Regulation Matters 2021 - Issue 1, May

Delegation Reg Talks

The Aha! Moments and FAQs

Thank you to all the participants. 

We really enjoyed the participation, questions, and survey feedback from the dietitians who participated in the Reg Talks webinars we held in March and April about the new Standard for Dietitians Practising Through Delegation of Controlled Acts. The webinars examined the laws and standards dietitians must follow when practicing a controlled act through a delegation. The practice scenarios considered in the webinar were based on the practical experiences of dietitians who called the Practice Advisory Service for guidance on this topic.

View workshop webinar here, along with the handouts.

  • 183 dietitians participated
  • 38 responded to our survey

Dietitians’ “Aha! Moments”

  • The a-ha moment for me was a recognition of the value of the resources shared by the College.
  • Check own knowledge and skills and capability to perform the controlled act.
  • The reminder that just because a task/controlled act may be delegated to you, that if you are not confident or competent in your own personal scope of practice that you should not accept the delegation to perform a controlled act. 
  • Check with liability insurance carrier to determine if liability insurance requirement by the College will cover performance of controlled acts.
  • I always appreciate the practice scenarios, so working through those provided some 'a-ha' moments.  Without these, the information is theoretical, without practical application.

Suggestions for Webinar Improvement

  • Please continue this format and ongoing workshops based on trends in inquiries.
  • I very much appreciate these CDO webinars.  Please keep them up - they are invaluable for my course preparation!  The next generation of dietitians thanks you.
  • We needed more precise answers from the CDO.

How Dietitians Reported They Will Change Their Practice

  • Better able to communicate in my role about CDO resources and how they link to legislation.
  • Always use the framework to check decision in performing controlled acts.
  • How I teach the material - via case scenarios.

Summary of FAQs 

1. Can dietitians call people with COVID results?

The College’s Role and Task framework can help you consider new tasks such as calling clients with results (negative or positive) for COVID-19. Here are the questions to consider:
a. Is the new task or role within the dietetic scope of practice and practicing dietetics?
No, calling people with results of COVID testing is not within dietetic scope, however, dietitians can be re-deployed to assist with tasks that are not typically part of the dietetic scope. Accepting new tasks may help reduce the pressure and demand on the health care system as the pandemic evolves.
b.  Are there any legal barriers restricting a dietitian from performing the task (e.g., performing a Controlled Act)? For example, would an authority mechanism be needed for a dietitian to perform the task?

In this situation, the dietitian will need to be careful to avoid violating the restrictions on performing the controlled act of communicating a diagnosis, and we are not aware of any exceptions at this time. If an organization determines that communicating test results falls within the controlled act of communicating a diagnosis, then authority mechanisms would be required to permit dietitians to perform this task. Dietitians should work with their employers and other team members to ensure that this is done safely, ethically, and competently.

c. Will dietitians be required to have additional skills and competence to perform the new task?

If yes, make sure you have the proper training and resources to be able to accomplish this task competently and safely.

c. What are the interprofessional care team possibilities? Given all the local circumstances, who is the most appropriate person(s) to perform the task (e.g., an RD, or another health care provider/team member, or both)?

Dietitians should work with their employers and other team members to ensure that this is done safely, ethically, and competently. Individual circumstances will vary depending on the practice setting and nature of professional practice.  

2. Do I need extra liability insurance when practising under a delegation of controlled acts? 

Dietitians are required to hold professional liability insurance when practicing dietetics that aligns with the College's requirements as outlined in By-law No. 1 (this can be through their employer’s coverage or through an individual policy). You may want to check about coverage for re-deployment activities that are not practicing dietetics. If the redeployment task is out of scope you need to inquire if there is coverage for these out-of-scope tasks or if additional coverage must be obtained.

3. When practising through a delegation of a controlled act, what are my obligations for record keeping?

Dietitians should implement the documentation method that makes practical sense for their practice setting and also, as applicable, to ensure they are meeting the College’s Professional Practice Standards for Record Keeping (i.e. the minimum expectations dietitians must meet).

When practising through a delegation of a controlled act:

  • Follow organizational policies regarding documentation

  • If the authorizing health care provider was required to document the intervention, then document in the same way

  • If you are unclear – ask your organization

Dietitians’ obligations and accountabilities do not change, and they have a fundamental responsibility to act in an ethical manner. Dietitians are accountable to all the standards of practice. Dietitians must use professional judgement to make decisions in the best interests of their clients.

4. Is communicating the results of a nutrition assessment the same as communicating a diagnosis?

Restrictions on who may perform the controlled act of ‘communicating a diagnosis’ does not prevent dietitians from formulating a diagnosis but prevents them from communicating it to clients in certain circumstances. Communicating a diagnosis does not prevent a dietitian from communicating the results of a nutrition assessment, which may include the results of specific lab tests, provided the laboratory result itself is not confirmation or labelling of a disease or condition. For example, a dietitian can discuss the elevated level of LDL cholesterol with their client and may even provide a rationale behind why this would be of concern to those who have type 2 diabetes. Presumably, the dietitian will also discuss how the elevated LDL level may impact the nutrition care of the client.

Communicating an elevated lab level to a client is not necessarily “communicating a diagnosis identifying a disease or disorder as the cause of symptoms…” as this is defined in the controlled act. As long as you are not communicating a formal diagnosis (i.e., heart disease) you are not violating the controlled act.

Therefore, dietitians may discuss the results of the lab test with their client and be open with them as to the implications without outright declaring a medical diagnosis. Dietitians can also discuss that they do not have the authority to communicate a medical diagnosis. Dietitians can also mention that any formal medical diagnosis would have to be established through medical testing with the results being formally communicated by the client’s physician.

Please refer to Communicating a Diagnosis for further information.