Abstract
Editor’s note: Figures 2 and 3 that accompany this article are available online at www.jandonline.org.
Client/Patient/Resident/Family/Customer
What Are the SOP and SOPP for NDTRs?
The SOP in Nutrition Care:
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Why Are the Standards Important for NDTRs?
- •safe, effective, quality, and efficient food, nutrition, and related services, and dietetics practice;
- •evidence-based practice and best practices;
- •improved nutrition and health-related outcomes and cost-reduction methods;
- •efficient management of time, finances, supplies, technology, and natural and human resources;
- •quality assurance, performance improvement, and outcomes reporting;
- •ethical and transparent business, billing, and financial management practices6,7;
- •verification of practitioner qualifications and competence because state and federal regulatory agencies, such as health departments and the Centers for Medicare and Medicaid Services (CMS) look to professional organizations to create and maintain standards of practice5,
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 151, 11-20-15); §482.28 Food and Dietetic Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed December 1, 2017
8;US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Transmittal 169−Advance Copy State Operations Manual. Appendix PP-Guidance to surveyors for long-term care facilities. Issued June 30, 2017 (updates current Appendix PP Rev. 168, with Phase 2 revisions effective 11-28-17); §483.60 Food and Nutrition Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf. Accessed December 1, 2017.
- •practitioner competence and adherence to the rules and regulations of state departments of health and federal regulatory agencies, such as CMS, which state that technical personnel demonstrate competence through education, experience, and specialized training with appropriate credentials as required to perform task(s) assigned5,
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 151, 11-20-15); §482.28 Food and Dietetic Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed December 1, 2017
8;US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Transmittal 169−Advance Copy State Operations Manual. Appendix PP-Guidance to surveyors for long-term care facilities. Issued June 30, 2017 (updates current Appendix PP Rev. 168, with Phase 2 revisions effective 11-28-17); §483.60 Food and Nutrition Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf. Accessed December 1, 2017.
- •consistency in practice and performance;
- •nutrition and dietetics research, innovation, and practice development; and
- •individual career advancement.
- •minimum competent levels of practice and performance;
- •common measurable indicators for self-evaluation;
- •a foundation for public accountability in nutrition and dietetics care and services;
- •a description of the role of nutrition and dietetics and the unique services that NDTRs offer within the health care team and in practice settings outside of health care;
- •guidance for policies and procedures, job descriptions, competence assessment tools; and
- •academic and supervised practice objectives for education programs.
How Does the Academy’s Scope of Practice for the NDTR Guide the Practice and Performance of NDTRs in All Settings?
Why Were the Standards Revised?
Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Dietetic Technicians, Registered.
Academy of Nutrition and Dietetics: Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians.
Long-Term Care
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489 Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities. Final Rule (FR DOC#2016; pp68688-68872)−Federal Register October 4, 2016; 81(192):68688-68872; §483.30(f)(2) Physician services (pp 65-66), §483.60 Food and Nutrition Services (pp 89-94), §483.60 Food and Nutrition Services (pp 177-178). https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed December 1, 2017.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Transmittal 169−Advance Copy State Operations Manual. Appendix PP-Guidance to surveyors for long-term care facilities. Issued June 30, 2017 (updates current Appendix PP Rev. 168, with Phase 2 revisions effective 11-28-17); §483.60 Food and Nutrition Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations/Downloads/Advance-Appendix-PP-Including-Phase-2-.pdf. Accessed December 1, 2017.
IMPACT Act—Implications for Hospitals and Post-Acute Care Conditions of Participation
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; revisions to requirements for discharge planning for hospitals, critical access hospitals, and home health agencies. 42 CFR Parts 482, 484, 485 Proposed Rule−Federal Register November 3, 2015. https://www.federalregister.gov/documents/2015/11/03/2015-27840/medicare-and-medicaid-programs-revisions-to-requirements-for-discharge-planning-for-hospitals. Accessed December 1, 2017.
National Diabetes Prevention Program
Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. National Diabetes Prevention Program. http://www.cdc.gov/diabetes/prevention/index.html. Accessed December 1, 2017.
Centers for Medicare & Medicaid Services. Medicare Diabetes Prevention Program (MDPP) Expanded Model. https://innovation.cms.gov/initiatives/medicare-diabetes-prevention-program/index.html. Accessed December 1, 2017.
How Were the Standards Revised?
What Is the Relationship of the NDTR and RDN in Delivering Person-/Client-/Population-Centered Care?
Academy of Nutrition and Dietetics. Practice tips: The RDN-NDTR team—Steps to preserve. http://www.eatrightstore.org/product/C6E60A2F-BCED-4F3F-BC55-9A99C6BF4002. Accessed December 1, 2017.
Academy of Nutrition and Dietetics. Practice tips. What is meant by “under the supervision of the RDN.” http://www.eatrightstore.org/product/9E555AC7-ED41-445E-931C-C951BE0F14B3. Accessed December 1, 2017.
Academy of Nutrition and Dietetics. Practice tips: The RDN-NDTR team—Steps to preserve. http://www.eatrightstore.org/product/C6E60A2F-BCED-4F3F-BC55-9A99C6BF4002. Accessed December 1, 2017.
Academy of Nutrition and Dietetics Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. https://ncpt.webauthor.com. Accessed December 1, 2017.
What is Meant by “Under the Supervision of an RDN”?
- •RDNs are accountable for the nutrition care of patients/clients in various health care settings (eg, hospitals, nursing homes, home health agencies, clinics, end-stage renal facilities), public health programs (eg, Special Supplemental Nutrition Program for Women, Infants, and Children), and nutrition services provided by the Older Americans Act (through provision of daily meals provided in congregate and home-delivered settings). NDTRs may be supervised by RDNs in any of these settings in which patient-/client-/population-centered care is provided.
- •In many health care settings, an NDTR and other staff may be available to assist the RDN and implement routine delivery of food and nutrition services to the patient/client/customer. An RDN in these settings may assign activities to the NDTR and other support personnel consistent with the individual’s qualifications and competence. The RDN is responsible for overseeing duties assigned to others and must answer to patients/clients/advocates, employers, regulators, and boards of dietetics licensure if care is compromised.
- •The RDN may assign certain tasks for the purpose of obtaining needed information (eg, screening data, diet history) or communicating with and educating patients/clients/populations. An RDN may assign interventions within the NDTR scope of practice and demonstrated and documented competence, such as nutrition education, monitoring consumption of meals and medical food/nutrition supplements, and referring patients/clients to community agencies and programs. The NDTR and other professional, technical, and support staff can contribute valuable information and observations to the RDN that supports quality patient-/client-/population-centered care.
- •Whether the supervision is direct (RDN is on premises and immediately available) or indirect (RDN is immediately available by telephone or other electronic means) is determined by regulations and the organization’s policies and procedures.
- •Additional considerations include regulations, state dietitian/nutritionist licensure statutes, and rules that may include definitions of supervision and scope of practice specifications for professional, technical, and other support staff. Federal and state rules and regulations for health care facilities, dialysis centers, and food and nutrition assistance programs specify the responsibilities for the qualified dietitian.
- •Organization accreditation must also be considered. Standards address compliance with federal and state regulations and may specify additional requirements for an RDN and/or NDTR.
Academy of Nutrition and Dietetics. Practice tips. What is meant by “under the supervision of the RDN.” http://www.eatrightstore.org/product/9E555AC7-ED41-445E-931C-C951BE0F14B3. Accessed December 1, 2017.
In What Other Settings Do NDTRs Provide Services?
How Are the Standards Structured?
How Can I Use the Standards to Evaluate and Advance My Practice and Performance?
Academy Scope of Practice for the Registered Dietitian Nutritionist (RDN) Academy Scope of Practice for the Nutrition and Dietetics Technician, Registered (NDTR) Scope of practice in nutrition and dietetics encompasses the range of roles, activities, and regulations within which nutrition and dietetics practitioners perform. Identify your individual scope of practice 2 :An RDN’s and NDTR’s individual scope of practice is determined by education, training, credentialing, and demonstrated competence, as well as state statutory scope of practice, if applicable. Establishment of statutory scope of practice is the authority of the state(s) in which the RDN or NDTR practices. See Academy of Nutrition and Dietetics (Academy) Definition of Terms for differences between licensure, statutory certification, and title protection.
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Academy Standards of Practice in Nutrition Care and Standards of Professional Performance The four standards of practice in nutrition care and six standards of professional performance describe a minimum competent level of nutrition and dietetics practice and professional performance. Standards of practice and standards of professional performance are self-evaluation tools. Standards of practice in nutrition care apply to practitioners who provide care to patients/clients/populations.
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Indicators Indicators are action statements that identify a minimum competent level of practice, demonstrate how each standard relates to practice, and link standards to outcomes.
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Examples of Outcomes for Each Standard The outcome statements illustrate examples of measurable actions that result from demonstrating competence in practice.
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How do I demonstrate competence in my practice? Take a continuous quality improvement approach to implementing the standards and achieving desirable outcomes. Re-evaluate on a regular basis. What do I need to do to enhance my practice? Use the standards to develop your Professional Development Portfolio. The CDR professional development recertification process provides a framework for the RDN and the NDTR to develop specific goals, identify essential practice competencies and performance indicators, and pursue continuing education opportunities. Incorporate your goals and essential practice competencies, practice illustrations, and actions into your annual performance review and learning development process. |
- •apply every indicator and achieve the outcomes in line with roles and responsibilities all at once, or identify areas to strengthen and accomplish;
- •identify additional indicators and examples of outcomes (ie, outcomes measurement is a way to demonstrate value and competence) that reflect their individual practices/settings; and
- •apply only applicable indicators based on diversity of practice roles, activities, organization performance expectations, and work or volunteer practice settings.
Role | Examples of use of SOP and SOPP documents by NDTRs in different practice roles |
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Food and nutrition services director/manager, long-term care facility | A nutrition and dietetics technician, registered (NDTR) accepts a position as the director/manager of dining services for a long-term care facility. The NDTR manages foodservice operations and assists the consulting registered dietitian nutritionist (RDN) by contributing information and observations (eg, screening data, diet history) for completing nutrition assessments and providing medical nutrition therapy as part of the health care team. The NDTR participates in care plan and discharge meetings; and responds to questions from residents and their families about the diet order, nutrition care plan, provision of nutrition supplements and snacks, and menu choices based on food preferences through collaboration with the consultant RDN as needed. The NDTR reports to the RDN on intervention responses, including documenting outcomes or providing evidence signifying a need to adjust the residents’ care plans. The NDTR updates professional development plan to incorporate competencies that address regulations, review of medical conditions, and nutrition care guidelines for population served by the facility, and foodservice-related skills. |
Clinical practitioner, hospital, inpatient care | A hospital-based NDTR assigned to the cardiology and intensive care units assists the RDN following up on nutrition screening by obtaining additional information that the RDN will use to determine whether a nutrition assessment is indicated. The RDN and NDTR review patients, with the NDTR obtaining and contributing additional data to support assessments. For designated patients, the NDTR monitors for status changes, patient or family questions, care team observations, meal intake, and need for a snack, nutritional supplement, or nutrition education on therapeutic diet to contribute to care plan development/revision. The NDTR uses the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs as the primary guide for self-evaluation to assess competent practice. The NDTR recognizes that this self-evaluation and review of nutrition and dietetics resources will assist in revising professional development plan to incorporate new essential competencies and to identify relevant continuing education activities. |
Nutrition practitioner, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic | An NDTR who is a staff member in the health department’s WIC clinic screens participants for nutrition risk, assigns food packages or food package changes following guidelines, and provides nutrition education both individually and in group classes using approved nutrition education resources. The NDTR refers high-risk participants to the RDN for nutrition assessment and provides RDN-identified education to participants. The NDTR received initial and ongoing training from the RDN who provides consultation and performance monitoring. The NDTR’s goal is to provide breastfeeding counseling, assessment, and support and identifies specific continuing education activities with the goal of qualifying for the International Board Certified Lactation Consultant (IBCLC) certification. The NDTR updates professional development plan with applicable essential practice competencies. |
Director/manager, school nutrition program | An NDTR works as the public school district’s director of food and nutrition services. Working with school nutrition managers, the NDTR oversees foodservice operations. Tasks include documenting compliance with regulations, purchasing food and equipment, addressing food safety and sanitation, developing menus, training staff, and overseeing kitchen design and renovation, in addition to the human resource functions of the position. The NDTR facilitates addressing students’ required dietary modifications in consultation with families, school nurses, referring physicians, and the state agency consultant RDN, if needed. Because of the various roles, the NDTR uses the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs as the guide for self-evaluation along with the state agency’s school nutrition professional development resources to reflect on any knowledge or skills needed for quality and competent practice. |
Telehealth practitioner, wellness organization | An NDTR with more than 5 years hospital nutrition care experience accepts a position in the call center with a national organization that contracts with private insurers to provide virtual general health and wellness coaching to an insurer’s members. Call center staff, who are supervised by a registered nurse, are provided with extensive training that includes coaching skills and identifying when the caller needs to follow-up with a health care professional, for example, medical provider, a pharmacist with medication questions, or an RDN to address a prescribed diet for a chronic condition. The NDTR follows organization guidelines for providing general health, nutrition, and physical activity information to callers. With the change in employment to this new position, the NDTR reviews the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs and updates professional development plan with new essential practice competencies, as needed. |
NDTR, nonpracticing | An NDTR takes a leave of absence from the nutrition and dietetics workforce. Because the NDTR is maintaining the credential, sustaining professional performance is an expectation. The NDTR maintains and establishes networking and professional relationships. The NDTR participates in, and volunteers for, the local and national nutrition and dietetics association. The NDTR volunteers with the community food bank and responds to public policy calls to action by contacting representatives via social media and e-mail. The NDTR obtains continuing professional education units for CDR certification requirement. The NDTR recognizes the need to maintain skills at least at the minimally competent level identified within the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs. |
Summary
Academy of Nutrition and Dietetics. Practice tips: The RDN-NDTR team—Steps to preserve. http://www.eatrightstore.org/product/C6E60A2F-BCED-4F3F-BC55-9A99C6BF4002. Accessed December 1, 2017.
Academy of Nutrition and Dietetics. Practice tips. What is meant by “under the supervision of the RDN.” http://www.eatrightstore.org/product/9E555AC7-ED41-445E-931C-C951BE0F14B3. Accessed December 1, 2017.
Academy of Nutrition and Dietetics. Definition of terms. http://www.eatrightpro.org/scope. Accessed December 1, 2017.
Acknowledgements
Supplementary Materials
Standards of Practice for Nutrition and Dietetics Technicians, Registered Standard 1: Participates in Nutrition Screening and Provides Support to Nutrition Assessment The nutrition and dietetics technician, registered (NDTR) participates in nutrition screening of patients/clients and populations and obtains and verifies relevant data and information for support of nutrition assessment under the supervision of the registered dietitian nutritionist (RDN). Rationale: Nutrition screening is the preliminary step to identify individuals who require a nutrition assessment performed by an RDN. Although nutrition assessment and reassessment are the responsibility of the RDN, the NDTR takes an active role in obtaining and verifying relevant data and information for the RDN to complete the assessment. | ||
Indicators for Standard 1: Participates in Nutrition Screening and Provides Support to Nutrition Assessment | ||
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Each NDTR: | ||
1.1 | Conducts nutrition screening according to pre-established criteria and/or tools based in evidence and organizational policy to identify individuals with a nutrition-related problem (eg, but not limited to, risk for malnutrition, food allergy/intolerance, missing dentures) | |
1.2 | Obtains food and nutrient administration and intake data | |
1.2A | Collects and reviews food and nutrient intake information (eg, current and previous diets, nutrition support, diet prescriptions, meal and snack patterns, medical foods/nutritional supplements, typical foods and beverages, cultural and religious preferences, and food allergies and intolerances) | |
1.2B | Records food and nutrient intake data | |
1.2C | Calculates food and nutrient intake | |
1.2D | Compares calculated intake data to reference standards identified by the RDN | |
1.2E | Summarizes food and nutrient intake information | |
1.3 | Conducts interviews and reviews records for the following data for patients/clients and populations | |
1.3A | Personal, medical, nutrition, oral health, family, and psychosocial/social history | |
1.3B | Anthropometric indicators (eg, height, weight, weight history, body mass index, waist circumference, growth pattern indices/percentile ranks/z scores) | |
1.3C | Biochemical data, medical tests, procedures, and evaluations | |
1.3D | Medication data (eg, prescription and over-the-counter medications; dietary supplements [see Academy Definition of Terms]; medication and supplement allergies; potential for medication/food interaction; and adherence) | |
1.3E | Behavior, beliefs, knowledge, and attitudes of patient/client/population that influence nutrition and health and understanding of medical and other conditions | |
1.3F | Cognitive and physical ability to complete specific developmentally appropriate nutrition-related tasks (eg, self-feeding and other activities of daily living [ADLs]) and instrumental ADLs (eg, shopping and food preparation) | |
1.3G | Physical activity habits, training, and restrictions | |
1.3H | Food security defined as factors affecting access to a sufficient quantity of safe, healthful food and water, as well as food/nutrition-related supplies | |
1.3I | Other factors affecting intake and nutrition and health status (eg, cultural, ethnic, religious, lifestyle influencers, psychosocial, and social determinants of health) | |
1.4 | Communicates results of nutrition screening to RDN | |
1.5 | Documents and communicates: | |
1.5A | Date and time of interview(s) | |
1.5B | Date and time of records and data review | |
1.5C | Pertinent data (eg, food and nutrient intake, anthropometrics, biochemical data, medical tests and procedures, malnutrition, patient/client/population and medical, psychosocial, social, behavioral history) | |
1.5D | Comparison to reference standards | |
1.5E | Patient/client/population perceptions, values, and motivation related to nutrition care | |
1.5F | Patient/client/population level of understanding, reported food-related behaviors, and other pertinent information | |
Examples of Outcomes for Standard 1: Participates in Nutrition Screening and Provides Support to Nutrition Assessment
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Standard 2: Provides Support to Nutrition Diagnosis The nutrition and dietetics technician, registered (NDTR) obtains, verifies, and documents relevant data and information to support the registered dietitian nutritionist (RDN) in determining the nutrition diagnosis(es) or nutrition problems and etiology for patients/clients/populations. NDTRs observe and communicate signs and symptoms/defining characteristics, and other relevant information in a timely and accurate manner. Rationale: NDTRs contribute to the RDN’s identification of a nutrition diagnosis(es) by obtaining, verifying, documenting, and communicating relevant data and information about problem, etiology, signs, and symptoms for the RDN to effectively cluster, analyze, and synthesize information to determine a nutrition diagnosis(es). Timely and appropriate nutrition diagnosis by the RDN leads to a timely appropriate nutrition intervention/plan of care. | ||
Indicators for Standard 2: Provides Support to Nutrition Diagnosis | ||
Each NDTR: | ||
2.1 | Observes signs and symptoms/defining characteristics | |
2.2 | Verifies signs and symptoms with patient/client/advocate a /community, caregivers, family members, or other health care professionals when possible and appropriateAdvocate: An advocate is a person who provides support or represents the rights and interests at the request of the patient/client. The person may be a family member or an individual not related to the patient/client who is asked to support the patient/client with activities of daily living or is legally designated to act on behalf of the patient/client, particularly when the patient/client has lost decision-making capacity. (Adapted from definitions within The Joint Commission Glossary of Terms4 and the Centers for Medicare and Medicaid Services, Hospital Conditions of Participation5). | |
2.3 | Documents signs and symptoms/defining characteristics | |
2.4 | Communicates signs and symptoms/defining characteristics and other relevant information to the RDN | |
Examples of Outcomes for Standard 2: Provide Support to Nutrition Diagnosis
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Standard 3: Provides Support to Nutrition Intervention/Plan of Care as Directed by the Registered Dietitian Nutritionist The nutrition and dietetics technician, registered (NDTR) works under the supervision of the registered dietitian nutritionist (RDN) and assists by contributing to the implementation of nutrition intervention/plan of care developed by the RDN. The person-centered nutrition intervention/plan of care is designed to maintain or promote a desirable change in nutrition-related behaviors, risk factors, environmental conditions, or aspects of health status for an individual, target group, or the community at large. Rationale: The NDTR contributes to the nutrition intervention/plan of care by assisting the RDN with implementation of individualized patient-/client-/population-centered nutrition interventions/plans of care and education with the goal of resolving, improving, or stabilizing the nutrition diagnosis/problem. | ||
Indicators for Standard 3: Provides Support to Nutrition Intervention/Plan of Care as Directed by the Registered Dietitian Nutritionist | ||
Each NDTR: | ||
3.1 | Provides nutrition intervention/plan of care as designed and directed by an RDN and in accordance with: | |
3.1A | Applicable laws and regulations | |
3.1B | Organization or program, policies and procedures | |
3.2 | Responds to patient/client/advocate/population inquiries regarding interventions that are within the established nutrition intervention/plan of care in accordance with the NDTR’s demonstrated competence | |
3.3 | Communicates and clarifies the nutrition intervention/plan of care, including nutrition prescription with patients/clients/advocates/population, caregivers, and interprofessional b team membersInterprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, and occupational and physical therapists), depending on the needs of the patient/client. Interprofessional could also mean interdisciplinary or multidisciplinary. | |
3.4 | Verifies that the nutrition intervention/plan of care is being implemented and that needs and preferences of the patient/client/population are being met | |
3.5 | Participates in discharge planning and transitions of care for patients/clients and populations | |
3.6 | Communicates with RDN about discussions with patient/client/advocate/population and observed changes in patient/client/population status that may influence the nutrition intervention/plan of care and/or discharge planning/transitions of care needs | |
3.7 | Documents and communicates: | |
3.7A | Date and time | |
3.7B | Nutrition intervention/plan of care provided as developed by the RDN | |
3.7C | Observed changes in patient/client status influencing the nutrition intervention/plan of care | |
3.7D | Patient/client/advocate/caregiver/community receptiveness | |
3.7E | Patient/client/advocate/caregiver/community comprehension of intervention/plan of care | |
3.7F | Observed barriers to change | |
3.7G | Plans for follow-up | |
Examples of Outcomes for Standard 3: Provides Support to Nutrition Intervention/Plan of Care as Directed by the RDN
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Standard 4: Nutrition Monitoring and Evaluation The nutrition and dietetics technician, registered (NDTR) participates in the nutrition monitoring of patients/clients and populations under the supervision of the registered dietitian nutritionist (RDN). The NDTR uses indicators as identified by the RDN that are relevant to the defined needs, nutrition diagnosis/problem, nutrition goals, preferences, and desired health results for the patient/client/population. Rationale: Nutrition monitoring and evaluation are essential components of an outcomes management system in order to assure quality, patient-/client-/population-centered care and to promote uniformity within the profession in evaluating the efficacy of nutrition interventions. By obtaining nutrition data and information at scheduled follow-up points, the NDTR assists the RDN in nutrition monitoring to support evaluation of the nutrition intervention/plan of care and tailoring the nutrition intervention/plan of care to the patient’s/client’s/population’s needs and preferences. | ||
Indicators for Standard 4: Nutrition Monitoring and Evaluation | ||
Each NDTR: | ||
4.1 | Assesses patient/client/advocate/population understanding and compliance with nutrition intervention/plan of care | |
4.2 | Determines whether the nutrition intervention/plan of care is being implemented as prescribed | |
4.3 | Identifies data and information impacting the effectiveness of the nutrition intervention/plan of care strategy and potential needs after discharge | |
4.4 | Communicates with the RDN regarding monitoring and evaluation activities and findings | |
4.5 | Tracks and documents: | |
4.5A | Progress toward goals | |
4.5B | Factors/barriers impacting progress | |
4.5C | Changes in patient/client/advocate/population level of understanding and food-related behaviors | |
4.5D | Change in clinical data, health, or functional status and discharge/transitions of care needs | |
4.5E | Outcomes of intervention | |
Examples of Outcomes for Standard 4: Provides Nutrition Monitoring and Supports Nutrition Evaluation
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US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 151, 11-20-15); §482.28 Food and Dietetic Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed December 1, 2017
Standards of Professional Performance for Nutrition and Dietetics Technicians, Registered Standard 1: Quality in Practice The nutrition and dietetics technician, registered (NDTR) provides quality services using a systematic process with identified ethics, leadership, accountability, and dedicated resources. Rationale: Quality practice in nutrition and dietetics is built on a solid foundation of education, supervised practice (if applicable), credentialing, evidence-based practice, demonstrated competence, and adherence to established professional standards. Quality practice requires systematic measurement of outcomes, regular performance evaluations, and continuous improvement. | ||
Indicators for Standard 1: Quality in Practice | ||
Each NDTR: | ||
1.1 | Complies with applicable laws and regulations as related to his or her area(s) of practice | |
1.2 | Performs within individual and statutory scope of practice and applicable laws and regulations | |
1.3 | Adheres to sound business and ethical billing practices applicable to the role and setting | |
1.4 | Uses national quality and safety data (eg, National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division, National Quality Forum, Institute for Healthcare Improvement) to improve the quality of services provided and to enhance customer-centered services | |
1.5 | Uses a systematic performance improvement model that is based on practice knowledge, evidence, research, and science for delivery of the highest quality services | |
1.6 | Participates in or designs an outcomes-based management system to evaluate safety, effectiveness, quality, person-centeredness, timeliness, and efficiency of practice | |
1.6A | Involves colleagues and others, as applicable, in systematic outcomes management | |
1.6B | Defines expected outcomes that may include quality indicators identified by the RDN when providing patient/client care | |
1.6C | Uses indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.) | |
1.6D | Measures quality of services in terms of structure, process, and outcomes | |
1.6E | Reviews reports from electronic clinical quality measures that evaluate care improvement for patients/clients at risk for malnutrition or with malnutrition (www.eatrightpro.org/emeasures) | |
1.6F | Documents measureable outcomes | |
1.7 | Identifies and addresses potential and actual errors and hazards in provision of services or brings to attention of supervisors (eg, RDN) and team members as appropriate | |
1.8 | Compares actual performance to performance goals (ie, Gap Analysis, SWOT Analysis [Strengths, Weaknesses, Opportunities, and Threats], PDCA Cycle [Plan-Do-Check-Act], DMAIC [Define, Measure, Analyze, Improve, Control]) | |
1.8A | Reports and documents action plan to address identified gaps in care and/or service performance | |
1.9 | Checks interventions and workflow process(es) and identifies needed service and delivery improvements | |
1.10 | Improves or enhances patient/client/population care and/or services working with RDN or others based on measured outcomes and established goals | |
Examples of Outcomes for Standard 1: Quality in Practice
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Standard 2: Competence and Accountability The nutrition and dietetics technician, registered (NDTR) demonstrates competence in, and accepts accountability and responsibility for ensuring safe, quality practice and services. Rationale: Competence and accountability in practice includes continuous acquisition of knowledge, skills, experience, and judgment in the provision of safe, quality customer-centered service. | ||
Indicators for Standard 2: Competence and Accountability | ||
Each NDTR: | ||
2.1 | Adheres to the codes(s) of ethics (eg, Academy/CDR, other national organizations, and/or employer code of ethics) | |
2.2 | Integrates Scope of Practice, Standards of Practice (SOP), and Standards of Professional Performance (SOPP) into practice, self-evaluation, and professional development | |
2.2A | Integrates applicable focus area SOP and SOPP into practice as directed by the RDN | |
2.3 | Demonstrates and documents competence in practice and delivery of customer-centered service(s) | |
2.4 | Assumes accountability and responsibility for actions and behaviors | |
2.4A | Identifies, acknowledges, and corrects errors | |
2.5 | Conducts self-evaluation at regular intervals | |
2.5A | Identifies needs for professional development | |
2.6 | Designs and implements plans for professional development | |
2.6A | Develops plan and documents professional development activities in career portfolio (eg, organizational policies and procedures, credentialing agency[ies]) | |
2.7 | Engages in evidence-based practice and uses best practices | |
2.8 | Participates in peer review of others as applicable to role and responsibilities | |
2.9 | Mentors and/or precepts others | |
2.10 | Pursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations, and requirements of practice setting | |
Examples of Outcomes for Standard 2: Competence and Accountability
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Standard 3: Provision of Services The nutrition and dietetics technician, registered (NDTR) provides safe, quality service based on customer expectations and needs, and the mission, vision, principles, and values of the organization/business. The NDTR works under the supervision of a registered dietitian nutritionist (RDN) when providing services related to direct care. Rationale: Quality programs and services are designed, executed, and promoted based on the NDTR’s knowledge, skills, experience, judgment, and competence in addressing the needs and expectations of the organization/business and its customers. | ||
Indicators for Standard 3: Provision of Services | ||
---|---|---|
Each NDTR: | ||
3.1 | Contributes to or leads in development and maintenance of programs/services that address the needs of the customer or target population(s) | |
3.1A | Aligns program/service development with the mission, vision, principles, values, and service expectations and outputs of the organization/business | |
3.1B | Uses the needs, expectations, and desired outcomes of customers/populations (eg, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service development | |
3.1C | Makes decisions and recommendations that reflect stewardship of time, talent, finances, and environment | |
3.1D | Proposes programs and services that are customer-centered, culturally appropriate, and minimize disparities | |
3.2 | Promotes public access and referral to credentialed nutrition and dietetics practitioners for quality food and nutrition programs and services | |
3.2A | Contributes to or designs referral systems that promote access to qualified, credentialed nutrition and dietetics practitioners | |
3.2B | Refers customers to appropriate providers when requested services or identified needs exceed the NDTR’s individual scope of practice | |
3.2C | Monitors effectiveness of referral systems and modifies as needed to achieve desirable outcomes | |
3.3 | Contributes to or designs customer-centered services | |
3.3A | Sets priorities based on needs, beliefs/values, goals, resources of the customer, and social determinants of health | |
3.3B | Uses knowledge of the customer’s/target population’s health conditions, culture, beliefs, and business objectives/services to guide design and delivery of customer-centered services | |
3.3C | Communicates principles of disease prevention and behavioral change appropriate to the customer or target population | |
3.3D | Collaborates with customers to set priorities, establish goals, and create customer-centered action plans to achieve desirable outcomes | |
3.3E | Involves customers in decision making | |
3.4 | Executes programs/services in an organized, collaborative, cost effective, and customer-centered manner | |
3.4A | Collaborates and coordinates with RDN, peers, colleagues, stakeholders, and within interprofessional a teamsInterprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, dietitian nutritionists, pharmacists, psychologists, social workers, and occupational and physical therapists), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary. | |
3.4B | Uses and participates in, or leads in the selection, design, execution, and evaluation of customer programs and services (eg, nutrition screening system, medical and retail foodservice, electronic health records, interprofessional programs, community education, grant management) | |
3.4C | Uses and develops or contributes to selection, design and maintenance of policies, procedures (eg, discharge planning/transitions of care), protocols, standards of care, technology resources (eg, Health Insurance Portability and Accountability Act [HIPAA] compliant telehealth platforms), and training materials that reflect evidence-based practice in accordance with applicable laws and regulations | |
3.4D | Complies with established billing regulations, organizational policies, grant funder guidelines, if applicable to role and setting, and adheres to ethical and transparent financial management and billing practices | |
3.4E | Communicates with the interprofessional team and referring party consistent with the HIPAA rules for use and disclosure of customer’s personal health information | |
3.5 | Uses professional, technical, and support personnel appropriately in the delivery of customer-centered care or services in accordance with laws, regulations, and organizational policies and procedures | |
3.5A | Assigns activities consistent with the qualifications, experience, and competence of professional, technical, and support personnel | |
3.5B | Supervises professional, technical, and support personnel | |
3.6 | Designs and implements food delivery systems to meet the needs of customers | |
3.6A | Collaborates in or leads the design of food delivery systems to address health care needs and outcomes (including nutrition status), ecological sustainability, and to meet the culture and related needs and preferences of target populations (ie, health care patients/clients, employee groups, visitors to retail venues, schools, child and adult day-care centers, community feeding sites, farm-to-institution initiatives, local food banks) | |
3.6B | Participates in, consults/collaborates with the RDN or others, or leads the development of menus to address health, nutritional, and cultural needs of target population(s) consistent with federal, state, or funding source regulations or guidelines | |
3.6C | Provides input to the RDN in the interprofessional process for determining medical foods/nutritional supplements, dietary supplements, enteral nutrition formulary for target population(s) | |
3.7 | Maintains records of services provided | |
3.7A | Documents according to organizational policies, procedures, standards, and systems, including electronic health records | |
3.7B | Implements data management systems to support interoperable data collection, maintenance, and utilization | |
3.7C | Uses data to document outcomes of services (ie, staff productivity, cost/benefit, budget compliance, outcomes, quality of services) and provide justification for maintenance or expansion of services | |
3.7D | Uses data to demonstrate program/service achievements and compliance with accreditation standards, laws, and regulations | |
3.8 | Advocates for provision of food and nutrition services as part of public policy | |
3.8A | Communicates with policy makers regarding the benefit/cost of quality food and nutrition services | |
3.8B | Advocates in support of food and nutrition programs and services for populations with special needs and chronic conditions | |
3.8C | Advocates for protection of the public through multiple avenues of engagement (eg, legislative action, establishing effective relationships with elected leaders and regulatory officials, participation in various Academy committees, workgroups and task forces, Dietetic Practice Groups, Member Interest Groups, and State Affiliates) | |
Examples of Outcomes for Standard 3: Provision of Services
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Standard 4: Application of Research The nutrition and dietetics technician, registered (NDTR) participates in and/or applies research to enhance practice. Evidence-based practice incorporates the best available research/evidence and information in the delivery of nutrition and dietetics services. Rationale: Participation in and application of nutrition and dietetics research leads to improved safety and quality of nutrition and dietetics practice and services. | ||
Indicators for Standard 4: Application of Research | ||
Each NDTR: | ||
4.1 | Reviews best available research/evidence and information for application to practice | |
4.1A | Understands basic research design and methodology | |
4.2 | Uses best available research/evidence and information as the foundation for evidence-based practice | |
4.3 | Applies best available research/evidence and information with best practices, clinical and managerial expertise, and customer values | |
4.4 | Contributes ideas and assists in activities of the research team | |
Examples of Outcomes for Standard 4: Application of Research
| ||
Standard 5: Communication and Application of Knowledge The nutrition and dietetics technician, registered (NDTR) effectively applies knowledge in communications. Rationale: The NDTR employs strategies and through collaboration with others, works to achieve common goals by effectively sharing and applying knowledge and skills in food, nutrition, dietetics, and management services. | ||
Indicators for Standard 5: Communication and Application of Knowledge | ||
Each NDTR: | ||
5.1 | Communicates and applies current knowledge and information based on evidence | |
5.1A | Demonstrates critical thinking and problem-solving skills when communicating with others | |
5.2 | Selects appropriate information and the most effective method or format that considers customer-centered care and needs of the individual/group/population when communicating information and conducting nutrition education or promotion | |
5.2A | Uses communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to various audiences | |
5.2B | Uses information technology to communicate, disseminate, manage knowledge, and support decision making | |
5.3 | Applies and demonstrates knowledge of food and nutrition integrated with knowledge of health, culture, social sciences, communication, informatics, sustainability, and management | |
5.4 | Shares current, evidence-based knowledge, and information with various audiences | |
5.4A | Guides customers, families, students, and interns in the application of knowledge and skills | |
5.4B | Assists individuals and groups to identify and secure appropriate and available nutrition and lifestyle education and other resources and services | |
5.4C | Uses professional writing and verbal skills in all types of communication | |
5.4D | Reflects knowledge of population characteristics in communication methods | |
5.5 | Establishes credibility and contributes as a food and nutrition resource within the interprofessional health care and management teams, organization, and community | |
5.6 | Seeks opportunities to participate in and assume leadership roles with local, state, and national professional and community-based organizations (eg, government-appointed advisory boards, community coalitions, schools, foundations or nonprofit organizations serving the food insecure) | |
Examples of Outcomes for Standard 5: Communication and Application of Knowledge
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Standard 6: Utilization and Management of Resources The nutrition and dietetics technician, registered (NDTR) uses resources effectively and efficiently. Rationale: The NDTR demonstrates and applies leadership skills through strategic management of time, finances, facilities, supplies, technology, natural, and human resources. | ||
Indicators for Standard 6: Utilization and Management of Resources | ||
Each NDTR: | ||
6.1 | Uses a systematic approach to manage resources and improve outcomes | |
6.2 | Evaluates management of resources with the use of standardized performance measures and benchmarking as applicable | |
6.2A | Uses the Standards of Excellence Metric Tool, consistent with roles and responsibilities, to self-assess quality in leadership, organization, practice, and outcomes for an organization (www.eatrightpro.org/excellencetool) | |
6.3 | Evaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and products | |
6.4 | Participates in quality assurance and performance improvement and documents outcomes and best practices relative to resource management | |
6.5 | Measures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators) | |
Examples of Outcomes for Standard 6: Utilization and Management of Resources
|
References
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Article info
Publication history
Footnotes
The Academy Quality Management Committee 2016-2018: Denise Andersen, MS, RDN, LD, CLC; Shari Baird, MS, RD, CPHQ, LSSBB; Tracey Bates, MPH, RD, LDN, FAND; Denise L. Chapel, MPH, MS, RDN, FAND; Alana D. Cline, PhD, RDN; Shyamala N. Ganesh, MS, RD, LD; Margaret Garner, MS, RDN, LD, FAND, CIC; Barbara L. Grant, MS, RDN, CSO, FAND; Kathryn K. Hamilton, MA, RDN, CSO, CDN, FAND; Krista Jablonski, MS, RDN, LDN; Sherri L. Jones, MS, MBA, RDN, LDN, FAND; Alexandra G. Kazaks, PhD, RDN, CDE; Susan H. Konek, MA, RDN, CSP, LD, FAND; Kelly K. Leonard, MS, RDN; Kimi G. McAdam, MS, RD; Beth N. Ogata, MS, RDN, CSP, CD; Egondu M. Onuoha, MS, RDN, CDE, IBCLC, CDN, GPC, FAND; Gretchen Y. Robinson, MS, RDN, LD, FADA, FAND; Darrin W. Schmidt, NDTR, FAND; Nancy G. Walters, MMSC, RDN, CSG, LDN, FAND; Pauline Williams, PhD, MPA, RDN, CD; Pamela Wu, DPA, RDN; Karen Hui, RDN, LDN; Carol Gilmore, MS, RDN, LD, FADA, FAND; Mujahed Khan, MBA, RDN, LDN; Dana Buelsing, MS; and Sharon M. McCauley, MS, MBA, RDN, LDN, FADA, FAND.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.