private practices.

Policy:

Registrants in private practice within BC must meet privacy requirements outlined in the Personal Information Protection Act (PIPA).  Private practice registrants within BC with clients who reside in other provinces are regulated federally by the Personal Information Protection and Electronic Documents Act (PIPEDA).

References:

Interpretive Guideline - Privacy Legislation for Private Practitioners

Introduction

The key focus of all privacy legislation is the protection of personal information.

In the context of private practice clients, personal information is defined as any identifiable information about a client, including name, age and birth date, height, weight, sex, ethnic origin, race, financial and credit card information, wage or salary, home contact information, medical information, Social Insurance Number, religious and political affiliations, marital or family status, education, personal opinions, personal habits, preferences,  photographs and employment information.

In the context of the private practitioner, personal information excludes information readily available to the public by mandate of the CDBC (legislated by the Health Professions Act (s.21)). This includes the registrant’s name, contact information and place of business.

One of the duties and objectives for a college legislated under the Health Professions Act is to inform individuals of their legal rights, including privacy legislation. In accordance with privacy legislation, sections 70 and 71 in CDBC bylaws outline privacy requirements of registrants who have private practices. The Office of the Information and Privacy Commissioner provides independent oversight and enforcement of BC’s access and privacy laws, including the Freedom of Information and Protection of Privacy Act (FIPPA) and the Personal Information Protection Act (PIPA).

Public Sector Privacy

Public sector privacy legislation, affecting hospitals, health authorities and regulatory bodies, including dietitians working in these areas, is found in FIPPA legislation.

Private Sector Privacy

BC dietitians in private practice within BC are governed by the provincial legislation, PIPA.

BC dietitians in private practice within BC, but who have clients across provincial boundaries are subject to the Personal Information Protection and Electronic Documents Act (PIPEDA). All organizations that operate in Canada and handle personal information crossing provincial or national borders are subject to PIPEDA.

Interpretation of PIPA and PIPEDA for Private Practitioners

The following table includes outlines ten principles of privacy legislation and recommended actions for private practice Dietitians.

Privacy Principle CDBC recommended actions
1. Be accountable – ensure compliance with the legislation.

·     Assume the role of ‘privacy officer’ – the person who is responsible for understanding the legislation and ensuring policies and processes are in place to protect the collection, use and disclosure of clients’ and employees’ personal information. This includes responsibility for contractors’ records, which would apply for a dietitian who is the owner of a clinic and employs other contract dietitians or medical professionals.

·     Be aware of who your Ministry Privacy Officer is.

2. Identify purpose – before or at the time of collection, identify the purpose for collecting personal information.

·     State purposes in writing whenever personal information is requested

·     Do not collect personal information if the purpose for collection cannot be stated

3.

Obtain consent – provide information and obtain consent for the collection, use and disclosure of personal information, including the consequences of consent not being provided (link below)

 

·     Prior to obtaining consent, ensure clients and employees understand who will have access to the information, how it will be used and when and how it will be disclosed.

·     Obtain written or verbal consent; implied consent is given when clients and employees provide answers to posed questions

·     Examples of implied consent in response to description of proposed nutrition intervention:

o   Nodding of the head

o   Keeping an appointment, voluntary answering of question related to nutrition history, submitting without objection to nutrition assessment and planned intervention.

·     Consent may be withdrawn subject to legal reason and reasonable notice

·     Understand that there are circumstances where consent is not required:

o  Urgent or emergency health care is required and the adult is incapable of making a decision

o  Involuntary psychiatric treatment is needed

o  Preliminary examinations such as triage are needed and,

o  Communicable diseases are involved.

4. Limit collection – collect only information that is required to fulfill the stated purpose

·     Review questions on forms for relevance and delete any not relevant to stated purpose.

·     Identify optional questions.

5.

Limit use, disclosure and retention –use personal information and disclose it to another person only for the purpose it was collected; keep personal information only as long as needed

 

·     Limit use of personal information to the purposes stated; contact information must be used for business purposes only, not personal.

·     Do not disclose an individual’s personal information to anyone unless written or verbal permission is obtained and recorded.

·     Keep information only as long as needed for the purpose stated or as required by PIPA (1 year) and as set out in the CDBC Standards for Record Keeping (standard 5).

·     Shred paper records once usefulness is over; destroy discarded computer hard drives.

·     In consultation with a lawyer, determine a retention period for client records and former employees’ files.

·     It is up to the registrant to know what Act/Law governs the allowance of the transfer/disclosure of personal information.

6. Ensure accuracy – ensure personal information collected is complete, current and accurate as needed to fulfill stated purpose ·     Review and update personal information on a regular basis if it will be used to make a decision affecting the individual.
7.

Use safeguards – protect against unauthorized access, disclosure, use, copying or modification of all personal information, regardless of the format.

 

·     Keep all records (computer and paper) containing personal information safe from public view and from access by other clients.

·     Do not discuss personal client and employee information in a public area.

·     Allow employee access to client records on a “need to know” basis.

·     Store records in lockable cabinets/drawers when not in use and at night; lock nightly.

·     Back-up computer records regularly and store back-ups in a safe, unobtrusive place.

·     Ensure computers have technological safeguards to protect against unauthorized access.

8.

Be open – communicate policies/practices

 

·     Publish a privacy policy for clients which includes information about management of personal information and accessing their personal records.

·     Include a privacy statement on emails, business websites, professional social media accounts, as well as computer and fax forms.

·     Ask staff members to sign confidentiality statements.

9. Provide individuals access – provide clients and employees access to their personal records on request to ensure accuracy and completeness

·     An individual’s “Right of Access” includes:

o   Access to his/her personal information

o   An explanation of how the personal information is being used

o   Identifying to whom personal information has been disclosed

·     Write all health records in an objective and professional manner, following standards accepted by the profession.

·     Develop a policy that enables employees and clients complete access to their personal file on request.

10. Provide recourse – provide a process for clients and employees to challenge compliance

·     Develop a process for monitoring the office’s compliance with privacy legislation

·     Develop a clear and simple process to manage complaints about the office’s privacy policy or access to information process

·     If a complaint has been received about how an individual’s personal information has been handled, contact the Privacy, Compliance and Training Branch.

Actions to be taken in the instance of a privacy breach

The majority of privacy breaches are due to human error. Take steps to (1) report, (2) recover, (3) remediate the breach, and (4) prevent future breaches.

To report a privacy breach, contact the Ministry Chief Information Officer by accessing the BC Government Privacy Breach website.

References:

QA-04 Co-signing Students’ Records

Date created: January 4, 2007
Date approved by the QAC: May 3, 2010, February 2, 2015 and May 6, 2019
Date approved by the Board: March 3, 2007, May 14, 2010, February 27, 2015 and June 17, 2019
Date last reviewed by the Board: June 17, 2019
Category: QAC
File code: Qac20/Policies/Qac-04-Co-signing-Students-Records-Final-9-Jun-20
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:

Practice Guideline – Co-signing Students’ Records

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.

  1. 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.

  1. 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.

  1. 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.
  1. Co-signer’s name and designation

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

References

QA-06 Right to Refuse Treatment

Date created: September 14, 2010
Date approved by the QAC: January 24, 2011, April 28, 2014, May 4, 2020
Date approved by the Board: March 25, 2011, June 20, 2014, June 23, 2020
Date last reviewed by the Board: June 23, 2020
Category: QAC
File code: Qac20/Policies/Qac-06-Right-Refuse-Tx-Jun-23-20.docx

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:

College of Physicians and Surgeons of BC. Public Information. FAQs – Patient/Physician Relationship. https://www.cpsbc.ca/for-public/faqs/patient-physician-relationships; accessed April 29, 2020.

QA-07 Consent to Nutrition Care

Date created: September 14, 2010
Date approved by the QAC: September 20, 2010, January 23, 2012, May 4, 2020
Date approved by the Board: March 2, 2012; January 21, 2016, June 23, 2020
Date last reviewed by the Board: March 2, 2012, January 21, 2016, June 23, 2020
Category: QAC
File code: Qac20/Policies/Qac-07-Consent-Tx-Jun-23-2020

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.

 

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

 

  1. 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).

 

  1. 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.

 

  1. 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.

 

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

 

  1. 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).

 

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

 

  1. 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).

 

  1. 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:

accessed April 22/20.

Ministry of Health. July 2011. Health Care Providers’ Guide to Consent to Health Care: http://www.health.gov.bc.ca/library/publications/year/2011/health-care-providers%27-guide-to-consent-to-health-care.pdf; accessed April 29, 2020

Consent to Treat Guideline

QA-09 Marketing, Sales and Conflict of Interest

This policy is currently under revision.

Date created: April 16, 2013
Date approved by the QAC: September 16, 2013, February 3, 2014, May 2, 2016, September 28, 2018
Date approved by the Board: November 1, 2013, June 24, 2016, October 29, 2018
Date last reviewed by the Board: June 24, 2016, October 15, 2018
Category: QAC
File code: Qac18/Policies/Qac-09-Advertising-Sales-COI-Oct-29-18

 Authority

Health Professions Act, sections 16(2)(g), 19(1)(l) and (s); 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

One of the duties and objectives of the College under the Health Professions Act is to establish and enforce principles of professional ethics for dietitians.

 In BC, Dietitians “may not endorse or lend themselves as a registrant to the advertisement of any property, investment, or service for sale to the public unless such property, investment or service relates directly to dietetics.” (CDBC bylaws, s.74(5c)).

This policy outlines guiding principles for marketing and selling nutrition services and products to clients and managing conflict of interest.

Definitions

  • Advertisement: the use of space or time in a public medium, or the use of a commercial publication such as a brochure or handbill, to communicate with the public, or a segment thereof, for promoting professional services or enhancing the image of the advertiser.
  • 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.
  • Conflict of interest: may be actual or perceived and occurs when a dietitian’s private interests (financial or personal) compromise his/her professional judgment, responsibilities and their client’s interest.
  • Marketing:
  1. an advertisement,
  2. any publication or communication in any medium with any client, prospective client or the public in the form of an advertisement, promotional activity or material, a listing in a directory, a public appearance and professional opinion or any other means by which professional services are promoted, and
  3. contact with a prospective client initiated by or under the discretion of a dietitian.
  • Public medium: any form of communication that is available and directed to the public, or a specific subsection of the public rather than to an individual person or persons. For example, radio, television, websites (e.g., blogs, social networks), flyers, brochures and newspapers are all examples of public media.

Policy

Marketing

  1. A dietitian ensures the information in an advertisement of his or her professional services:
    • Is true, accurate and verifiable.
    • Includes registered professional title (e.g., RD, Dietitian or Registered Dietitian) and applicable restricted activity.
    • Includes any other title, abbreviations or initials of formal education degrees, diplomas or certificates that are relevant to the practice of dietetics
    • Provides information to help clients understand his/her qualifications and services, so they may make informed choices.
    • Includes detailed fees about services and products as to enable the client to understand the nature and extent of services and products and their cost.
    • Is evidence-informed, clear and comprehensible, not misleading to the public by either omitting relevant information or including irrelevant information
    • Follows best practice principles outlined in the Canadian Code of Advertising Standards and the Influencer Marketing Disclosure Guidelines for Social Media.
  1. A dietitian’s advertisement may not:
  • Be calculated or likely to take advantage of the weakened state, either physical, mental, emotional of the client or intended client.
    • Promote or imply unjustified expectations about the results which the registrant may achieve.
    • Promote or imply the dietitian is capable of achieving results not achievable by other dietitians or by improper means.
    • Promote or imply guarantee as to the success of the service and product provided or recommended.
    • Compare the quality and cost of his or her services and products with those of another dietitian, a person authorized to provide health care services under another enactment or another health professional.
    • Imply endorsement or recommendation for the exclusive use of a product or brand used or sold in the practice.
    • Include information that could be interpreted to be an endorsement of another dietitian or his or her practice (e.g., self-endorsement and endorsement of preferred colleagues over others).
    • Refer to the dietitian as a “specialist” or any similar designation suggesting a recognized special status or accreditation.
  1. A dietitian’s advertisement must only include services that are within the scope of practice of dietetics and within the dietitian’s individual competence.
  2. A dietitian may not endorse or lend himself or herself to the advertisement of any property, investment or service for sale to the public unless related to the practice of dietetics.
  3. A dietitian may not state publicly that he or she speaks on behalf of the CDBC unless expressly authorized to do so by the CDBC Board of Directors.
  4. A dietitian retains for one year after the date of publication or broadcast, a copy of any advertisement (paper, radio, TV or electronic transmission).
  5. A dietitian maintains a record of when and where the advertisement was made and make this information readily available to the Board upon request.
  6. A dietitian verifies the information contained in any advertisement when called upon by the Inquiry Committee, Discipline Committee or Board.

Selling Products and Conflict of Interest

  1. A dietitian only sells products related to the provision of nutrition care services and separates sales from healthcare functions whenever possible (e.g., promoting and selling a food product as part of a counseling session).
  2. A dietitian assesses a client’s nutritional needs and determines that a product sold by a dietitian or a service recommended to the client is based on current nutrition evidence and practice guidelines,and is in accordance with the CDBC Code of Ethics and Standards of Practice.
  3. A dietitian discloses to the client in advance any business relationship and financial interest they, or a person related to the dietitian, may have in a vendor of a product and in the profit from the promotion, distribution or the sale of a product. The Dietitian also discloses any industry relationships that exist between him/her and the product or product line being recommended.
  4. A dietitian offers the client at least one alternative to a specific product or brand.
  5. A dietitian assures the client that his or her selection of an alternate product will not adversely affect the nutrition services provided by the dietitian.
  6. A dietitian discloses 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.
  7. A dietitian ensures his or her nutrition services are not dependent on the sale of products (e.g., tell the client that nutrition services are unavailable without the purchase of a specific product sold by the dietitian).
  8. A dietitian may sell a product at fair market value if purchased by the dietitian. The cost may include reasonable handling, shipping and storage cost.
  9. A dietitian should/may not sell or promote products that involve a multi-level marketing strategy or a pyramid-sales scheme.
  10. A dietitian keeps records of each product:
  • 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.
  1. A dietitian is responsible for identifying and managing any real, perceived or potential conflicts of interest where their professional integrity could be interpreted as being compromised. Conflict of interest is managed through disclosure, recusal and/or discontinuation of professional services (refer to the CDBC Patient Relations Program and Chapter 4 of the Jurisprudence Guide for Dietitians more information on conflict of interest)
  2. A dietitian documents discussion about conflict of interest in the client record.
  3. A dietitian provides information about conflict of interest when called upon by the Inquiry Committee, Discipline Committee or Board.

References

 

QA-10 Virtual Dietetic Practice Policy

Date created: September 9, 2013
Date approved by the QAC: September 28, 2018, May 28, 2019, May 4, 2020
Date approved by the Board: March 14, 2014, October 29, 2018, May 28, 2019
Date last reviewed by the Board: April 15, 2014, October 15, 2018, May 28, 2019
Category: QAC
File code: Qac20/Policies/Qac-10-Virtual-Dietetic-Practice-final-May-04-2020

 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.

Note: 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.

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) No

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

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

b.  inform the SDA they are providing virtual dietetic services in SK, and

c.  become familiar with SK laws, regulations, standards and code of ethics.

College of Dietitians of Manitoba (CDM) No

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

a.  have successfully completed the CDRE,

b.  contact CDM prior to providing services and

c.  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) No

If a dietitian is physically located outside of Québec and providing virtual dietetic services to QC residents, the OPDQ advises the dietitian:

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

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

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.

  1. Be aware of and comply with restricted activities in the province where the client resides and each province where the dietitian is registered.
  2. 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).
  3. Disclose where they are registered to the client.
  4. 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).
  5. 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.
  6. 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.
  7. Have a process to explain benefits and limitations of virtual dietetic care, collect and record informed client consent to virtual services.
  8. Have a process to ensure client information confidentiality, access to information and safety of records.
  9. Have a process for emergency response to address any health emergencies that may occur during a virtual consultation (must be cross jurisdictional, if applicable).
  10. Provide interprofessional practice and have a process to refer the client to other health professionals, as necessary.
  1. 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