Abstract
Editor’s note: Figures 1 and 2 that accompany this article are available at www.jandonline.org.
- Tholking M.M.
- Mellowspring A.C.
- Eberle S.G.
- et al.
Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR) Code of Ethics for the Nutrition and Dietetics Profession Academy website. https://www.eatrightpro.org/practice/code-of-ethics/what-is-the-code-of-ethics. Accessed May 23, 2018.
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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 165, 12-16-16); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 413, 416, 440 et al. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II; Final rule (FR DOC #2014-10687; pp 27106-27157). http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – 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 July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 16, 2018.
Academy Quality and Practice Resources
Three Levels of Practice
Standards of Practice are authoritative statements that describe practice demonstrated through nutrition assessment, nutrition diagnosis (problem identification)nutrition intervention (planning, implementation), outcomes monitoring and evaluation (four separate standards), and the responsibilities for which registered dietitian nutritionists (RDNs) are accountable. The Standards of Practice (SOP) for RDNs in Mental Health and Addictions presuppose that the RDN uses critical thinking skills; analytical abilities; theories; best available research findings; current accepted nutrition, dietetics, and medical knowledge; and the systematic holistic approach of the nutrition care process as they relate to the application of the standards. Standards of Professional Performance (SOPP) for RDNs in Mental Health and Addictions are authoritative statements that describe behavior in the professional role, including activities related to Quality in Practice; Competence and Accountability; Provision of Services; Application of Research; Communication and Application of Knowledge; and Utilization and Management of Resources (six separate standards). |
SOP and SOPP are complementary standards and serve as evaluation resources. All indicators may not be applicable to all RDNs’ practice or to all practice settings and situations. RDNs operate within the directives of applicable federal and state laws and regulations, as well as policies and procedures established by the organization in which they are employed. To determine whether an activity is within the scope of practice of an RDN, the practitioner compares his or her knowledge, skill, experience, judgment, and demonstrated competence with the criteria necessary to perform the activity safely, ethically, legally, and appropriately. The Academy’s Scope of Practice Decision Tool, which is an online, interactive tool, is specifically designed to assist practitioners with this process. |
The term patient/client is used in the SOP as a universal term as these Standards relate to direct provision of nutrition care and services. Patient/client could also mean client/patient, resident, participant, consumer, or any individual or group who receives mental health and addictions care and services. Customer is used in the SOPP as a universal term. Customer could also mean client/patient, client/patient/customer, participant, consumer, or any individual, group, or organization to which the RDN provides services. These services are provided to individuals ages 13 years and older. The SOP and SOPP are not limited to the clinical setting. In addition, it is recognized that the family and caregiver(s) of patient/clients of all ages, including individuals with special health care needs, play critical roles in overall health and are important members of the team throughout the assessment and intervention process. The term appropriate is used in the standards to mean: Selecting from a range of best practice or evidence-based possibilities, one or more of which would give an acceptable result in the circumstances. |
Each standard is equal in relevance and importance and includes a definition, a rationale statement, indicators, and examples of desired outcomes. A standard is a collection of specific outcome-focused statements against which a practitioner’s performance can be assessed. The rationale statement describes the intent of the standard and defines its purpose and importance in greater detail. Indicators are measurable action statements that illustrate how each specific standard can be applied in practice. Indicators serve to identify the level of performance of competent practitioners and to encourage and recognize professional growth. |
Standard definitions, rationale statements, core indicators, and examples of outcomes found in the Academy of Nutrition and Dietetics: Revised 2017 SOP in Nutrition Care and SOPP for RDNs have been adapted to reflect three levels of practice (competent, proficient, and expert) for RDNs in mental health and addictions (see figure below). In addition, the core indicators have been expanded to reflect the unique competence expectations for the RDN providing mental health and addictions related care and/or services. |
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Competent Practitioner
Academy of Nutrition and Dietetics. Definition of terms list. www.eatrightpro.org/scope. Accessed July 16, 2018.
Academy of Nutrition and Dietetics. Definition of terms list. www.eatrightpro.org/scope. Accessed July 16, 2018.
Proficient Practitioner
Academy of Nutrition and Dietetics. Definition of terms list. www.eatrightpro.org/scope. Accessed July 16, 2018.
Expert Practitioner
Academy of Nutrition and Dietetics. Definition of terms list. www.eatrightpro.org/scope. Accessed July 16, 2018.
Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR) Code of Ethics for the Nutrition and Dietetics Profession Academy website. https://www.eatrightpro.org/practice/code-of-ethics/what-is-the-code-of-ethics. Accessed May 23, 2018.
Overview
Reports and Detailed Tables from the 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Accessed July 16, 2018.
Reports and Detailed Tables from the 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Accessed July 16, 2018.
Reports and Detailed Tables from the 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Accessed July 16, 2018.
Druss BG, Walker ER. Mental disorders and medical comorbidity. Research Synthesis Report #21 February 2011. Robert Woods Johnson Foundation website. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf69438/subassets/rwjf69438_1. Published February 2011. Accessed July 16, 2018.

Substance Use Disorders. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/disorders/substance-use. Accessed July 16, 2018.
Academy Revised 2018 SOP and SOPP for RDNs (Competent, Proficient, and Expert) in Mental Health and Addictions
- •identify the competencies needed to provide mental health and addictions nutrition and dietetics care and services;
- •self-evaluate whether he or she has the appropriate knowledge, skills, experience, and judgment to provide safe, effective, and quality mental health and addictions nutrition and dietetics care and service for their level of practice;
- •identify the areas in which additional knowledge, skills, and experience are needed to practice at the competent, proficient, or expert level of mental health and addictions nutrition and dietetics practice;
- •provide a foundation for public and professional accountability in mental health and addictions nutrition and dietetics care and services;
- •support efforts for strategic planning, performance improvement, outcomes reporting, and assist management in the planning and communicating of mental health and addictions nutrition and dietetics services and resources;
- •enhance professional identity and skill in communicating the nature of mental health and addictions nutrition and dietetics care and services;
- •guide the development of mental health and addictions nutrition and dietetics-related education and continuing education programs, job descriptions, practice guidelines, protocols, clinical models, competence evaluation tools, and career pathways; and
- •assist educators and preceptors in teaching students and interns the knowledge, skills, and competencies needed to work in mental health and addictions nutrition and dietetics, and the understanding of the full scope of this focus area of practice.
Application to Practice
Role | Examples of use of SOP and SOPP documents by RDNs in different practice roles a For each role, the RDN updates the professional development plan to include applicable essential practice competencies for mental health and/or addictions nutrition care and services to support needed knowledge and skills, such as effective counseling techniques, pharmacology for common drugs of abuse, and potential nutrition-related impact(s). |
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Clinical practitioner, psychiatric hospital or acute care psychiatric unit | An RDN working in a psychiatric hospital reports seeing more patients/clients with a psychiatric disorder complicated by drug and/or alcohol addictions. The RDN reviews available resources to guide nutrition services and medical nutrition therapy for these individuals. The RDN refers to the Revised 2018 Standards of Practice (SOP) and Standards of Professional Performance (SOPP) for RDNs in Mental Health and Addictions to evaluate current knowledge, skills, experience, and competence for identifying areas to strengthen. The RDN consults with a colleague working with individuals with addictions in a community mental health center for information and recommendations for continuing education options. |
Clinical practitioner, post-acute/long-term care | An RDN consultant for a long-term care facility notices an increase in the number of new residents with a psychiatric disorder. The RDN refers to the SOP and SOPP in Mental Health and Addictions to enhance knowledge and skills for guiding assessment and plan of care decision making for these individuals. The RDN reviews the resources identified in the SOP and SOPP article and figures to identify areas for continuing education. The RDN consults with an RDN colleague who provides care for individuals with mental illnesses for appropriate diet orders and type of adjustments that may be needed for menus and dining options to support a resident’s nutritional needs. |
Clinical nutrition manager | A clinical nutrition manager (CNM) who oversees RDNs in a large psychiatric hospital considers the SOP and SOPP for Mental Health and Addictions for developing job descriptions, work assignments, assisting staff in evaluating competence and additional knowledge and/or skills needs in mental health and addictions nutrition care and services. The CNM recognizes the SOP and SOPP along with other applicable focus area SOP and SOPP (eg, diabetes care) as important tools for staff to use in assessing their own competence, identifying personal performance plans, and guiding quality improvement data monitoring and evaluation to optimize patient/client outcomes. |
Food and nutrition services manager | A new food and nutrition services manager in an addictions treatment facility uses the resources identified in the SOP and SOPP in Mental Health and Addictions and other relevant focus area SOP and/or SOPP to identify practice expectations when working with individuals with addictions. The RDN learns further information to assist with design/redesign of foodservice systems and menu and snack offerings in support of meeting the nutritional needs of the client population. |
Community-based support program practitioner | An RDN working in a community-based flexible support program provides consultations for participants with mental illnesses and other medical diagnoses who present with nutrition-related problems. The RDN reviews the SOP and SOPP for RDNs in Mental Health and Addictions and other relevant focus area SOP SOPP periodically to evaluate knowledge, skills and competence level for providing care to program participants. The SOP and SOPP are used as a resource for developing approaches in nutrition care, and guiding quality improvement projects to maximize participant and program outcomes. |
Telehealth practitioner | An RDN working in telehealth whose nutrition consultations include individuals with mental illness considers the SOP and SOPP in Mental Health and Addictions when determining expertise needed. The RDN identifies knowledge areas and resources to support care for individuals with mental illness, for communications with referring practitioner, and to strengthen professional counseling and education skills. The RDN reviews all relevant state laws and regulations, the Academy of Nutrition and Dietetics telehealth resources, and organizational policies and procedures regarding the practice of telehealth, noting differences for providing patient/client services to those not residing within the same state as the RDN. |
University Health Center practitioner | An RDN in a university student health center who provides counseling for nutrition and healthy lifestyle notes an increasing number of students being referred for poor nutrition because of alcohol and/or substance abuse. The RDN reviews the SOP and SOPP in Mental Health and Addictions for resources to guide nutrition assessments and develop interventions/plans of care. Review of indicators showed areas for increased knowledge, skills, and experience that were needed. The RDN consults with the interprofessional team on medical and nutrition management plans, and for recommendations on continuing education options. |
Private practice practitioner | An RDN working in a private practice setting whose nutrition consultations include individuals with mental illness and/or addictions considers the SOP and SOPP in Mental Health and Addictions when determining knowledge, skills and expertise needed. The RDN collaborates with the referring provider and, with client’s permission, other health care professionals guiding client’s treatment plan to incorporate addressing nutrition needs. The RDN uses the SOP and SOPP to identify resources for personal development and to support care for clients with mental illness and/or addictions. |
Future Directions
Summary
Acknowledgements
Author Contributions
Supplementary Materials
Standards of Practice for Registered Dietitian Nutritionists in Mental Health and Addictions Standard 1: Nutrition Assessment The registered dietitian nutritionist (RDN) uses accurate and relevant data and information to identify nutrition-related problems. Rationale: Nutrition screening is the preliminary step to identify individuals who require a nutrition assessment performed by an RDN. Nutrition assessment is a systematic process of obtaining and interpreting data in order to make decisions about the nature and cause of nutrition-related problems and provides the foundation for nutrition diagnosis. It is an ongoing, dynamic process that involves not only initial data collection, but also reassessment and analysis of patient/client or community needs. Nutrition assessment is conducted using validated tools based in evidence, the five domains of nutrition assessment, and comparative standards. Nutrition assessment may be performed via in-person, or facility/practitioner assessment application, or Health Insurance Portability and Accountability Act (HIPAA)-compliant video conferencing telehealth platform. | |||||||
Indicators for Standard 1: Nutrition Assessment | |||||||
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Bold Font Indicators are Academy Core RDN Standards of Practice Indicators | The “X” signifies the indicators for the level of practice | ||||||
Each RDN: | Competent | Proficient | Expert | ||||
1.1 | Patient/client/population history: Assesses current and past information related to personal, medical, family, and psychosocial/social history | X | X | X | |||
1.1A | Evaluates medical and nutritional history | X | X | X | |||
1.1A1 | Reviews information from nutrition screening for application to nutrition assessment | X | X | X | |||
1.1A2 | Reviews existing individualized service plans or plans of care addressing patient’s/client’s nutritional concerns and any progress made toward achieving established goals, and assesses patient’s/client’s level of understanding of nutrition concerns | X | X | X | |||
1.1B | Evaluates reports and evidence of: gastrointestinal discomfort, pain, difficulty chewing, and/or swallowing | X | X | X | |||
1.1C | Evaluates medical and family history for mental health disorders, addictions, and comorbidities | X | X | X | |||
1.1D | Evaluates for medical and disease conditions common in:
| X | X | ||||
1.2 | Anthropometric assessment: Assesses anthropometric indicators (eg, height, weight, body mass index [BMI], waist circumference, arm circumference), comparison to reference data (eg, percentile ranks/z-scores), and individual patterns and history | X | X | X | |||
1.2A | Uses age-appropriate standard procedures and equipment for height, weight, calculation of BMI, waist circumference, amputation adjustments | X | X | X | |||
1.2B | Evaluates developmental history (eg, growth history, developmental milestones) | X | X | X | |||
1.2C | Identifies and interprets trends in anthropometric indices taking into consideration cultural diversity | X | X | X | |||
1.2D | Evaluates abdominal girth in the presence of ascites, aerophagia | X | X | ||||
1.2E | Uses in-depth knowledge of body composition and nutritional physiology | X | |||||
1.3 | Biochemical data, medical tests, and procedure assessment: Assesses laboratory profiles (eg, acid–base balance, renal function, endocrine function, inflammatory response, vitamin/mineral profile, and lipid profile), and medical tests and procedures (eg, gastrointestinal study and metabolic rate) | X | X | X | |||
1.3A | Evaluates consultation reports for nutrition implications (eg, psychological testing, dental consults, speech/occupational/physical therapy evaluations, physician consultative reports) | X | X | X | |||
1.3A1 | Includes the World Health Organization Disability Assessment Schedule 2 (WHODAS 2.0) | X | X | ||||
1.3B | Uses biochemical data to evaluate nutritional status in relation to mental illness and addictions | X | X | X | |||
1.3B1 | Comprehensive blood panels | X | X | X | |||
1.3B2 | Vitamin/mineral deficiency/toxicity | X | X | ||||
1.3B3 | Heavy metal toxicity | X | X | ||||
1.3B4 | Essential fatty acids | X | X | ||||
1.4 | Nutrition-focused physical examination (NFPE) may include visual and physical examination: Obtains and assesses findings from NFPE (eg, indicators of vitamin/mineral deficiency/toxicity, edema, muscle wasting, subcutaneous fat loss, altered body composition, oral health, feeding ability, [suck/swallow/breathe], appetite, and affect) | X | X | X | |||
1.4A | Conducts NFPE that includes, but is not limited to: evaluate for evidence of oral, perioral, and skin-related abnormalities; notes patient/client reports of alterations in taste, smell, and dentition/chewing ability; considers vital signs (blood pressure, temperature, and rate of respiration) as reported by others | X | X | X | |||
1.4B | Evaluates body composition measures (eg, fat and muscle stores, anthropometrics) | X | X | X | |||
1.4C | Evaluates clinical signs of fluid imbalance (eg, edema, ascites, pulmonary congestion, skin turgor with dehydration, fatigue, muscle cramps, dark urine, rapid weight changes with fluid overload or loss, constipation) | X | X | X | |||
1.4D | Evaluates clinical signs of undernutrition (eg, dry, brittle, or thinning hair and nails, irritability, inability to concentrate) | X | X | X | |||
1.4E | Evaluates clinical signs of malnutrition (eg, hypothermia, bradycardia, lanugo, muscle wasting, tooth erosion, bony protrusions, parotid gland enlargement, gastrointestinal distress) in the context of mental illness and addictions | X | X | ||||
1.5 | Food and nutrition–related history assessment (ie, dietary assessment)–Evaluates the following components: | ||||||
1.5A | Food and nutrient intake including the composition and adequacy, meal and snack patterns, and appropriateness related to food allergies and intolerances | X | X | X | |||
1.5A1 | Assesses food and beverage intake for macro- and micronutrient sufficiency or excess | X | X | X | |||
1.5A2 | Assesses for variations in patterns of intake commonly found in mental health and addiction disorders or conditions (eg, polydipsia, self-restriction, binging, purging, abuse of appetite suppressants [diet pills, caffeine, nicotine], oral defensiveness, food/fluid avoidance due to paranoia, hallucinations, or delusions, excessive or inadequate intake related to mania or depression, post-traumatic stress disorder, anxiety) | X | X | ||||
1.5A3 | Assesses for variations in timing of food and fluid intake common in mental health and addictions disorders or conditions (eg, persons with chemical dependency eating only once a day or not at all; persons with dementia who forget to eat or forget to stop eating; night-time eating contributing to sleep disturbances and obesity) | X | X | ||||
1.5B | Food and nutrient administration, including current and previous diets and diet prescriptions and food modifications, eating environment, and enteral and parenteral nutrition administration | X | X | X | |||
1.5B1 | Assesses influences on eating patterns (eg, budget, time, food preferences) and responsibilities related to meal planning, purchasing, and preparation | X | X | X | |||
1.5B2 | Assesses social environment (eg, living situation and the influence of others on eating and food and beverage choices) | X | X | X | |||
1.5B3 | Assesses lifestyle practices (eg, food episodes, structure, location, and timing of meals and snacks) | X | X | X | |||
1.5B4 | Assesses level of support needed for self-directed food selection, attainment, preparation, and intake (eg, support of care providers, adaptive equipment, literacy tools) | X | X | ||||
1.5C | Medication and dietary supplement use, including prescription and over-the-counter medications, and integrative and functional medicine products | X | X | X | |||
1.5C1 | Evaluates potential interactions between nutrients/ nutritional status and prescribed medications, over-the-counter and illicit drugs, dietary supplements, including herbals, functional medicine products, bioactive substances, caffeine | X | X | X | |||
1.5C2 | Evaluates drug/food and dietary supplement/food interactions (eg, St John’s wort, valerian root, kava kava, grapefruit juice); refer to database resources (eg, Natural Medicine Comprehensive Database: http://naturaldatabase.therapeuticresearch.com/home.aspx) | X | X | X | |||
1.5C3 | Evaluates nutrition-related side effects of common mental health and addictions medications (eg, weight gain, fluid retention, dry mouth, excessive thirst, constipation, altered glucose and/or lipid metabolism, reduced calorie needs, gastrointestinal discomfort, anorexia, increased appetite) | X | X | ||||
1.5C4 | Evaluates drug-food/nutrient interactions of common mental health and addictions medications (eg, monoamine oxidase inhibitors, Antabuse, lithium) | X | X | ||||
1.5C5 | Evaluates use of illicit drugs and potential complications (eg, ascites, Wernicke-Korsakoff syndrome, oral-dental conditions, vitamin/mineral deficiencies) | X | X | ||||
1.5C6 | Incorporates and applies in-depth knowledge of drug-food/nutrient and drug–dietary supplement interactions and associated pharmacokinetics and pharmacodynamics | X | |||||
1.5D | Knowledge, beliefs, and attitudes (eg, understanding of nutrition-related concepts, emotions about food/nutrition/health, body image, preoccupation with food and/or weight, readiness to change nutrition- or health-related behaviors, and activities and actions influencing achievement of nutrition-related goals) | X | X | X | |||
1.5D1 | Assesses food preparation skills and knowledge | X | X | X | |||
1.5D2 | Assesses patient/client and/or family/caregiver reports of food cravings (eg, fats, simple carbohydrates) | X | X | X | |||
1.5D3 | Listens for and notes eating beliefs and convictions (eg, food combinations, orthorexia, food is poisoned) | X | X | ||||
1.5D4 | Documents patient/client reports of triggers for maladaptive behaviors | X | X | ||||
1.5D5 | Notes behavioral mediators (or antecedents) related to dietary intake (eg, attitudes, self-efficacy, knowledge, intentions, motivations, readiness and willingness to change, perceived social support, and feelings about living with a mental illness) | X | X | ||||
1.5D6 | Notes readiness of patient/client to receive selected nutrition interventions, considering patient’s/client’s cognitive, emotional, developmental, and behavioral readiness to benefit from planned interventions | X | X | ||||
1.5E | Food security defined as factors affecting access to a sufficient quantity of safe, healthful food and water, as well as food/nutrition-related supplies | X | X | X | |||
1.5E1 | Evaluates psychosocial, socioeconomic, functional, and behavioral factors related to food access, selection, preparation, and understanding of health condition | X | X | X | |||
1.5E2 | Notes observations of health care professionals and/or patient/client/family and social services reports:
| X | X | X | |||
1.5E3 | Investigates non-apparent barriers or conflicts that would interfere with food access, selection, preparation | X | X | ||||
1.5F | Physical activity, cognitive and physical ability to engage in developmentally appropriate nutrition-related tasks (eg, self-feeding and other activities of daily living), instrumental activities of daily living (eg, shopping, food preparation), and breastfeeding | X | X | X | |||
1.5F1 | Evaluates nutrition-related tasks the patient/client is able to perform independently, with assistance, and is able to do, but is not doing routinely | X | X | X | |||
1.5F2 | Observes ability to complete activities of daily living (eg, self-feeding, grocery shopping, cooking) | X | X | X | |||
1.5F3 | Notes observations and/or reports of excessive activity or non-activity (eg, pacing, wandering, excessive sleeping) | X | X | X | |||
1.5F4 | Observes for presence of, or risks for, depression, cognitive decline, anxiety, delusions | X | X | ||||
1.5G | Other factors affecting intake and nutrition and health status (eg, cultural, ethnic, religious, lifestyle influencers, psychosocial and social determinants of health) | X | X | X | |||
1.5G1 | Considers risk of harm to self and possible interaction with nutrition care | X | X | X | |||
1.5G2 | Evaluates impact of substance use disorder (eg, alcohol, tobacco, drugs) on ability to care for self | X | X | X | |||
1.5G3 | Notes significant recent stressors and any influence on food intake (eg, change of caregiver, loss of significant other) | X | X | X | |||
1.5G4 | Uses validated assessment instruments to assess level of developmental function (eg, activities of daily living) and mental status | X | X | ||||
1.5G5 | Evaluates symptoms suggesting a negative health event (eg, delirium tremens, withdrawal, seizures, overdose or toxic use, dehydration) | X | X | ||||
1.5G6 | Evaluates risk/history of DE/ED, and related factors (eg, medication adjustments, food intake, physical activity, weight history, food texture issues, psychiatric diagnosis) | X | X | ||||
1.5G7 | Evaluates other behaviors or factors that may delay the patient’s/client’s progress toward nutritional independence (eg, history of trauma, 45 refusal of food, motivation)Trauma-Informed Approach and Trauma-Specific Interventions. https://www.samhsa.gov/nctic/trauma-interventions. Substance Abuse and Mental Health Services Administration web site. Updated April 27, 2018. Accessed July 16, 2018. | X | X | ||||
1.5G8 | Notes involvement and/or preoccupation with religious/ cultural factors that may influence nutrition (eg, religious fasting, food avoidance) | X | X | ||||
1.6 | Comparative standards: Uses reference data and standards to estimate nutrient needs and recommended body weight, BMI, and desired growth patterns | X | X | X | |||
1.6A | Identifies the most appropriate reference data and/or standards (eg, international, national, state, institutional, and regulatory) based on practice setting and patient-/client-specific factors (eg, age and disease state) | X | X | X | |||
1.7 | Physical activity habits and restrictions: Assesses physical activity, history of physical activity, and physical activity training | X | X | X | |||
1.7A | Evaluates reports of current level of physical activity relative to Physical Activity Guidelines for Americans | X | X | X | |||
1.7B | Evaluates physical activity in context of current mental health and addictions treatment plan | X | X | X | |||
1.7C | Evaluates physical activities patient/client enjoys, but is not doing routinely | X | X | X | |||
1.7D | Evaluates for atypical physical activities (eg, non-ambulatory, athletes, compulsivity) | X | X | ||||
1.8 | Collects data and reviews collected and/or documented data by the nutrition and dietetics technician, registered (NDTR), other health care practitioner(s), patient/client, or staff for factors that affect nutrition and health status | X | X | X | |||
1.8A | Obtains and integrates data from members of the interprofessional a treatment teamInterprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physician, nurses, dietitian nutritionists, physician assistants, pharmacists, psychologists, social workers, and occupational and physical therapists), depending on the needs of the patient/client. Interprofessional could also mean interdisciplinary or multidisciplinary. | X | X | X | |||
1.9 | Uses collected data to identify possible problem areas for determining nutrition diagnoses | X | X | X | |||
1.10 | Documents and communicates: | X | X | X | |||
1.10A | Date and time of assessment | X | X | X | |||
1.10B | Pertinent data (eg, medical, social, behavioral) | X | X | X | |||
1.10C | Comparison to appropriate standards | X | X | X | |||
1.10D | Patient/client/population perceptions, values and motivation related to presenting problems | X | X | X | |||
1.10E | Changes in patient/client/population perceptions, values and motivation related to presenting problems | X | X | X | |||
1.10F | Reason for discharge/discontinuation or referral if appropriate | X | X | X | |||
1.10F1 | Provides pertinent nutrition information to contribute to coordination of transitions of care (eg, post discharge follow-up, transfer to another care setting) | X | X | X | |||
Examples of Outcomes for Standard 1: Nutrition Assessment
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Standard 2: Nutrition Diagnosis The registered dietitian nutritionist (RDN) identifies and labels specific nutrition problem(s)/diagnosis(es) that the RDN is responsible for treating. Rationale: Analysis of the assessment data leads to identification of nutrition problems and a nutrition diagnosis(es), if present. The nutrition diagnosis(es) is the basis for determining outcome goals, selecting appropriate interventions, and monitoring progress. Diagnosing nutrition problems is the responsibility of the RDN. | |||||||
Indicators for Standard 2: Nutrition Diagnosis | |||||||
Bold Font Indicators are Academy Core RDN Standards of Practice Indicators | The “X” signifies the indicators for the level of practice | ||||||
Each RDN: | Competent | Proficient | Expert | ||||
2.1 | Diagnoses nutrition problems based on evaluation of assessment data and identifies supporting concepts (ie, etiology, signs, and symptoms) | X | X | X | |||
2.1A | Evaluates and integrates complex assessment data consisting of physical, behavioral, psychosocial, and environmental nutrition assessment findings that impact nutritional status to identify nutrition diagnosis(es) and the etiology(ies) | X | X | X | |||
2.1B | Evaluates multiple factors that impact nutrition diagnosis(es) to identify the major cause(s) likely to respond to intervention(s) | X | X | ||||
2.1C | Uses complex information related to food and nutrient intake and clinical complications in relationship to their management within the treatment environment | X | |||||
2.2 | Prioritizes the nutrition problem(s)/diagnosis(es) based on severity, safety, patient/client needs and preferences, ethical considerations, likelihood that nutrition intervention/plan of care will influence the problem, discharge/ transitions of care needs, and patient/client/advocate b perception of importanceAdvocate: An advocate is a person who provides support and/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 Terms13 and the Centers for Medicare and Medicaid Services, Hospital Conditions of Participation8). | X | X | X | |||
2.2A | Uses evidence-based protocols and guidelines to prioritize nutrition diagnoses in order of urgency | X | X | X | |||
2.2B | Uses experience, critical thinking skills and judgment to determine nutrition diagnosis hierarchy for patients/clients with complex needs | X | X | ||||
2.2C | Determines the nutrition diagnosis hierarchy for disease states and complications to incorporate into nutrition protocols and guidelines, and guides discussions with interprofessional team | X | |||||
2.3 | Communicates the nutrition diagnosis(es) to patients/clients/advocates, community, family members or other health care professionals when possible and appropriate | X | X | X | |||
2.3A | Uses the most appropriate communication method (eg, written, oral, low literacy) to share information | X | X | X | |||
2.4 | Documents the nutrition diagnosis(es) using standardized terminology and clear, concise written statement(s) (eg, using Problem [P], Etiology [E], and Signs and Symptoms [S] [PES statement(s)] or Assessment [A], Diagnosis [D], Intervention [I], Monitoring [M], and Evaluation [E] (ADIME statement(s)]) | X | X | X | |||
2.5 | Re-evaluates and revises nutrition diagnosis(es) when additional assessment data become available | X | X | X | |||
2.5A | Uses most current information that may impact nutrition diagnosis(es), revises if needed, and communicates change to interprofessional team, patient/client/family/caregiver as appropriate in a timely manner | X | X | X | |||
Examples of Outcomes for Standard 2: Nutrition Diagnosis
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Standard 3: Nutrition Intervention/Plan of Care The registered dietitian nutritionist (RDN) identifies and implements appropriate, person-centered interventions designed to address nutrition-related problems, behaviors, risk factors, environmental conditions, or aspects of health status for an individual, target group, or the community at large. Rationale: Nutrition intervention consists of two interrelated components–planning and implementation.
| |||||||
Indicators for Standard 3: Nutrition Intervention/Plan of Care | |||||||
Bold Font Indicators are Academy Core RDN Standards of Practice Indicators | The “X” signifies the indicators for the level of practice | ||||||
Each RDN: | Competent | Proficient | Expert | ||||
Plans the Nutrition Intervention/Plan of Care: | |||||||
3.1 | Addresses the nutrition diagnosis(es) by determining and prioritizing appropriate interventions for the plan of care | X | X | X | |||
3.1A | Prioritization may include consideration of: | ||||||
3.1A1 | Medical conditions | X | X | X | |||
3.1A2 | Urgency of the issue/evidence of abnormal nutrition (eg, history of unhealthy weight loss/gain, prolonged poor nutritional intake) | X | X | X | |||
3.1A3 | Comorbid diseases or conditions | X | X | X | |||
3.1A4 | Actual or risk of acute complications | X | X | X | |||
3.1A5 | Patient’s/client’s available resources and support | X | X | X | |||
3.1A6 | Patient’s/client’s ability and willingness to implement and adhere to nutrition care plan | X | X | X | |||
3.1A7 | Mental health and addictions disorders (eg, schizophrenia, bipolar disorder, depression, intellectual and developmental disabilities [IDD], DE/ED, substance use disorder) | X | X | ||||
3.1A8 | Maladaptive behaviors (eg, hording, pica) | X | X | ||||
3.1A9 | Challenges that impact nutrition status (eg, genetic disorders, sensory processing disorders, pica) | X | X | ||||
3.2 | Bases intervention/plan of care on best available research/evidence and information, evidence-based guidelines, and best practices | X | X | X | |||
3.2A | Consults nationally developed adult and pediatric evidence-based practice guidelines and position papers (eg, Academy of Nutrition and Dietetics [Academy] position and practice papers, Academy Evidence Analysis Library, and Adult and Pediatric Nutrition Care Manuals) for guidelines for control or improvement of the disease or conditions as defined and supported in the literature | X | X | X | |||
3.2A1 | Evaluates and applies the most appropriate practice guidelines for the patient’s/client’s diagnosis(es), nutritional needs, and other factors (eg Evidence Analysis Library, Nutrition Care Manual, Substance Abuse and Mental Health Services Administration, Association for Addiction Professionals) | X | X | X | |||
3.2A2 | Tailors plan of care based on the individual’s needs and response to intervention | X | X | X | |||
3.2A3 | Recognizes when it is appropriate and safe to deviate from established guidelines | X | X | ||||
3.2A4 | Contributes to or directs the development of intervention guidelines | X | |||||
3.2B | Incorporates scientific, clinical, and humanistic knowledge and skills in clinical decision making and practice | X | X | ||||
3.2C | Applies knowledge, skills, and practice experiences in communications, information management, problem solving, and resource utilization to guide interventions and interactions with interprofessional team | X | |||||
3.3 | Refers to policies and procedures, protocols, and program standards | X | X | X | |||
3.3A | Adheres to federal, state, and local laws and regulations related to care of patients/clients with mental health and addictions disorders | X | X | X | |||
3.3B | Adheres to departmental/organizational program policies, procedures, guidelines, and protocols | X | X | X | |||
3.4 | Collaborates with patient/client/advocate/population, caregivers, interprofessional team, and other health care professionals | X | X | X | |||
3.4A | Serves as an integral member of the interprofessional team | X | X | X | |||
3.4A1 | Recognizes specific knowledge and skills of other providers, and collaborates to provide comprehensive care | X | X | ||||
3.4A2 | Teaches clinical practice skills and rationales for nutrition interventions to students, colleagues, and interprofessional team members | X | |||||
3.4B | Considers individual and family/caregiver knowledge, self-management skills, behavior/habits, and willingness to implement nutrition interventions to achieve goals | X | X | X | |||
3.4C | Collaborates with the patient/client, including family, caregiver, interprofessional team, and other health care practitioners as needed in all aspects of nutrition care and patient/client-centered interventions and planning | X | X | X | |||
3.4D | Refers patient/client to appropriate health care provider for problems outside scope of practice | X | X | X | |||
3.5 | Works with patient/client/population, advocate, and caregivers to identify goals, preferences, discharge/transitions of care needs, plan of care, and expected outcomes | X | X | X | |||
3.5A | Encourages patient/client to play an active role in goal setting for behavior change | X | X | X | |||
3.5B | Develops expected outcomes in observable and measurable terms that are clear, concise, patient-/client-centered, and tailored to what is reasonable for the patient’s/client’s circumstances, and specific in relation to treatments and outcomes; seeks assistance as needed | X | X | X | |||
3.5C | Identifies potential barriers to successful implementation of plan (eg, patient compliance, food availability and preparation issues, social support, readiness to change) | X | X | ||||
3.5D | Develops and implements strategies to address lapses in commitment or behaviors, and identifies recovery strategies | X | X | ||||
3.5E | Anticipates how nutrition intervention may minimize treatment-related side effects, treatment delays, and the need for increased level of care (eg, hospital admission) | X | |||||
3.6 | Develops the nutrition prescription and establishes measurable patient-/client-focused goals to be accomplished | X | X | X | |||
3.6A | Engages the patient/client in establishing nutrition prescription and plans for execution of interventions | X | X | X | |||
3.6A1 | Considers behavioral and environmental influences on nutritional intake | X | X | ||||
3.6A2 | Considers impacts of nutrition and appetite on behavior and readiness to learn | X | X | ||||
3.6B | Tailors nutrition prescription by taking into consideration factors affecting nutrition status (eg, health risks associated with overweight and obesity, addictions, mental health, comorbidities, such as disordered eating, intellectual and developmental disabilities, and living situation) | X | X | X | |||
3.6B1 | Reviews pharmacotherapy plan to evaluate for potential impact on nutrition prescription | X | X | ||||
3.6B2 | Uses critical thinking and synthesis skills to guide decision making in complicated, unpredictable, and dynamic situations | X | X | ||||
3.6B3 | Considers emerging/alternative treatment strategies that are supported by scientific evidence (evidence-based research, guidelines, and information) | X | |||||
3.6C | Addictions–Includes consideration of the following when developing the nutrition prescription: | ||||||
3.6C1 | Types of maladaptive substance use | X | X | X | |||
3.6C2 | Contraindications for alcohol consumption (eg, medication interaction, commitment to abstinence, history of substance use disorder, peri-conception, pregnant, or lactating, children and adolescents, specific medical conditions) | X | X | X | |||
3.6C3 | Nutrition in the prevention of developmental disabilities (eg, maternal nutrition, abstaining from alcohol and drugs, pica) | X | X | X | |||
3.6C4 | Effects of chemical dependency on physical health (eg, ascites, osteoporosis, peptic ulcer disease, esophageal reflux disease; cancers of the mouth, esophagus, stomach, bowel; heart disease, pancreatitis, altered glucose regulation, liver cirrhosis/necrosis, dyslipidemia, lactose intolerance, malnutrition) | X | X | X | |||
3.6C5 | Stage of detoxification or recovery from substance use disorder | X | X | ||||
3.6C6 | Effects of substance use disorder on mental and brain health (eg, altered mood, encephalopathy, neuropathy, dementia) | X | X | ||||
3.6C7 | Nutrition for recovery and relapse prevention | X | X | ||||
3.6C8 | Appropriate use of vitamin, mineral, and other nutritional supplements (eg, thiamin and digestive enzymes) in recovery | X | X | ||||
3.6C9 | Use of addictive substances acting as appetite suppressants (eg, caffeine, nicotine, and other addictive stimulants) | X | X | ||||
3.6C10 | Necessity for, as well as the psychological and health effects of, nutrition intervention | X | X | ||||
3.6C11 | Community/prevention programs specific to substance use disorder that provide nutrition-related support | X | X | ||||
3.6D | Mental Health–Includes consideration of the following when developing the nutrition prescription: | ||||||
3.6D1 | Nutrient imbalances associated with changes in mental functioning (eg, vitamin B-12 deficiency in depression, thiamin deficiency in dementia, lithium-electrolyte imbalance) | X | X | ||||
3.6D2 | Altered energy requirements associated with changes in activity patterns, sleep patterns, medications | X | X | ||||
3.6D3 | Altered hydration status (eg, polydipsia/water intoxication, dehydration, medication toxicity) | X | X | ||||
3.6D4 | Influence of mood and thought disorders in food selection and meal structuring | X | X | ||||
3.6D5 | Loss of appetite and poor self-care as symptoms of mental illness (vegetative or negative symptoms) | X | X | ||||
3.6D6 | Personality disorders (eg, borderline, antisocial, avoidant, narcissistic, passive-aggressive, and dependent personality features) that may impact nutrition | X | X | ||||
3.6E | Comorbidities and/or dual diagnosis(es) of DE/ED, IDD–Includes consideration of the following when developing the nutrition prescription: | ||||||
3.6E1 | Physiological consequences of eating disorders (eg, dental erosion, osteoporosis, esophageal erosion/tears/bleeding, delayed growth and sexual development, hair loss, muscle atrophy, dermatitis, mental confusion, reduced hormone production, bradycardia, cardiac arrest, dehydration, hypotension, weakness, hypothermia, death) | X | X | X | |||
3.6E2 | Need for alternative feeding methods or dining setting, rehabilitation evaluation/treatment | X | X | X | |||
3.6E3 | Prevention of, or need to address potential for, refeeding syndrome | X | X | X | |||
3.6E4 | Impairments of oral structure and function | X | X | ||||
3.6E5 | Oral hygiene and overcoming oral defensiveness | X | X | ||||
3.6E6 | Food and fluid textures to optimize safety and acceptance | X | X | ||||
3.6E7 | Realistic weight goals considering the impact of any skeletal abnormalities, psychiatric medications, actual or potential for physical activity, behaviors unique to the patient/client | X | X | ||||
3.6E8 | Psychological consequences of disordered eating (eg, depression, substance use disorder, self-harm) | X | X | ||||
3.6E9 | Patient/client distortions in body image and food portions | X | X | ||||
3.6E10 | Environmental/cultural/media literacy factors influencing disordered eating | X | X | ||||
3.6F | Considers impact of living situation information on addressing nutrition needs and design of nutrition prescription | X | X | X | |||
3.6F1 | Healthful content of food choices, frequency, and schedule of meals | X | X | X | |||
3.6F2 | Daily routines that interfere with nutritional intake | X | X | X | |||
3.6F3 | Access to food and nutrition services (eg, access to grocery store, funds to purchase, living situation where meals can be prepared) | X | X | X | |||
3.6F4 | Access to mental health and/or addictions services in the continuum of care (eg, transportation, community support clubhouse programs, mental health outreach programs) | X | X | ||||
3.6F5 | Policies/regulations that influence access to food and nutrition services | X | X | ||||
3.7 | Defines time and frequency of care including intensity, duration, and follow-up | X | X | X | |||
3.7A | Identifies time and frequency of care based on individual needs, established goals and outcomes, and expected response to intervention(s) | X | X | X | |||
3.7B | Considers severity of nutritional issues, and/or pending medical and/or behavioral/psychiatric interventions that are influenced by or may influence nutrition status | X | X | ||||
3.8C | Develops guidelines for timing of intervention(s) and follow-up based on organization guidelines, research, and best practices | X | |||||
3.8 | Uses standardized terminology for describing interventions | X | X | X | |||
3.9 | Identifies resources and referrals needed | X | X | X | |||
3.9A | Identifies:
| X | X | X | |||
3.9B | Identifies and facilitates referrals as needed for physical assistance (eg, adaptive equipment, speech therapy, occupational therapy, physical therapy, dental services, home care) | X | X | X | |||
3.9C | Identifies and facilitates referrals as needed for:
| X | X | X | |||
Implements the Nutrition Intervention/Plan of Care: | |||||||
3.10 | Collaborates with colleagues, interprofessional team, and other health care professionals | X | X | X | |||
3.10A | Collaborates with physician and interprofessional team to use approved protocols or similar documents consistent with facility/program polices | X | X | X | |||
3.10B | Collaborates for guidance or assistance or refers to other members of the interprofessional team when need is outside scope of practice of RDN (eg, psychiatrist, psychologist, social worker, occupational therapist, speech therapist, RDN with expertise in DE/ED) | X | X | X | |||
3.10C | Facilitates and fosters active communication, learning, partnerships, and collaboration with the interprofessional team | X | X | ||||
3.10D | Leads or directs the interprofessional team and others as appropriate | X | |||||
3.11 | Communicates and coordinates the nutrition intervention/plan of care | X | X | X | |||
3.11A | Reviews nutrition goals, interventions, and referrals/resources necessary to meet goals in nutrition plan of care and communicates with patient/client, caregivers, interprofessional team, other health care or community settings) | X | X | X | |||
3.11B | Collaborates with the interprofessional team and other agencies to coordinate nutrition care after discharge (eg, caregivers, family) | X | X | X | |||
3.11C | Ensures communication of nutrition plan of care and transfer of nutrition-related data between care settings as needed | X | X | X | |||
3.11D | Coordinates care for the patient/client with multiple diagnoses or repeat admissions with other members of the interprofessional team (eg, physician, psychiatrist, psychologist, social worker, behavioral therapist) | X | X | ||||
3.12 | Initiates the nutrition intervention/plan of care | X | X | X | |||
3.12A | Uses approved clinical privileges, physician/non-physician practitioner c -driven orders (ie, delegated orders), protocols, or other facility-specific processes for order writing or for provision of nutrition-related services consistent with applicable specialized training, competence, medical staff, and/or organizational policyNon-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, qualified dietitian, or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.8,9 The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and long-term care facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements, or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.11,12 | X | X | X | |||
3.12A1 | Implements, initiates, or modifies orders for therapeutic diet, nutrition-related pharmacotherapy management, or nutrition-related services (eg, medical foods/nutrition/dietary supplements, food texture modifications, enteral and parenteral nutrition, intravenous fluid infusions, laboratory tests, medications, and education and counseling) | X | X | X | |||
3.12A2 | Manages nutrition support therapies (eg, formula selection, rate adjustments, addition of designated medications and vitamin/mineral supplements to parenteral nutrition solutions or supplemental water for enteral nutrition) | X | X | X | |||
3.12A3 | Initiates and performs nutrition-related services (eg, bedside swallow screenings, inserting and monitoring nasoenteric feeding tubes, and indirect calorimetry measurements, or other permitted services) | X | X | X | |||
3.12B | Individualizes nutrition and mental health- and addictions-related interventions to the setting and patient/client | X | X | X | |||
3.12C | Uses a variety of educational and behavioral approaches, tools, and materials as appropriate | X | X | X | |||
3.12D | Integrates proficient-level experience and clinical judgment skills to guide and tailor interventions (eg, selects from a range of possibilities with additional consideration of the patient/client learning style, readiness, and willingness to change)
| X | X | ||||
3.12E | Exercises advanced diagnostic reasoning and judgment (eg, reflecting the holistic focus of mental health and addictions as complex disorders) | X | |||||
3.12F | Draws on experiential knowledge and current body of expert knowledge about the patient/client population to individualize the strategy/plan of care for complex interventions in complicated, unpredictable, and dynamic situations | X | |||||
3.13 | Assigns activities to NDTR and other professional, technical, and support personnel in accordance with qualifications, organizational policies/ protocols, and applicable laws and regulations | X | X | X | |||
3.13A | Supervises professional, technical, and support personnel | X | X | X | |||
3.13A1 | Provides support personnel with information and guidance to complete assigned activities | X | X | X | |||
3.14 | Continues data collection | X | X | X | |||
3.14A | Uses measurable, standardized indicators based on goals and outcomes and documents using prescribed/standardized format for recording data | X | X | X | |||
3.15 | Documents: | ||||||
3.15A | Date and time | X | X | X | |||
3.15B | Specific and measurable treatment goals and expected outcomes | X | X | X | |||
3.15C | Recommended interventions | X | X | X | |||
3.15D | Patient/client/advocate/caregiver/community receptiveness | X | X | X | |||
3.15E | Referrals made and resources used | X | X | X | |||
3.15F | Patient/client/advocate/caregiver/community comprehension | X | X | X | |||
3.15G | Barriers to change | X | X | X | |||
3.15H | Other information relevant to providing care and monitoring progress over time | X | X | X | |||
3.15I | Plans for follow-up and frequency of care | X | X | X | |||
3.15J | Rationale for discharge or referral if applicable | X | X | X | |||
Examples of Outcomes for Standard 3: Nutrition Intervention
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Standard 4: Nutrition Monitoring and Evaluation The registered dietitian nutritionist (RDN) monitors and evaluates indicators and outcomes data directly related to the nutrition diagnosis, goals, preferences, and intervention strategies to determine the progress made in achieving desired results of nutrition care and whether planned interventions should be continued or revised. 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. Through monitoring and evaluation, the RDN identifies important measures of change or patient/client/population outcomes relevant to the nutrition diagnosis and nutrition intervention/plan of care; describes how best to measure these outcomes; and intervenes when intervention/plan of care requires revision. | |||||||
Indicators for Standard 4: Nutrition Monitoring and Evaluation | |||||||
Bold Font Indicators are Academy Core RDN Standards of Practice Indicators | The “X” signifies the indicators for the level of practice | ||||||
Each RDN: | Competent | Proficient | Expert | ||||
4.1 | Monitors progress: | X | X | X | |||
4.1A | Assesses patient/client/advocate/population understanding and compliance with nutrition intervention/plan of care | X | X | X | |||
4.1A1 | Verifies patient’s/client’s understanding of nutrition intervention by having the patient/client/family/caregiver verbalize and/or demonstrate understanding | X | X | X | |||
4.1B | Determines whether the nutrition intervention/plan of care is being implemented as prescribed | X | X | X | |||
4.1B1 | Investigates barriers to implementation of nutrition intervention | X | X | X | |||
4.1B2 | Evaluates nutrition intervention in the face of complex clinical situations | X | X | ||||
4.2 | Measures outcomes: | X | X | X | |||
4.2A | Selects the standardized nutrition care measurable outcome indicator(s) | X | X | X | |||
4.2A1 | Uses indicators that are S.M.A.R.T. (specific, measurable, attainable, realistic, and timely) | X | X | X | |||
4.2B | Identifies positive or negative outcomes, including impact on potential needs for discharge/transitions of care | X | X | X | |||
4.2C | Checks intended effects and potential adverse effects of pharmacological and nonpharmacological treatment (eg, change in weight and glycemic control associated with antipsychotic medication) | X | X | X | |||
4.3 | Evaluates outcomes: | X | X | X | |||
4.3A | Compares monitoring data with nutrition prescription and established goals or reference standard | X | X | X | |||
4.3A1 | Monitors and analyzes clinical data to improve patient/client outcomes; seeks assistance as needed | X | X | X | |||
4.3A2 | Reviews and understands data based on experience, clinical judgment, and/or identifies criteria to which the indicator(s) is compared | X | X | ||||
4.3A3 | Compares and analyzes the data for each problem area to nutrition prescription/goal using experience and clinical judgment skills, and incorporates additional consideration of progress with mental health and addictions treatment plan, the patient’s/client’s learning style, readiness, and willingness to change | X | X | ||||
4.3A4 | Analyzes data considering the complexity of problems and correlates one problem to another (eg, using expert clinical judgment skills reflecting on the holistic focus of mental health and addictions as complex disorders) | X | |||||
4.3A5 | Conducts comprehensive data analysis to identify trends in collaboration with interprofessional team | X | |||||
4.3A6 | Benchmarks data sets from program participants to national, state, and local public health data sets (eg, Healthy People 2010 Leading Health Indicators, Health Plan Employer Data and Information Set, National Quality Forum Behavioral Health Measures, Hospital-Based Inpatient Psychiatric Services Core Measures) | X | |||||
4.3B | Evaluates impact of the sum of all interventions on overall patient/client/population health outcomes and goals | X | X | X | |||
4.3B1 | Evaluates positive and negative outcomes in context of overall treatment plan, including impact on potential needs for discharge/transitions of care | X | X | X | |||
4.3C | Evaluates progress or reasons for lack of progress related to problems and interventions | X | X | X | |||
4.3C1 | Uses most appropriate measures for evaluation of goal attainment (eg, changes in food intake, anthropometrics, or biochemical data) | X | X | X | |||
4.3C2 | Identifies patient/client factors that facilitate or impede progress (eg, emotional, social, cognitive, behavioral, environmental, motivators, and incentives to change and/or consequences to change) | X | X | X | |||
4.3C3 | Uses multiple resources to assess progress (eg, laboratory and other clinical data, self-monitoring tools, changes in body weight/composition) relative to effectiveness of plan | X | X | X | |||
4.3C4 | Identifies changes to patient’s/client’s cognitive, physical, environmental status and implications of subsequent changes to medical treatment that could interfere with the nutrition plan of care | X | X | ||||
4.3C5 | Identifies problems beyond scope of nutrition care that are interfering with the interventions to review with interprofessional team | X | |||||
4.3D | Evaluates evidence that the nutrition intervention/plan of care is maintaining or influencing a desirable change in the patient/client/population behavior or status | X | X | X | |||
4.3D1 | Accesses appropriate sources for evidence of problems or adherence (eg, food choices, food logs, laboratory results, objective data, NFPE) | X | X | X | |||
4.3D2 | Uses direct observation, interviews, and/or other factors specific to the patient/client (eg, social, cognitive, environmental) that can explain lack of response or could influence response to nutrition intervention | X | X | X | |||
4.3D3 | Consults with the interprofessional team and other health care practitioners | X | X | X | |||
4.3E | Supports conclusions with evidence | X | X | X | |||
4.3E1 | Demonstrates that prescribed nutrition intervention is successful/unsuccessful through documentation of clinical, cognitive, and psychosocial indicators | X | X | X | |||
4.3E2 | Uses current evidence-based literature to support conclusions | X | X | ||||
4.4 | Adjusts nutrition intervention/plan of care strategies, if needed, in collaboration with patient/client/population/advocate/caregiver and interprofessional team | X | X | X | |||
4.4A | Improves or adjusts intervention/plan of care strategies based upon outcomes data, trends, best practices, and comparative standards | X | X | X | |||
4.4A1 | Modifies intervention(s) as appropriate to address individual patient/client needs and preferences or priorities; seeks assistance as needed | X | X | X | |||
4.4A2 | Arranges for additional resources, or more intensive resources, to fulfill the nutrition prescription and achieve treatment goals in collaboration with interprofessional team as needed | X | X | ||||
4.4A3 | Tailors tools and methods to ensure desired outcomes that reflect the patient’s/client’s social, physical, and environmental factors | X | X | ||||
4.4A4 | Uses experience and expertise to identify additional resources and/or avenues of therapy to enhance effectiveness or follow through of intervention | X | |||||
4.5 | Documents: | X | X | X | |||
4.5A | Date and time | X | X | X | |||
4.5B | Indicators measured, results, and the method for obtaining measurement | X | X | X | |||
4.5C | Criteria to which the indicator is compared (eg, nutrition prescription/goal or a reference standard) | X | X | X | |||
4.5D | Factors facilitating or hampering progress | X | X | X | |||
4.5E | Other positive or negative outcomes | X | X | X | |||
4.5F | Adjustments to the nutrition intervention/plan of care, if indicated | X | X | X | |||
4.5G | Future plans for nutrition care, nutrition monitoring and evaluation, follow-up, referral, or discharge | X | X | X | |||
Examples of Outcomes for Standard 4: Nutrition Monitoring and Evaluation
|
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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 165, 12-16-16); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – 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 July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 16, 2018.
Standards of Professional Performance for Registered Dietitian Nutritionists in Mental Health and Addictions Standard 1: Quality in Practice The registered dietitian nutritionist (RDN) 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 and supervised practice, 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 | ||||||||
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Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
1.1 | Complies with applicable laws and regulations as related to his/her area(s) of practice | X | X | X | ||||
1.1A | Complies with state licensure laws and regulations, including telehealth (http://www.telehealthresourcecenter.org/toolbox-module/licensure-and-scope-practice) and continuing education requirements | X | X | X | ||||
1.2 | Performs within individual and statutory scope of practice and applicable laws and regulations | X | X | X | ||||
1.2A | Adheres to the practice boundaries related to nutrition vs mental health/psychotherapy or addictions counseling unless qualified through additional credentials (eg, National Certified Counselor, National Certified Addiction Counselor) and state-specific regulations | X | X | X | ||||
1.3 | Adheres to sound business and ethical billing practices applicable to the role and setting | X | X | X | ||||
1.3A | Complies with appropriate billing codes for payer and type of nutrition visit applicable to setting | X | X | X | ||||
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 | X | X | X | ||||
1.4A | Uses nationally standardized and consensus-based behavioral health performance measures (eg, American Psychiatric Association Mental Health Performance Measures, SAMHSA National Behavioral Health Quality Framework) in design and evaluation of nutrition care and services; seeks assistance if needed | X | X | X | ||||
1.4B | Leads efforts to maximize mental health and addictions nutrition services using national quality and safety data | X | X | |||||
1.4C | Leads organization’s/program’s interprofessional team review and application of national consensus-based standards and measures in performance monitoring process | X | ||||||
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 | X | X | X | ||||
1.5A | Uses the organization/department performance improvement process to measure performance against desired outcomes | X | X | X | ||||
1.5B | Leads the development of performance improvement criteria to monitor effectiveness of services | X | X | |||||
1.5C | Collaborates with the interprofessional b team to create and evaluate systems, processes, and programs that support the organization’s/program’s and mental health and addictions and nutrition-related objectivesInterprofessional: 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, physician assistants, pharmacists, psychologists, social workers, and occupational and physical therapists), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary. | X | ||||||
1.5D | Directs the development and management of systems, processes, and programs in mental health and/or addictions nutrition-related care for continuous quality assurance and performance improvement | X | ||||||
1.6 | Participates in or designs an outcomes-based management system to evaluate safety, effectiveness, quality, person-centeredness, equity, timeliness, and efficiency of practice | X | X | X | ||||
1.6A | Involves colleagues and others, as applicable, in systematic outcomes management | X | X | X | ||||
1.6A1 | Participates in and coordinates interprofessional efforts to evaluate and improve mental health and/or addictions patient/client population outcomes | X | X | |||||
1.6A2 | Leads interprofessional efforts to promote and measure quality of mental health and addictions nutrition care and services | X | ||||||
1.6B | Defines expected outcomes | X | X | X | ||||
1.6B1 | Identifies evidence-based nutrition-specific care and service outcomes and related processes to measure | X | X | |||||
1.6B2 | Determines the desired nutrition-specific outcomes for the patient/client population through direct evaluation, benchmarking, and evaluation of environmental trends | X | ||||||
1.6C | Uses indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.) | X | X | X | ||||
1.6D | Measures quality of services in terms of structure, process, and outcomes | X | X | X | ||||
1.6D1 | Participates in organization and local, state, and national quality improvement initiatives | X | X | X | ||||
1.6D2 | Develops and/or uses systematic processes to collect and organize data | X | X | X | ||||
1.6D3 | Uses defined outcomes and related processes to measure as part of the outcomes management program | X | X | X | ||||
1.6D4 | Uses aggregated data to evaluate current performance measurement process against expected outcomes observed to determine if changes are required | X | X | |||||
1.6D5 | Leads the development of clinical, operational, and financial measures related to mental health and addictions nutrition-related care and services | X | ||||||
1.6E | Incorporates electronic clinical quality measures to evaluate and improve care of patients/clients at risk for malnutrition or with malnutrition (www.eatrightpro.org/emeasures) | X | X | X | ||||
1.6E1 | Ensures that screening for nutrition risk is a component of assessment using evidence-based screening tools for the setting and/or population | X | X | X | ||||
1.6F | Documents outcomes and patient-reported outcomes (eg, PROMIS) | X | X | X | ||||
1.6F1 | Documents and reports outcomes to appropriate individuals and groups; seeks assistance if needed | X | X | X | ||||
1.6F2 | Evaluates patient/client and service outcomes using identified metrics to reinforce current practices or implement changes in practice(s) | X | X | |||||
1.6F3 | Synthesizes and shares effectiveness outcomes on programs and services with the mental health and addictions communities | X | ||||||
1.6G | Participates in, coordinates, or leads program participation in local, regional, or national registries and data warehouses used for tracking, benchmarking, and reporting service outcomes | X | X | X | ||||
1.6H | Collaborates with RDN colleagues in local/regional mental health/addictions treatment programs to collect data for documenting and reporting outcomes of nutrition interventions | X | X | |||||
1.6I | Leads local, state, and national quality initiative efforts to support mental health and addictions nutrition and related services | X | ||||||
1.7 | Identifies and addresses potential and actual errors and hazards in provision of services or brings to attention of supervisors and team members as appropriate | X | X | X | ||||
1.7A | Evaluates and ensures safe nutrition care delivery; seeks assistance as needed | X | X | X | ||||
1.7A1 | Collaborates with pharmacist to contribute to the awareness of potential drug–food/nutrient and drug–dietary supplement (eg, vitamin mineral, herbal) interactions; and to educate patients/clients/families and interprofessional team | X | X | X | ||||
1.7A2 | Refers patients/clients to appropriate services when error/hazard is outside of the RDN’s scope of practice | X | X | X | ||||
1.7B | Collaborates with the interprofessional team to identify, address, and prevent errors in the delivery of mental health and addictions nutrition services (eg, food allergy/intolerance vs food aversion) | X | X | X | ||||
1.7B1 | Develops safety alert systems to monitor key indicators of mental health and addictions patients’/clients’ medical conditions | X | X | |||||
1.7C | Maintains awareness of problematic product names and error prevention recommendations provided by ISMP (www.ismp.org), FDA (www.fda.gov), and USP (www.usp.org) | X | X | |||||
1.7D | Recognizes possible drug–nutrient interactions and potential interactions between prescribed treatments and integrative and functional medicine therapies | X | X | |||||
1.7E | Develops best practices to identify, address, and prevent errors and hazards in the delivery of mental health and addictions food and nutrition services | X | ||||||
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]) | X | X | X | ||||
1.8A | Reports and documents action plan to address identified gaps in care and/or service performance | X | X | X | ||||
1.8B | Compares individual performance to established goals and expected outcomes | X | X | X | ||||
1.8C | Compares departmental/organizational performance to established goals and outcomes; and to national programs and standards | X | X | |||||
1.8D | Leads in benchmarking of mental health and addictions nutrition care based on health and population-based indicators (eg, https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Mental-Health) | X | ||||||
1.9 | Evaluates interventions and workflow process(es) and identifies service and delivery improvements | X | X | X | ||||
1.9A | Uses evaluation data and/or collaborates with interprofessional team to identify organizational/departmental improvements | X | X | |||||
1.9B | Leads the development, testing, and redesign of program evaluation systems | X | ||||||
1.10 | Improves or enhances patient/client/population care and/or services working with others based on measured outcomes and established goals | X | X | X | ||||
1.10A | Adjusts services and programs based on data and review of current evidence-based information (eg, practice guidelines and quality improvement data for mental health and addictions) in collaboration with interprofessional team | X | X | X | ||||
1.10B | Leads the evaluation and revision of nutrition systems, processes, and programs to ensure mental health and/or addictions evidence-based practices and organizational policies and procedures are followed | X | ||||||
Examples of Outcomes for Standard 1: Quality in Practice
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Standard 2: Competence and Accountability The registered dietitian nutritionist (RDN) 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 | ||||||||
Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
2.1 | Adheres to the code(s) of ethics (eg, Academy/Commission on Dietetics Registration (CDR), other national organizations, health care professional organizations, and/or employer code of ethics) | X | X | X | ||||
2.2 | Integrates the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) into practice, self-evaluation, and professional development | X | X | X | ||||
2.2A | Integrates applicable focus area(s) SOP and/or SOPP into practice (www.eatrightpro.org/sop) | X | X | X | ||||
2.2B | Uses SOP and SOPP for RDNs in Mental Health and Addictions to:
| X | X | X | ||||
2.2C | Develops corporate/organizational policies, guidelines, human resource materials (eg, job descriptions, career ladders, care and service activities for each performance level) using the SOP and SOPP for RDNs in Mental Health and Addictions | X | X | |||||
2.3 | Demonstrates and documents competence in practice and delivery of customer-centered service(s) | X | X | X | ||||
2.3A | Manages change effectively, demonstrating knowledge of the change process | X | X | X | ||||
2.3B | Demonstrates attributes, such as assertiveness, enhanced listening, and conflict resolution skills | X | X | |||||
2.3C | Documents examples of expanded professional responsibility reflective of a proficient or expert practice role | X | X | |||||
2.4 | Assumes accountability and responsibility for actions and behaviors | X | X | X | ||||
2.4A | Identifies, acknowledges, and corrects errors | X | X | X | ||||
2.4B | Knows and complies with policies, procedures, and other organizational standards applicable to role and responsibilities | X | X | X | ||||
2.4C | Develops and implements policies and procedures that ensure staff accountability and responsibility | X | X | |||||
2.5 | Conducts self-evaluation at regular intervals | X | X | X | ||||
2.5A | Identifies needs for professional development | X | X | X | ||||
2.5A1 | Evaluates role and responsibilities at the organizational and/or systems level to identify areas for continuing education to strengthen knowledge/skills or qualifications for new roles | X | X | |||||
2.5B | Evaluates current level of practice to:
| X | X | X | ||||
2.6 | Designs and implements plans for professional development | X | X | X | ||||
2.6A | Develops plan and documents professional development activities in career portfolio (eg, organizational policies and procedures, credentialing agency[ies]) | X | X | X | ||||
2.7 | Engages in evidence-based practice and uses best practices | X | X | X | ||||
2.7A | Integrates evidence-based practice and research evidence in delivering quality care using SAMHSA, NIMH, NIAAA, Academy resources, Academy EAL, position papers, and best practices | X | X | X | ||||
2.7B | Develops skill in accessing and critically analyzing research | X | X | X | ||||
2.7C | Advocates for the advancement of evidence-based knowledge for the profession (eg, research, presentations, publications) | X | X | X | ||||
2.7D | Participates in research activities and publication of results to advance evidence and best practices in mental health and addictions nutrition practice | X | X | |||||
2.7E | Serves as an author of mental health and/or addictions-related evidence-based publications | X | X | |||||
2.7F | Contributes expertise and critical thinking skills as a reviewer of original research and/or evidence-based guidelines relevant to mental health and addictions nutrition practice | X | ||||||
2.7G | Uses and guides others in applying planned change principles to integrate research into practice | X | ||||||
2.8 | Participates in peer review of others as applicable to role and responsibilities | X | X | X | ||||
2.8A | Engages in peer review activities consistent with setting, responsibilities, and patient/client population (eg, peer evaluation, peer supervision, clinical chart review, performance evaluations) | X | X | X | ||||
2.8B | Conducts scholarly review of professional articles, chapters, books, programs, and guidelines | X | X | |||||
2.8C | Leads/serves on editorial board for review of professional articles, chapters, and books | X | ||||||
2.9 | Mentors and/or precepts others | X | X | X | ||||
2.9A | Participates in mentoring students and interns and serves as a preceptor for dietetic interns/students; seeks guidance as needed | X | X | X | ||||
2.9B | Develops mentor/mentee programs for nutrition and dietetics practitioners and health professionals of other disciplines | X | X | |||||
2.9C | Mentors competent- and proficient-level RDNs and non-nutrition professionals (eg, medical students/residents, advanced practice nurses, pharmacists) | X | ||||||
2.10 | Pursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations and requirements of practice setting | X | X | X | ||||
2.10A | Serves on committees with the Academy and dietetics practice groups to develop programs, tools, and resources in support of assisting the RDN to obtain relevant certifications/credentials | X | X | |||||
2.10B | Leads efforts to develop or advance education, training, and credential opportunities in mental health and/or addictions | X | ||||||
Examples of Outcomes for Standard 2: Competence and Accountability
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Standard 3: Provision of Services The registered dietitian nutritionist (RDN) provides safe, quality service based on customer expectations and needs, and the mission, vision, principles, and values of the organization/business. Rationale: Quality programs and services are designed, executed, and promoted based on the RDN’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 | ||||||||
Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
3.1 | Contributes to or leads in development and maintenance of programs/ services that address needs of the customer or target population(s) | X | X | X | ||||
3.1A | Aligns program/service development with the mission, vision, principles, values, and service expectations and outputs of the organization/business | X | X | X | ||||
3.1A1 | Participates in strategic planning for the acquisition and utilization of internal and external resources for mental health and addictions nutrition programs (ie, program planning, staffing, marketing, budgeting, billing, if applicable) | X | X | |||||
3.1A2 | Develops and manages nutrition programs tailored to the needs of the organization and the patient/client populations | X | X | |||||
3.1A3 | Designs, provides justification, promotes, and seeks executive commitment to new services that will meet organization and department/program goals for mental health and addictions nutrition services | X | ||||||
3.1A4 | Contributes to and leads business and strategic planning with interprofessional team to identify programs and services that address the needs of the patient/client population served by the organization | X | ||||||
3.1B | Uses the needs, expectations, and desired outcomes of the customers/populations (eg, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service development | X | X | X | ||||
3.1B1 | Adheres to the practice boundaries related to nutrition vs mental health/psychotherapy or addictions counseling; seeks assistance if needed | X | X | X | ||||
3.1B2 | Develops mental health and addictions-specific community/prevention nutrition-related programs (eg, education, treatment, or service) incorporating behavior change theory, self-concept, lifestyle functions, and systematic evaluation of learning | X | X | |||||
3.1B3 | Develops, evaluates, and ensures programs/services meet/address the customer characteristics, health status, and nutrition needs of mental health and/or addictions population | X | X | |||||
3.1B4 | Collaborates with local and regional programs that support and optimize provision of mental health and addictions nutrition services (eg, NAMI, NIMH) | X | X | |||||
3.1C | Makes decisions and recommendations that reflect stewardship of time, talent, finances, and environment | X | X | X | ||||
3.1C1 | Advocates for staffing that supports the customer population care and education needs, census/case load, goals, and programs and services | X | X | |||||
3.1D | Proposes programs and services that are customer-centered, culturally appropriate, and minimize disparities | X | X | X | ||||
3.2 | Promotes public access and referral to credentialed nutrition and dietetics practitioners for quality food and nutrition programs and services | X | X | X | ||||
3.2A | Contributes to or designs referral systems that promote access to qualified, credentialed nutrition and dietetics practitioners | X | X | X | ||||
3.2A1 | Receives referrals for services from and makes referrals to other nutrition or health care professionals to address identified customer needs | X | X | X | ||||
3.2A2 | Participates in or designs process to receive or make referrals to other providers that address the needs of the customer population (eg, social worker, pharmacist, case manager) | X | X | |||||
3.2A3 | Designs, directs, and coordinates referral process and systems | X | ||||||
3.2B | Refers customers to appropriate providers when requested services or identified needs exceed the RDN’s individual scope of practice | X | X | X | ||||
3.2B1 | Builds relationships with other health care practitioners to facilitate collaboration and making referrals that meet customer needs | X | X | X | ||||
3.2B2 | Establishes and maintains networks to support the overall care and recovery of customers transitioning to home or another care or community setting | X | X | |||||
3.2B3 | Supports referral resources with curriculum and training regarding the types of complex nutrition needs of customers with mental illness and addictions | X | ||||||
3.2C | Monitors effectiveness of referral systems and modifies as needed to achieve desirable outcomes | X | X | X | ||||
3.2C1 | Tracks data to evaluate efficiency and effectiveness of the nutrition referral processes | X | X | X | ||||
3.2C2 | Collaborates with the interprofessional team and other health care providers to review data and update the nutrition referral process and tools when needed | X | X | |||||
3.2C3 | Manages and/or leads the review and revision process for nutrition referrals and tools in collaboration with the interprofessional team and others as needed | X | ||||||
3.3 | Contributes to or designs customer-centered services | X | X | X | ||||
3.3A | Assesses needs, beliefs/values, goals, resources of the customer, and social determinants of health | X | X | X | ||||
3.3A1 | Recognizes the influences that culture, health literacy, and socioeconomic status have on health/illness experiences and the customer population’s use of and access to health care services | X | X | X | ||||
3.3A2 | Participates in or conducts needs assessment in collaboration with interprofessional team and community stakeholders to identify needs of the customer population and services that are available | X | X | |||||
3.3A3 | Incorporates behavior change strategies and counseling theories in program/service design | X | X | |||||
3.3A4 | Leads in utilizing, evaluating, and communicating the effectiveness of different theoretical frameworks for interventions (eg, health belief model, social cognitive theory/social learning theory, stages of change [ie, transtheoretical theory]) | X | ||||||
3.3B | Uses knowledge of the customer’s/target population’s health conditions, cultural beliefs, and business objectives/services to guide design and delivery of customer-centered services | X | X | X | ||||
3.3B1 | Adapts practice to meet the needs of an ethnically and culturally diverse population (eg, using translators, conducting culturally appropriate assessments, selecting appropriate levels of intensity of cultural interventions, adapting education/counseling approaches and materials, adapting content to teaching modality) | X | X | X | ||||
3.3B2 | Identifies and connects customers and support networks with established resources and services within the specific ethnic/cultural community | X | X | X | ||||
3.3B3 | Participates in or plans, develops, and implements systems of care and services reflecting needs of the population (health conditions, ethnic/cultural characteristics) | X | X | |||||
3.3B4 | Pursues and collaborates with additional resources to positively influence health-related decision making within the customer’s specific ethnic/cultural community | X | X | |||||
3.3C | Communicates principles of disease prevention and behavioral change appropriate to the customer or target population | X | X | X | ||||
3.3C1 | Identifies and considers customer-specific characteristics that influence delivery of mental health and addictions nutrition education and care | X | X | X | ||||
3.3C2 | Designs tools to communicate disease prevention and behavioral change principles | X | X | |||||
3.3D | Collaborates with the customers to set priorities, establish goals, and create customer-centered action plans to achieve desirable outcomes | X | X | X | ||||
3.3D1 | Designs mental health and addictions nutrition plans of care systems according to customers’ care needs and priorities, desired outcomes with consideration of and input from other health care practitioners/caregivers | X | X | X | ||||
3.3D2 | Confirms that mental health and addictions nutrition plans of care are reflective of evidence-based approaches | X | X | X | ||||
3.3D3 | Incorporates systems to support customers in stages of readiness to change by establishing realistic goals | X | X | X | ||||
3.3D4 | Participates in or initiates development of guidelines and tools to guide customers and/or their support networks (eg, family, caregivers) in health-related shared decision making and goal setting for maximizing outcomes | X | X | |||||
3.3E | Involves customers in decision making | X | X | X | ||||
3.3E1 | Uses appropriate tools, such as deep listening, motivational interviewing, and cognitive behavioral therapy to involve customers in directing their mental health and addictions nutrition care | X | X | |||||
3.4 | Executes programs/services in an organized, collaborative, cost-effective, and customer-centered manner | X | X | X | ||||
3.4A | Collaborates and coordinates with peers, colleagues, stakeholders, and within interprofessional teams | X | X | X | ||||
3.4A1 | Serves as a consultant for issues related to nutrition for mental health and addictions | X | X | |||||
3.4A2 | Directs efforts to improve collaboration between customers and other care providers | X | ||||||
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, and grant management) | X | X | X | ||||
3.4B1 | Plans and implements mental health and addictions nutrition programs and services that reflect evidence-based guidelines and best practices | X | X | |||||
3.4B2 | Uses or develops nutrition screening guidelines, programs, and recommendations relevant to the patient/client population | X | X | |||||
3.4B3 | Implements and manages organization and/or community-based nutrition programs for mental health and addictions populations consistent with recognized practice guidelines | X | X | |||||
3.4B4 | Reviews and applies community/prevention program indicators and national, state, and local public health and population-based indicators (eg, Healthy People 2020 Leading Health Indicators, HEDIS, Behavioral Health Quality Improvement measure sets) to benchmark against organization/program outcomes for positive impact on program planning and development | X | ||||||
3.4B5 | Leads team on program/service review, identifying changes, and process revisions as needed | X | ||||||
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, HIPAA-compliant telehealth platforms), and training materials that reflect evidence-based practice in accordance with applicable laws and regulations | X | X | X | ||||
3.4C1 | Collaborates with interprofessional team to inform and seek input on the design and evaluation of nutrition policies, procedures, and services for meeting needs of customer population (eg, screening for nutrition risk, discharge/transitions of care process, process for team reporting observations on patient/client response to nutrition care or educational needs) | X | X | |||||
3.4C2 | Leads department and interprofessional process of developing, monitoring, evaluating, and improving the protocols, guidelines, and practice tools | X | ||||||
3.4D | Uses and participates in or develops processes for order writing and other nutrition-related privileges, in collaboration with the medical staff, or medical director (eg, post-acute care settings, dialysis center, public health, community, free-standing clinic settings), consistent with state practice acts, federal and state regulations; organization policies; and medical staff rules, regulations, and bylaws | X | X | X | ||||
3.4D1 | Uses and participates in or leads development of processes for privileges or other facility-specific processes related to (but not limited to) implementing physician/non-physician practitioner o -driven delegated orders or protocols, initiating or modifying orders for therapeutic diets, medical foods/nutrition supplements, dietary supplements, enteral and parenteral nutrition, laboratory tests, medications, and adjustments to fluid therapies or electrolyte replacementsNon-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, qualified dietitian, or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.8,9 The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and long-term care facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.11,12 | X | X | X | ||||
3.4D1i | Adheres to setting-specific medical director protocol or medical staff bylaws, rules, and regulations that address ordering privileges or delegated orders for diet order writing | X | X | X | ||||
3.4D1ii | Contributes to organization/medical staff process for identifying RDN privileges to support mental health and addictions care and services (eg, diet orders, medical food/nutritional supplements, vitamin and mineral supplements) | X | X | |||||
3.4D1iii | Negotiates and/or establishes nutrition privileges at organization/systems level for new advances in practice | X | ||||||
3.4D2 | Uses and participates in or leads development of processes for privileging for provision of nutrition-related services, including (but not limited to) initiating and performing bedside swallow screenings, inserting and monitoring nasoenteric feeding tubes, providing home enteral nutrition or infusion management services (eg, ordering formula and supplies), and indirect calorimetry measurements | X | X | X | ||||
3.4D3 | Establishes collaborative practice with other health care providers at organization or systems level (eg, participate in treatment team meetings, and/or a disease management program, case management) | X | X | |||||
3.4E | Complies with established billing regulations, organization policies, grant funder guidelines, if applicable to role and setting, and adheres to ethical and transparent financial management and billing practices | X | X | X | ||||
3.4E1 | Develops tools to monitor adherence to billing regulations and ethical billing practices | X | X | |||||
3.4F | Communicates with the interprofessional team and referring party consistent with the HIPAA rules for use and disclosure of customer’s personal health information (PHI) | X | X | X | ||||
3.4F1 | Develops process and tools to monitor adherence to HIPAA rules and/or address breaches in the protection of PHI | X | X | |||||
3.5 | Uses professional, technical, and support personnel appropriately in the delivery of customer-centered care or services in accordance with laws, regulations, and organization policies and procedures | X | X | X | ||||
3.5A | Assigns activities, including direct care to patients/clients, consistent with the qualifications, experience, and competence of professional, technical, and support personnel | X | X | X | ||||
3.5A1 | Determines capabilities/expertise of support staff in working with customer population to determine tasks that may be delegated | X | X | |||||
3.5B | Supervises professional, technical, and support personnel | X | X | X | ||||
3.5B1 | Trains professional, technical, and support personnel and evaluates their competence/skills | X | X | |||||
3.6 | Designs and implements food delivery systems to meet the needs of customers | X | X | X | ||||
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) | X | X | X | ||||
3.6A1 | Participates in foodservice planning and delivery for health care and community settings that provide mental health and addictions services | X | X | X | ||||
3.6A2 | Develops mental health and addictions nutrition-related guidelines for foodservice system planning and delivery | X | X | |||||
3.6A3 | Evaluates effectiveness of foodservice planning and delivery for patients/clients with mental illness and addictions to identify areas for improvement | X | X | |||||
3.6A4 | Serves as consultant to organizational leadership in determining services to be provided | X | ||||||
3.6B | Participates in, consults/collaborates with, 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 | X | X | X | ||||
3.6B1 | Participates in the development of master menus and snack options with modifications to address health and nutrition needs of mental health and addictions populations served by the setting 32 , 33 | X | X | X | ||||
3.6B2 | Directs the development of menus, recipes, and foodservice operations consistent with role and setting | X | X | |||||
3.6C | Participates in, consults/collaborates with, or leads interprofessional process for determining medical foods/nutritional supplements, dietary supplements, enteral and parenteral nutrition formularies, and delivery systems for target population(s) | X | X | X | ||||
3.6C1 | Designs structured best practice programs to fund and provide enteral/parenteral nutrition support | X | ||||||
3.7 | Maintains records of services provided | X | X | X | ||||
3.7A | Documents according to organization policies, procedures, standards, and systems, including electronic health records | X | X | X | ||||
3.7B | Implements data management systems to support interoperable data collection, maintenance, and utilization | X | X | X | ||||
3.7B1 | Contributes to the design of the electronic health record system for capturing data needed in documenting nutrition care and monitoring outcomes | X | X | |||||
3.7B2 | Advocates for and participates in the development of clinical, operational, and financial databases upon which mental health and addictions nutrition care-sensitive outcomes can be derived, reported, and used for improvement | X | ||||||
3.7B3 | Seeks opportunities to contribute expertise to national mental health or addictions-related bioinformatics projects as applicable/requested | X | ||||||
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 | X | X | X | ||||
3.7C1 | Analyzes and uses data to communicate value of nutrition services in relation to customer population and organization outcomes/goals | X | X | |||||
3.7D | Uses data to demonstrate program/service achievements and compliance with accreditation standards, laws, and regulations | X | X | X | ||||
3.7D1 | Collects data and documents outcomes and compares against targets and evidence-based/best practices, standards, laws, and regulations | X | X | X | ||||
3.7D2 | Determines impact of data to the organizations and providers specific to mental health and addictions care settings; participates in development of sustainable plan of compliance | X | X | |||||
3.7D3 | Prepares and presents analysis of nutrition care service and outcomes data for organization and accrediting bodies | X | ||||||
3.8 | Advocates for provision of quality food and nutrition services as part of public policy | X | X | X | ||||
3.8A | Communicates with policy makers regarding the benefit–cost of quality food and nutrition services | X | X | X | ||||
3.8A1 | Advocates with state and national congressional representatives regarding benefit of mental health and addictions nutrition care services on health care costs (eg, responds to Academy Action Alerts and other calls to action via Action Center, letters, emails, and/or phone calls) | X | X | X | ||||
3.8A2 | Interacts and serves as a resource with legislators, payers, and policy makers to contribute and influence mental health and addictions care and services (eg, providing testimony at legislative and regulatory hearings and meetings) | X | X | |||||
3.8B | Advocates in support of food and nutrition programs and services for populations with special needs and chronic conditions | X | X | X | ||||
3.8B1 | Participates in patient/client advocacy activities | X | X | X | ||||
3.8B2 | Advocates for policies that reduce discrimination based on disability related to mental illness and addictions | X | X | X | ||||
3.8B3 | Leads advocacy activities (eg, authors article(s), delivers presentations on topics, networks) | X | X | |||||
3.8B4 | Leads the development of public policy related to mental health and addictions nutrition services at the regional or national level | X | ||||||
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) | X | X | X | ||||
Examples of Outcomes for Standard 3: Provision of Services
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Standard 4: Application of Research The registered dietitian nutritionist (RDN) applies, participates in, and/or generates research to enhance practice. Evidence-based practice incorporates the best available research/evidence and information in the delivery of nutrition and dietetics services. Rationale: Application, participation, and generation of research promote improved safety and quality of nutrition and dietetics practice and services. | ||||||||
Indicators for Standard 4: Application of Research | ||||||||
Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
4.1 | Reviews best available research/evidence and information for application to practice | X | X | X | ||||
4.1A | Understands basic research design and methodology | X | X | X | ||||
4.1B | Reads major peer-reviewed publications in mental health and addictions and nutrition; uses evidence-based guidelines, practice guidelines, and related resources | X | X | X | ||||
4.1C | Demonstrates understanding of current research, trends, and epidemiologic surveys in mental health and addictions nutrition, and related areas and applies to professional practice as appropriate | X | X | X | ||||
4.1D | Identifies key clinical and management questions and uses systematic methods to apply research and evidence-based guidelines to answer questions and inform decisions | X | X | |||||
4.1E | Promotes the use of evidence-based tools/resources (eg, Academy EAL, practice guidelines) as a basis for stimulating awareness and integration of current evidence into practice | X | X | |||||
4.2 | Uses best available research/evidence and information as the foundation for evidence-based practice | X | X | X | ||||
4.2A | Demonstrates adherence to evidence-based practice guidelines (eg, SAMHSA, NIMH, NIAAA, Academy EAL, Academy) to provide safe, effective quality care for individuals with mental illness and addictions; seeks guidance as needed | X | X | X | ||||
4.2B | Demonstrates adherence to evidence-based practice to reduce variation in practice patterns (eg, considers the best available research on nutrition-related prevention of relapses/exacerbations in mental health and addictions nutrition care) | X | X | |||||
4.2C | Analyzes and applies the available scientific literature in situations where evidence-based practice guidelines for mental health and addictions nutrition care are not established | X | X | |||||
4.2D | Uses advanced training, available research, and emerging theories to manage complex cases in mental health and addictions nutrition care (eg, dialectical behavioral therapy, cognitive behavioral therapy, motivational interviewing) | X | ||||||
4.3 | Integrates best available research/evidence and information with best practices, clinical and managerial expertise, and customer values | X | X | X | ||||
4.3A | Develops familiarity with and accesses commonly used sources of evidence in identifying applicable courses of action for patient/client care and services (eg, NQF mental illness resources, SAMHSA) | X | X | X | ||||
4.4 | Contributes to the development of new knowledge and research in nutrition and dietetics | X | X | X | ||||
4.4A | Participates in efforts to extend research into practice through journal clubs, professional supervision, and the Academy’s Research workgroups | X | X | X | ||||
4.4B | Participates in practice-based research networks (eg, Academy Research workgroups) and the development and/or implementation of practice-based research | X | X | |||||
4.4C | Develops Academy EAL questions in mental health and addictions nutrition care | X | X | |||||
4.4D | Authors original research papers and book chapters to advance evidence and best practices | X | ||||||
4.4E | Identifies and initiates research relevant to mental health and addictions as the principal or co-investigator in collaborative research or interprofessional teams that examine relationships related to nutrition and mental health and addictions care and outcomes | X | ||||||
4.4F | Serves as advisor, preceptor, and/or committee member for graduate level research | X | ||||||
4.4G | Provides analysis of evidence-based guidelines, best practices, and practice experience to generate new knowledge in mental health and addictions nutrition care and services | X | ||||||
4.5 | Promotes application of research in practice through alliances or collaboration with food and nutrition and other professionals and organizations | X | X | X | ||||
4.5A | Identifies research issues/questions and participates in studies related to mental health and addictions care services | X | X | X | ||||
4.5B | Collaborates with interprofessional and/or interorganizational teams to perform and disseminate nutrition research related to mental health and addictions | X | X | |||||
4.5C | Leads interprofessional and/or interorganizational collaborative research activities | X | ||||||
Examples of Outcomes for Standard 4: Application of Research
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Standard 5: Communication and Application of Knowledge The registered dietitian nutritionist (RDN) effectively applies knowledge and expertise in communications. Rationale: The RDN works with others to achieve common goals by effectively sharing and applying unique knowledge, skills, and expertise in food, nutrition, dietetics, and management services. | ||||||||
Indicators for Standard 5: Communication and Application of Knowledge | ||||||||
Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
5.1 | Communicates and applies current knowledge and information based on evidence | X | X | X | ||||
5.1A | Demonstrates critical thinking and problem-solving skills when communicating with others | X | X | X | ||||
5.1A1 | Demonstrates ability to review and apply evidence-based guidelines when communicating and disseminating information | X | X | |||||
5.1A2 | Demonstrates flexibility and innovation to effectively communicate and apply complex ideas | X | X | |||||
5.1A3 | Demonstrates the ability to convey complex concepts to other health care practitioners, patients/clients, and the public when communicating and disseminating information | X | ||||||
5.1B | Identifies and uses relevant mental health/addictions nutrition care and education publications in practice | X | X | X | ||||
5.1C | Interprets regulatory, accreditation, and reimbursement programs and standards for organizations and providers that are specific to mental health and addictions care and education (eg, CMS, TJC, CARF, NCQA, HFAP, NIMH); seeks assistance if needed | X | X | X | ||||
5.1D | Evaluates public health trends and epidemiological reports related to mental health and addictions prevalence, prevention, and treatment, as well as underlying etiologies and applies data in clinical practice, professional activities, and work settings | X | X | |||||
5.1E | Oversees the process of interpretation, distribution, and communication of evidence-based research in behavioral health and education initiatives to mental health and addictions nutrition practice | X | X | |||||
5.1F | Consults as an expert on complex mental health and addictions nutrition issues with other health care professionals, organizations, and the community | X | ||||||
5.2 | Selects appropriate information and the most effective communication method or format that considers customer-centered care and the needs of the individual/group/population | X | X | X | ||||
5.2A | Uses communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to various audiences | X | X | X | ||||
5.2A1 | Adapts communications with customers to consider health literacy, culture, preferred language, educational level, and hearing or vision disabilities | X | X | X | ||||
5.2B | Uses information technology to communicate, disseminate, manage knowledge, and support decision making | X | X | X | ||||
5.2B1 | Identifies and uses web-based/electronic practice tools/resources and electronic health records within the worksite as appropriate | X | X | X | ||||
5.2B2 | Develops and updates web-based/electronic mental health and addictions nutrition and patient/client or professional education tools and resources | X | X | |||||
5.2B3 | Leads the design and development of individual- and system-specific approaches that effectively convey nutrition information to diverse audiences addressing a variety of mental health and addictions nutrition-related conditions | X | ||||||
5.2B4 | Provides mental health and addictions nutrition expertise to national informatics projects (eg, national databases) | X | ||||||
5.3 | Integrates knowledge of food and nutrition with knowledge of health, culture, social sciences, communication, informatics, sustainability, and management | X | X | X | ||||
5.3A | Uses and applies current and emerging knowledge of mental health and addictions nutrition, when considering a customer’s health status, behavior barriers, communication skills, and interprofessional team involvement; seeks guidance as needed | X | X | X | ||||
5.3B | Participates in and/or leads the integration of scientific knowledge and experience in mental health and addictions nutrition into practice for complex problems or in new research methodologies | X | X | |||||
5.4 | Shares current, evidence-based knowledge, and information with various audiences | X | X | X | ||||
5.4A | Guides customers, families, students, and interns in the application of knowledge and skills | X | X | X | ||||
5.4A1 | Contributes to and/or coordinates the educational and professional development of RDNs and Nutrition and Dietetics Technicians, Registered, students/interns, and health care practitioners in other fields, through formal and informal teaching activities, preceptorships, and mentorship | X | X | |||||
5.4A2 | Develops formal, structured mentor and preceptorship programs in mental health and addictions nutrition care and education | X | ||||||
5.4B | Assists individuals and groups to identify and secure appropriate and available educational and other resources and services | X | X | X | ||||
5.4B1 | Identifies and recommends current, evidence-based mental health and addictions nutrition educational resources (eg, Academy, Behavioral Health Nutrition Dietetic Practice Group [https://www.bhndpg.org], NIMH, US Department of Agriculture Choose My Plate) | X | X | X | ||||
5.4B2 | Establishes systematic process to identify, track, and update resources available to patients/clients and interprofessional team | X | X | |||||
5.4B3 | Leads individuals and groups in efforts to identify and secure appropriate and available resources and services (eg, outpatient, community) | X | X | |||||
5.4C | Uses professional writing and verbal skills in all types of communications | X | X | X | ||||
5.4C1 | Demonstrates professional writing and oral communication skills with the ability to translate complex scientific and policy information to the public | X | X | X | ||||
5.4D | Reflects knowledge of population characteristics in communication methods | X | X | X | ||||
5.4D1 | Considers culture, literacy, and communication styles in dialogue, written communications, and educational activities for all audiences (eg, patients/clients, organization staff/leaders, community stakeholders) | X | X | |||||
5.5 | Establishes credibility and contributes as a food and nutrition resource within the interprofessional health care and management team, organization, and community | X | X | X | ||||
5.5A | Promotes the use of evidence-based guidelines and the Academy’s EAL with the interprofessional team and others to integrate food, nutrition, and lifestyle behaviors with mental health and addictions treatment | X | X | X | ||||
5.5B | Consults with physicians and other health care professionals (eg, psychologists, social workers, nurses, physical/occupational/ recreational therapists, addictions counselors) | X | X | X | ||||
5.5C | Participates in and leads interprofessional collaborations at the organization and systems level | X | X | |||||
5.5D | Contributes nutrition-related expertise and serves as lead collaborator for national projects and professional organizations (eg, Academy practice groups, NIMH, SAMHSA, NQF) | X | ||||||
5.6 | Communicates performance improvement and research results through publications and presentations | X | X | X | ||||
5.6A | Presents evidence-based mental health and addictions nutrition research and information to community groups and colleagues | X | X | X | ||||
5.6B | Contributes to and advocates for the advancement of the body of knowledge for the profession (eg, research, presentations, publications, patient/client education) | X | X | |||||
5.6C | Presents evidence-based mental health and addictions nutrition research, guidelines, and information at professional meetings and conferences (eg, local, regional, national, international) | X | X | |||||
5.6D | Serves in a leadership role for mental health and addictions nutrition–related scholarly work (eg, reviewer, editor, editorial advisory board) and in program planning and conferences (eg, local, regional, national, international) | X | ||||||
5.6E | Translates research findings for incorporation into development of policies, procedures, and guidelines for nutrition in mental health and addictions at national and international levels | X | ||||||
5.6F | Directs collation of research data into publications and presentations (eg, position papers, practice papers, meta-analyses, review articles) | X | ||||||
5.7 | 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 non-profit organizations serving the food insecure) providing food and nutrition expertise | X | X | X | ||||
5.7A | Functions as mental health and addictions and nutrition resource as an active member of local/state/national organizations | X | X | X | ||||
5.7B | Serves on local mental health and addictions nutrition and service planning committees/coalitions/task forces for health professionals, industry, and the community | X | X | X | ||||
5.7C | Serves on regional and national mental health and addictions committees/task forces/advisory boards for health-related organizations, industry, and community | X | X | |||||
5.7D | Advocates for the advancement of mental health and addictions nutrition practice to stakeholders (eg, CMS, TJC, state licensure boards, the Academy’s Policy Initiative and Advocacy Office) | X | X | |||||
5.7E | Identifies new opportunities for leadership and cross discipline dialogue to promote nutrition and dietetics in a broader context | X | X | |||||
5.7F | Proactively seeks opportunities (local, regional, and national, and international levels) to integrate practice expertise and programs with larger systems, such as SAMHSA; mental health-specific professional groups, such as Mental Health America, NAMI; and addictions-specific professional groups, such as the Association for Addiction Professionals, the International Association of Addictions and Offender Counselors, and the National Association of Addiction Treatment Providers | X | ||||||
5.7G | Proactively seeks opportunities for leadership development and positions, and is identified as an expert related to mental health and addictions nutrition issues | X | ||||||
5.7H | Serves and advocates in leadership roles on committees and/or for publications (eg, editor, editorial board member, column editor) | X | ||||||
5.7I | Functions in leadership roles and as a content expert for business, industry, and national organizations | X | ||||||
Examples of Outcomes for Standard 5: Communication and Application of Knowledge
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Standard 6: Utilization and Management of Resources The registered dietitian nutritionist (RDN) uses resources effectively and efficiently. Rationale: The RDN demonstrates leadership through strategic management of time, finances, facilities, supplies, technology, natural and human resources. | ||||||||
Indicators for Standard 6: Utilization and Management of Resources | ||||||||
Bold Font Indicators are Academy Core RDN Standards of Professional Performance Indicators | The “X” signifies the indicators for the level of practice | |||||||
Each RDN: | Competent | Proficient | Expert | |||||
6.1 | Uses a systematic approach to manage resources and improve outcomes | X | X | X | ||||
6.1A | Participates in operational planning of mental health and addictions nutrition programs and services | X | X | X | ||||
6.1B | Recognizes and uses existing resources (eg, educational/training tools and materials, and staff time) as needed in the provision of mental health and addictions nutrition services | X | X | X | ||||
6.1C | Implements administratively sound programs (eg, food quality and food safety, mental health and addictions nutrition care and services) | X | X | X | ||||
6.1D | Collaborates with administrative, medical, and foodservice staffs, if applicable, in operational planning to secure resources and services for achieving desired outcomes | X | X | |||||
6.1E | Directs or manages the design and delivery of mental health and addictions nutrition services in various settings | X | ||||||
6.2 | Evaluates management of resources with the use of standardized performance measures and benchmarking as applicable | X | X | X | ||||
6.2A | Uses the Standards of Excellence Metric Tool to self-assess quality in leadership, organization, practice, and outcomes for an organization (www.eatrightpro.org/excellencetool) | X | X | X | ||||
6.2B | Collects or contributes data and participates in analyzing customer population and outcomes data, program resource/service participation, and expense data to evaluate and adjust programs and services | X | X | X | ||||
6.2C | Monitors, documents, and evaluates program and service resource usage against budget or other metrics (eg, staff hours, staff to patient/client ratio, referral requests, program participation rates, revenue/insurance reimbursement data, and supplies, training, technology, professional development, and food cost) | X | X | |||||
6.2D | Directs operational review reflecting evaluation of performance and benchmarking data to manage resources and modifications to design and delivery of mental health and addictions nutrition programs and services | X | ||||||
6.3 | Evaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and products | X | X | X | ||||
6.3A | Participates in evaluation and selection of equipment, tools, and new products (eg, nutritional supplements, dietary supplements, medical foods, food/meals, web-based programs, and monitoring systems) to assure safe, optimal, and cost-effective delivery of services | X | X | X | ||||
6.3B | Evaluates safety, effectiveness, and value of programs and services in meeting the needs of the target populations | X | X | |||||
6.3C | Uses operational data to enhance program outcomes | X | X | |||||
6.3D | Evaluates safety, effectiveness, productivity, sustainability practices, and value of services at the system level | X | ||||||
6.4 | Participates in quality assurance and performance improvement (QAPI) and documents outcomes and best practices relative to resource management | X | X | X | ||||
6.4A | Collects QAPI data using designated tools and analyzes to improve outcomes and identify best practices in collaboration with others as needed | X | X | X | ||||
6.4B | Participates in QAPI activities to evaluate and report outcomes of delivery of services against goals and performance targets (eg, services provided [eg, number of assessments, hours for group classes], budgeted vs actual hours, actual vs budgeted revenue, actual vs projected patient/client volumes) | X | X | X | ||||
6.4C | Proactively and systematically recognizes needs, anticipates outcomes and consequences of various approaches, and modifies resources and/or service delivery to achieve targeted outcomes | X | X | |||||
6.4D | Integrates quality measures and performance improvement processes into management of human and financial resources, and information technology | X | ||||||
6.5 | Measures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators) | X | X | X | ||||
6.5A | Gathers and assesses data regarding customer satisfaction related to mental health and/or addictions care, education, and related services; seeks assistance as need | X | X | X | ||||
6.5B | Analyzes and communicates data and, where indicated, recommends or modifies programs and services to improve stakeholder (eg, patient/client, caregivers, employees, administration) satisfaction with mental health and addictions nutrition program and services | X | X | |||||
6.5C | Implements, monitors, and evaluates changes based on collected data | X | ||||||
Examples of Outcomes for Standard 6: Utilization and Management of Resources
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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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 165, 12-16-16); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – 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 July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 16, 2018.
References
- American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Generalists, Specialists, and Advanced) in Behavioral Health Care.J Am Diet Assoc. 2006; 106: 608-613.e23
- Academy of Nutrition and Dietetics: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Intellectual and Developmental Disabilities.J Acad Nutr Diet. 2012; 112: 1454-1464.e35
- American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Disordered Eating and Eating Disorders (DE and ED).J Am Diet Assoc. 2011; 111: 1242-1249.e37
- Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.J Acad Nutr Diet. 2018; 118: 132-140.e15
Academy of Nutrition and Dietetics (Academy)/Commission on Dietetic Registration (CDR) Code of Ethics for the Nutrition and Dietetics Profession Academy website. https://www.eatrightpro.org/practice/code-of-ethics/what-is-the-code-of-ethics. Accessed May 23, 2018.
- Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.J Acad Nutr Diet. 2018; 118: 141-165
- Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee. Academy of Nutrition and Dietetics Scope of Practice Decision Tool: A self-assessment guide.J Acad Nutr Diet. 2013; 113: S10
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. 176, 12-29-17); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 165, 12-16-16); §485.635(a)(3)(vii) Dietary Services ; §458.635 (d)(3) Verbal Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 413, 416, 440 et al. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II; Final rule (FR DOC #2014-10687; pp 27106-27157). http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf. Accessed July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872) – 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 July 16, 2018.
US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed July 16, 2018.
- Glossary.Comprehensive Accreditation Manual for Hospitals. Joint Commission Resources, Oak Brook, IL2018
- Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.J Acad Nutr Diet. 2017; 117: 2003-2014
- Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer.Free Press, New York, NY1986
Academy of Nutrition and Dietetics. Definition of terms list. www.eatrightpro.org/scope. Accessed July 16, 2018.
- Diagnostic and Statistical Manual of Mental Disorders.5th ed. American Psychiatric Association Publishing, Washington, DC2014
Reports and Detailed Tables from the 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collections/reports-detailed-tables-2016-NSDUH. Accessed July 16, 2018.
- Graham A.W. Shultz T.K. Mayo-Smith M.F. Ries R.K. Wilford B.B. Principles of Addiction Medicine. 3rd ed. American Society of Addiction Medicine, Inc, Chevy Chase, MD2003
Substance Use Disorders. Substance Abuse and Mental Health Services Administration website. https://www.samhsa.gov/disorders/substance-use. Accessed July 16, 2018.
Druss BG, Walker ER. Mental disorders and medical comorbidity. Research Synthesis Report #21 February 2011. Robert Woods Johnson Foundation website. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf69438/subassets/rwjf69438_1. Published February 2011. Accessed July 16, 2018.
- Lipids in psychiatric disorders and preventive medicine.Neurosci Biobehav Rev. 2017 May; 76: 336-362
- Food, mood, and your brain: Implications for the modern clinician. Missouri Medicine.J Missouri State Med Assoc. 2015; 112: 111-115
- Nutritional psychiatry: The present state of the evidence.Proc Nutr Soc. 2017; 76: 427-436
- Nutritional medicine as mainstream in psychiatry.Lancet Psychiatry. 2015; 2: 271-274
- International Society for Nutritional Psychiatry Research consensus position statement: Nutritional medicine in modern psychiatry.World Psychiatry. 2015; 14: 370-371
- The importance of nutrition in aiding recovery from substance use disorders: A review.Drug Alcohol Depend. 2017; 179: 229-239
- Nutrition education is positively associated with substance abuse treatment program outcomes.J Am Diet Assoc. 2004; 104: 604-610
- Prevalence of malnutrition and nutritional risk factors in patients undergoing alcohol and drug treatment.Nutrition. 2012; 28: 738-743
- Diet and body composition outcomes of an environmental and educational intervention among men in treatment for substance addiction.J Nutr Educ Behav. 2013; 45: 154-158
- The effects of educational intervention on nutritional behaviour in alcohol-dependent patients.Alcohol Alcoholism. 2011; 46: 77-79
Wiss DA, Schellenberger M, Prelip ML. Registered dietitian nutritionists in substance use disorder treatment centers [published online October 25, 2017]. J Acad Nutr Diet. https://doi.org/10.1016/j.jand.2017.08.113.
- Food for Recovery: Resolving malnutrition and disordered eating patterns in addiction and substance abuse populations. Behavioral Health Nutrition Dietetic Practice Group.BHN Newslett. 2017; 34: 3-8
- The role of nutrition intervention for improving health and outcomes in patients with alcohol use disorders: A literature review. Behavioral Health Nutrition Dietetic Practice Group.BHN Newslett. 2015; 33: 3-10
- Nutrition counseling boundaries: Connecting with patients without practicing psychotherapy. Behavioral Health Nutrition Dietetic Practice Group.BHN Newslett. 2012; : 7-9
- Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities.Public Health Nutr. 2012; 15: 1159-1167
- Food insecurity and mental health status: A global analysis of 149 countries.Am J Prev Med. 2017; 53: 264-273
- The professional development portfolio process: Setting goals for credentialing.J Am Diet Assoc. 2002; 102: 1439-1444
- The essential practice competencies for the Commission on Dietetic Registration’s credentialed nutrition and dietetics practitioners.J Acad Nutr Diet. 2015; 115: 978-984
- Ethics opinion: Registered dietitian nutritionists and nutrition and dietetics technicians, registered are ethically obligated to maintain personal competence in practice.J Acad Nutr Diet. 2015; 115: 811-815
- Another look at competency-based education in dietetics.J Am Diet Assoc. 1996; 96: 614-617
- Nutritional psychiatry: Where to next?.EBioMed. 2017; 17 (https://doi.org/10.1016/j.ebiom.2017.02.020): 24-29
- Nutrition therapy in substance use disorders.Today’s Dietitian. 2018; 20: 12-13
- Investigating philosophies underpinning dietetic private practice.Behav Sci. 2017; 7: e1-e19
Trauma-Informed Approach and Trauma-Specific Interventions. https://www.samhsa.gov/nctic/trauma-interventions. Substance Abuse and Mental Health Services Administration web site. Updated April 27, 2018. Accessed July 16, 2018.
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STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.