What is Quality Dietetics? Do RDs Practice It ...

1 What is Quality Dietetics? Do RDs Practice It? How Do Dietetics Practitioners Know the Activities They Are Authorized to Perform? by Sharon M. McCauley, MS, MBA, RD, LDN, FADA & Cecily Byrne, MS, RD, LDN. Quality is about providing safe, effective, patients/residents/clients under their nutrition care. RDs patient/resident/client-centered, timely, efficient, and who demonstrate competency at the advanced Practice equitable dietetics care. These six dimensions of Quality are level may then apply to obtain clinical privileging in their outlined in a report by the committee on the Quality of facilities to perform medical level tasks. Health Care in America (1). Overall, the report makes an urgent call for fundamental change to close the Quality How do RDs know that they are able to apply for gap, recommends a redesign of the American health care privileges within their facility? system, and provides overarching principles for specific According to CMS, clinical privileging is a process by direction for policymakers, health care leaders, clinicians, which the governance of the hospital- specifically the regulators, purchasers, and others.

2 The report urges these governing body and the medical staff- develop and health care constituencies to commit to a national implement a process to ensure safe and Quality patient statement of purpose for the health care system as a care (2). Practitioners, including RDs, must demonstrate whole. In making this commitment, the parties would competence of medical level tasks ( , ordering accept as their explicit purpose to continually reduce the therapeutic diets, ordering parenteral nutrition) to obtain burden of illness, injury, and disability, and to improve the and maintain clinical privileges. Obtaining clinical health and functioning of the people of the United States privileges for RDs depends on the RD's legal scope of (1). Practice , medical staff bylaws in the facility, culture of the What steps must be taken to provide Quality dietetics facility, and the RD's competency level (2).

3 Care? How is scope of Practice defined? RDs in all Practice settings must review and understand Scope of Practice is defined by The University of California federal and state regulations, accreditation standards (if at San Francisco's Center for the Health Professions as: applicable to their facility or service), their facility policies legal scopes of Practice for the health care professions and procedures, and their individual scope of Practice . RDs establish which professionals may provide which health must read the regulations and interpretive guidelines of care services, in which settings, and under which the Centers for Medicare & Medicaid Services (CMS) - guidelines or parameters. With a few exceptions, Conditions of Participation for their respective Practice determining scopes of Practice is a state-based activity. setting. State legislatures consider and pass Practice acts, which RDs must know the federal and state licensure are referred to as statue, law, or code.

4 State regulatory requirements for food and dietetics service personnel, the agencies, such as medical or other health professions'. food and dietetics service standards, laws and regulations, boards, implement laws by writing and enforcing rules and and their state Practice acts to locate what, if any, legal regulations detailing the acts (3). scope of Practice is defined within the state where they are Each RD must know his/her individual scope of Practice employed. and should be performing at his/her highest level to RDs must also note their accreditation standards (if provide best Quality care. How does an RD determine this applicable) that their facility or Practice setting utilizes to level? By using the ADA Scope of Dietetics Practice ensure they are providing Quality care. These accreditation Framework to determine his/her own individual scope of standards are aligned with the CMS Services - Conditions Practice and verify if he/she is qualified to do what he/she of Participation and its regulations for food and dietetic has been hired to do.

5 What competencies has the RD. services. Accreditation organizations are: The Joint obtained? Does the RD accept responsibility and Commission, Healthcare Facilities Accreditation Program of accountability for his/her own nutrition care actions? the American Osteopathic Association, DNV-National Bottom-line --- Quality begins with Competency. Integrated Accreditation for Healthcare Organizations, and The ADA Scope of Dietetics Practice Framework is Public Health Accreditation Board. designed to assist the RD with determining whether a service is within his/her own scope of Practice . RDs will Next, RDs must know their facility policies and procedures not find a laundry list of services and skills a dietetics in order to perform effectively within medical executive practitioner can do. Lists tend to limit Practice . Scope of approved disease and condition specific protocols that Practice is a fluid concept.

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10 J Am Diet Assoc. 2006;106:459-463. (5) The American Dietetic Association Quality Management Committee. American Dietetic Association Revised 2008 Standards of Practice for Registered Dietitians in Nutrition Care; Standards of Professional Performance for Registered Dietitians; Standards of Practice for Dietetic Block Two Evaluation Resources comprises the Technicians, Registered, in Nutrition Care; and Standards of Professional 5* 8 5 5 Standards ' 2 % 2 1 0 8 - 5of 6 / Practice 8 39 6 / 5 59 (SOP). 8 7 30 / in 6 / 5 Nutrition Care 1 ) 6 5: 1 2 - . 2 3. / 58 45and 0 9 6 5: ! 50- 5 1 Performance ! 32 9 1 Standards 30 1 0 8 - 5& 2 36 52 -for . 5 Dietetic Technicians, Registered. J Am Diet Assoc. 2008;. of! 38 Professional . 2 3. / 58 45 46 / / 0 8 - 2 % 5! 6 348 Performance 3 2 - 9 6 5: ! ! (SOPP)548 35 for / 52 -RDs . 5 * and 0 9 ) 52 36 52 5 0 . 6 548 35/ 6 % 4 6 ' 2 % 2 1 0 8 - / 5 )DTRs 108(9):1538-1542, 55.