Quality Assurance Program

Authority

Health Professions Act, sections 16(2)(e), 26.1, 26.2, and CDBC bylaws, s. 58-61.

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 three learning goals at the start of each registration year.

The Standards of Practice 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 Report 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 Report 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 Report (PDR) online annually to the CDBC. Each PDR 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 Report nor renew their registration

Dietitians selected for an audit receive a general assessment letter as well as individualized detailed feedback. Incomplete Professional Development Reports 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 Report. 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 Report.

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 Assessment Process  to identify gaps in knowledge and skills. The assessment process consists of:
  • a competence self-assessment questionnaire and knowledge assessment case studies (KACS) and/or,
  • a practical assessment interview (PAI)

The assessment process is administered on a cost-recovery basis at the expense of the registrant, in accordance with Schedule B.

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. 61 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 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 Archived. 
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 58-60
5.  CDBC Code of Ethics and Standards of Practice
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.

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. 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

• BC Laws. Health Care (Consent) and Care Facilities (Admission) Act:http://www.bclaws.ca/civix/document/id/complete/statreg/96181_01 accessed April 29, 2020..
• BC Laws. Infants Act: http://www.bclaws.ca/civix/document/id/complete/statreg/96223_01 accessed April 29, 2020. .
• BC Laws. Mental Health Act: http://www.bclaws.ca/civix/document/id/complete/statreg/96288_01 accessed April 29, 2020..
• BC Laws. Representation Agreement Act: http://www.bclaws.ca/civix/document/id/complete/statreg/96405_01 accessed Arpil 29, 2020..
• College of Dietitians of BC, CDBC Bylaws: Code of Ethics: https://collegeofdietitiansofbc.org/cdbc-bylaws/.
• College of Dietitians of BC, Consent to Nutrition Care Guidelines: https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/
• College of Physical Therapists of BC, Consent to Treatment: cptbc.org/pdf/Consent.pdf; accessed April 29, 2020.
• College of Physical Therapists of BC, Practice Standard, Consent to Treatment: cptbc.org/pdf/PracticeStandards/PracticeStandards4.pdf; accessed April 29, 2020.
• College of Registered Nurses of BC, Consent: Practice Standards Principles: https://www.bccnm.ca/RN/ProfessionalStandards/Pages/Default.aspx; 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

Authority

CDBC bylaws, sections 52(1)(c)(iii) and 58.

Background

In accordance with section 52(1)(c)(iii) of the bylaws, “…the registration of a former full or non- practicing registrant, who ceased to be registered under section 50(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 58, as though the applicant had not ceased to be registered under section 50(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 52 the bylaws can only be reinstated within the 3-year period. After 3 years, they are considered under sections 53 (reinstatement within 6 years) or 54 (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 58(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.

Authority

Health Professions Act, section 16(2)(d); CDBC Code of Ethics, Principle 2 Co-signing Students’ Records – Practice Guideline

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 hold [themelves] 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, RD(T)) 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

• CDBC Practice Guidelines – Co-signing Students’ Records
• CDBC Code of Ethics – Principles and Guidelines

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 CDBC Code of Ethics, Principle 2 states: “A Registered Dietitian assumes responsibility and hold [themselves] 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, which include both Full Registrants and Temporarily Registered Dietitians, 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 and RD(T)) 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 Registrant obtains information about a dietetic student’s knowledge, skill and ability level.

2. Supervisory level

The Registrant sets their 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. Note: a Temporarily Registered Dietitian (RD(T)) may not supervise a full Registrant, per CDBC bylaw 45(7a)³. An RD(T) who has failed the CDRE may not supervise, nor co-sign student records.

3. Observation of client care

When the dietetic student or client case requires direct observation, the Registrant supervising ensures they is present during the dietetic student’s session with the client. The Registrant 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 Registrant discusses the care provided to the client and reviews the dietetic student client record entry to ensure appropriate care is provided.

• If the supervising Registrant observes the dietetic student providing care and agrees with the care provided and the dietetic student’s signed record entry, the Registrant co-signs the record.
• If the Registrant doesn’t see the care provided, they review the record entry and if both the stated care provided and the record entry are appropriate and accurate, the Registrant co-signs the record.
• Whether or not the Registrant sees the care provided, if the record entry is determined to be incomplete/unsigned, the Registrant 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” or “RD(T)” in accordance with facility protocol. 

References

1. Health Professions Act, section 16(2)(d).

2. CDBC Code of Ethics – Principles and Guidelines.

3. CDBC Bylaws, section 45(7a).

Position Statement on Dietitians’ Authority to Order Nutritional Substances for Therapeutic Diets

Privacy Guide

Authority

Health Professions Act (HPA), section 16(2); CDBC Code of Ethics and Standards of Practice

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 Code of Ethics and 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

• Entry-to-practice competence requirements are defined in the Integrated Competencies for Dietetic Education and Practice.
• The Canadian Dietetic Registration Examination (CDRE) is the national competence examination for dietitians in Canada
• The CDBC Jurisprudence Guide and Examination ensure dietitians understand the profession’s legal framework, the CDBC’s mandate to protect the public and regulatory processes in place to ensure dietitians practice safely, ethically and competently
• The CDBC Standards of Practice, Indicators and Outcomes define safe and competent practice standards for CDBC registrants.
• The CDBC Indigenous Cultural Safety, Humility, and Anti-Racism Practice Standard. Core Concepts 1 and 2.
• The CDBC Code of Ethics, Principles and Guidelines describes ethical practice expectations for CDBC registrants.
• The CDBC Restricted Activity Interpretive Guide and Application to Practice Restricted Activities describe safe and competent practice of enteral and parenteral nutrition services.
• Standards and Practice Guidelines inform competent and safe insertion of feeding tubes.
• The Continuing Competence Program requires dietitians enhance and maintain their practice of the Standards of Practice throughout their career.

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
• The CDBC Indigenous Cultural Safety, Humility, and Anti-Racism Practice Standard. Core Concepts 1 and 2.
• Section 73 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 interested parties (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
• The CDBC Indigenous Cultural Safety, Humility, and Anti-Racism Practice Standard. Core Concepts 4, 5, 6.
• 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

• BC Legislation:
  • Health Care (Consent) and Care Facilities (Admissions) Act
  • Infants Act
  • Mental Health Act
• BC Ministry of Health’s Health Care Providers’ Guide to Consent to Health Care, Consent to Nutrition Care Guidelines
• Standard of Practice 6 describes practice expectations regarding consent
• The CDBC Indigenous Cultural Safety, Humility, and Anti-Racism Practice Standard. Core Concepts 5 and 6.
• Code of Ethics Principles 4 and 5 describe behaviour expected of dietitians when obtaining consent
• CDBC QA-07 Consent to Nutrition Care Policy and Guidelines

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

• Refer to the Dietitians Regulation and CDBC policies and guidelines as a starting point and ensure you meet workplace policies and protocols (employers may specify expected responsibilities and scope of practice in greater detail).

6. Document and notify

a. Document nutrition services following appropriate legislation.

b. Notify appropriate interested parties about services as soon as reasonably possible.

Resources

• BC Legislation:
  • Freedom of Information and Protection of Privacy Act
  • Health Care (Consent) and Care Facilities (Admissions) Act
  • Hospital Act Regulation
  • Limitation Act
  • Personal Information Protection Act
  • Residential Care Regulation (Community Care and Assisted Living Act)
• Section 73 of the CDBC bylaws describes information categories dietitians must consider when providing client-centered services.
• Standards of Practice 14 and 15 describe practice expectations regarding timely documentation of services and interprofessional notification of services
• Standards for Record Keeping describe best practice principles for documenting services

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.

Authority

BC Human Rights Code; CDBC Code of Ethics and 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

• BC Laws. BC Human Rights Code: http://www.bclaws.ca/EPLibraries/bclaws_new/document/ID/freeside/00_96210_01; accessed April 29, 2020.
• College of Dental Hygienists of BC, Interpretation Guidelines. Refusal to Treat: https://oralhealthbc.ca/wp-content/uploads/2022/08/02.02.025-IG-Informed-Refusal-to-Consent.pdf; accessed April 29, 2020.
• College of Chiropractors of BC. Professional Conduct Handbook. Appendix A. Withdrawing from Patient Care: https://www.chirobc.com/standards-legislation/standards-of-practice/professional-conduct-handbook/;accessed April 22,2000.
• 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.

Testimonial Position Statement

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 B, Fees.

Provincial Registration Requirements for Dietitians providing Virtual Care in Canada

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

• Alliance of Canadian Dietetic Regulatory Bodies. 2018. Cross Border Dietetic Practice in Canada [not published].
• BC College of Nursing Professionals. Practice Standard Telehealth. https://www.bccnm.ca/RN/ProfessionalStandards/Pages/Default.aspx; accessed September 8, 2020.
• Canadian Alliance of Physiotherapy Regulators. Cross Border Physiotherapy – Guidelines for Physiotherapists. September 2017. https://www.alliancept.org/download/11290; accessed September 8, 2020.
• College of Dietitians of BC. CDBC , Code of Ethics and  Standards of Practice:https://collegeofdietitiansofbc.org/registrants/quality-assurance-program/ 
• College of Pharmacists of BC. Professional Practice Policy 55. Telepharmacy. http://www.bcpharmacists.org/readlinks/new-telepharmacy-requirements; accessed September 8, 2020.
• College of Physicians and Surgeons of British Columbia. Professional Standards and Guidelines. Telemedicine. https://www.cpsbc.ca/files/pdf/PSG-Telemedicine.pdf; accessed September 8, 2020.
• Health Standards Organization (HSO). 2018. Standards Council of Canada and International Society for Quality in Health Care. Virtual Health. https://healthstandards.org/standard/virtual-health-global/; accessed October 15, 2020.

Decision Tool for New Aspects of Dietetic Practice

Private Practice Resource

Recording of September 29, 2021 Marketing Standards Webinar