Abstract
Editor’s note: Figure 1 that accompanies this article is available at www.jandonline.org.
Academy Quality and Practice Resources
Why Were the Standards Revised?
- •The Scope of Practice for the RDN4and the Scope of Practice for the NDTR12were revised and published in the Academy’s Journal in January 2018 and February 2018, respectively. The RDN Scope reflects changes impacting practice, such as the Centers for Medicare and Medicaid Services (CMS) updates; national efforts to address malnutrition; and sections on coaching, global health, and telehealth, among other updates. The NDTR Scope also includes revisions, such as updated practice areas, and a new individual scope of practice figure.
- •The CMS, Department of Health and Human Services, Hospital,7and Critical Access Hospital
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. 183, 10-12-18); §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 November 19, 2018.
8Conditions of Participation now allow a hospital and its medical staff the option of including RDNs or other clinically qualified nutrition professionals within the category of “non-physician practitioners” eligible for ordering privileges for therapeutic diets and nutrition-related services if consistent with state law and health care regulations.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. 183, 10-12-18); § 485.635(a)(3)(vii) Dietary Services; § 458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed November 19, 2018.
9For more information, review the Academy’s practice tips that outline the regulations and implementation steps at www.eatrightpro.org/dietorders. For assistance, refer questions to the Academy’s State Affiliate organization.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 November 19, 2018.
- •The Long-Term Care Final Rule published October 4, 2016, now “allows the attending physician to delegate to a qualified dietitian or other clinically qualified nutrition professional the task of prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by state law” and permitted by the facility’s policies.10The CMS State Operations Manual, Appendix PP-Guidance for Surveyors for Long-Term Care Facilities contains the revised regulatory language.
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 November 19, 2018.
11CMS periodically revises the State Operations Manual Conditions of Participation; obtain the current information at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107Appendicestoc.pdf.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 November 19, 2018.
- •The 2015 report from the Institute of Medicine, now the National Academies of Sciences, Engineering, and Medicine, provides evidence linking interprofessional education to patient, population, and health system outcomes.13Interprofessional education endeavors to gather different professionals, including RDNs in EONDP, to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients.14The Institute of Medicine report recommends actions that a diverse group of interprofessional stakeholders, including RDNs in EONDP, can take to better measure the impact of interprofessional education beyond the classroom, and in actual clinical practice.15,16
Three Levels of Practice
The Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Education of Nutrition and Dietetics Practitioners (EONDP) 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). |
The SOPP, along with the Standards of Practice (SOP) in Nutrition Care, applicable to practitioners who provide direct patient/client nutrition care services, 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 the 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, an online interactive tool, is specifically designed to assist practitioners with this process (www.eatrightpro.org/scope). |
The term customer is used in this evaluation resource as a universal term. Customer could also mean nutrition and dietetics student/intern, preceptor, client/patient, participant, consumer, or any individual, group, or organization to which the RDN provides services. These services are provided to individuals of all ages. These Standards of Professional Performance are applicable to all settings. In addition, it is recognized that faculty, preceptors, academic institution administrators, and supervised practice setting liaisons play critical roles in the education of nutrition and dietetics students/interns and are important members of the team throughout the educational experience. 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 2018 Standards of Professional Performance for RDNs have been adapted to reflect three levels of practice (competent, proficient, and expert) for RDNs in Education of Nutrition and Dietetics Practitioners (see image below). In addition, the core indicators have been expanded to reflect the unique competence expectations for the RDN in Education of Nutrition and Dietetics Practitioners.![]() |
Competent Practitioner
Proficient Practitioner
Expert Practitioner
Overview
Overview of learning theories. http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/learning-overview/. Berkeley Graduate Division website. Accessed November 19, 2018.
Overview of learning theories. http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/learning-overview/. Berkeley Graduate Division website. Accessed November 19, 2018.
Background Information on Distance and Correspondence Education. Higher Learning Commission website. http://www.hlcommission.org/Accreditation/distance-delivery.html. Accessed November 19, 2018.
Distance Education Certification Standards. International Distance Education Certification Center website. https://www.idecc.org/Downloads/I_DistanceEducationStandards.pdf. Published 2017. Accessed November 19, 2018.
Professional Development Portfolio. Commission on Dietetic Registration website. https://www.cdrnet.org/pdp/professional-development-portfolio-guide. Accessed November 19, 2018.
- •understanding the Nutrition Care Process and clinical workflow elements6,29;
Electronic Nutrition Care Process and Terminology. Academy of Nutrition and Dietetics Nutrition Care Process web site. https://www.ncpro.org/. Accessed November 19, 2018.
- •recognizing emerging trends;
- •understanding and using current evidence-based concepts in medical nutrition therapy and nutrition informatics; and
- •recognizing emerging trends in clinical, community and public health nutrition, food science, nutrigenomics, food security, foodservice management, sustainability, and practice management to deliver quality and appropriate patient/client care and student/intern education and training.
Resource | Address | Description and Application |
---|---|---|
Academy of Nutrition and Dietetics (Academy) | ||
Academy Coding and Billing Handbook: A Guide for Program Directors and Preceptors | www.eatrightstore.org/product/72D93968-26F0-44BB-AE78-C9D2AD2C8ABD | This Academy publication provides information on coding and billing for nutrition services for program directors and preceptors to use when teaching nutrition and dietetics students/interns. This resource is free to members, and is available in the Academy store for non-members. |
Academy Certificate of Training: Informatics in Nutrition: Spanning all Areas of Practice | www.eatrightstore.org/cpe-opportunities/certificates-of-training/informatics-in-nutrition-module-1 | A series of 5 modules that apply the definition and historical background of Nutrition Informatics content of the Nutrition Informatics Surveys (2008, 2011, and 2014), National Delphi Study on Nutrition Informatics, Academy's Evidence Analysis Library, and the upcoming release of an Electronic Health Record (EHR)/Personal Health Record Nutrition Best Practices Implementation Guide. EHR Toolkit is now provided per subscription to the electronic Nutrition Care Process Terminology. |
Academy Dietetic Practice Groups | www.eatrightpro.org/resources/membership/academy-groups/dietetic-practice-groups | Educators and preceptors may choose to belong to practice groups that relate to their area of nutrition and dietetics expertise in addition to being an educator or preceptor. |
Academy Nutrition and Dietetics Career Development Guide | www.eatrightpro.org/practice/career-development/career-toolbox/dietetics-career-development-guide | The Academy’s Nutrition and Dietetics Career Development Guide is based on the Dreyfus model 18 of knowledge and skill acquisition. “This guide is designed to provide students, educators and practitioners the tools to assist in career development and advancement.” |
Academy Position and Practice Papers | www.eatrightpro.org/resources/practice/position-and-practice-papers | The Academy position and practice papers are resources that assist in promoting optimal nutrition, health, and well-being for the public in addition to guiding critical thinking. These are helpful documents for educators in providing evidence-based nutrition information to nutrition and dietetics students/interns. |
Academy Practice Resources | www.eatrightpro.org/practice#dietetics-resources | The Academy of Nutrition and Dietetics offers members many resources to manage their practice and career, from standards of practice tools to marketing resources. |
Nutrition and Dietetic Educators and Preceptors (NDEP), an Academy organizational unit | www.ndepnet.org/ | NDEP provides several resources for educators and preceptors. NDEP members access webinars, the NDEP portal with a library of resources, and a mentoring program. |
Advanced Practice | ||
The Accreditation Council for Education in Nutrition and Dietetics (ACEND) Advanced Practice Residency (APR) Program | www.eatrightpro.org/acend/about-acend/advanced-practice | The ACEND APR Program Guidelines were established to foster the development of APR programs for registered dietitian nutritionists (RDNs) across the spectrum of nutrition and dietetics practice. |
Commission on Dietetic Registration (CDR) Advanced Practice Certification in Clinical Nutrition (RDN-AP) | www.cdrnet.org/board-certification-in-advanced-practice | The CDR offers an Advanced Practice Certification in Clinical Nutrition. Certification is granted in recognition of an applicant's documented practice experience and successful completion of an examination. |
Non–Academy-Based Pedagogical Resources | ||
Competency Assessment Field Guide: A Real World Guide for Implementation and Application by D. Wright, Creative Health Care Management, Minneapolis, MN (2015) | https://books.google.com/books/about/Competency_Assessment_Field_Guide.html?id=pyhzDgAAQBAJ&printsec=frontcover&source=kp_read_button#v=onepage&q&f=false | This book is a competency-based assessment field guide and reviews the misconceptions of competency-based assessment while providing information on what every educator needs to know. |
Health Care Provider Preceptor Training Program–California Community Colleges | www.sdnsec.org/forms/PreceptorModelCurriculumObjectives-RHORC.pdf | This resource is a health care provider model preceptor training curriculum. It could be used as an educational tool for training preceptors in a group setting, and provides examples of pedagogy, worksheets, and guidelines for a facilitator in a health care setting. |
How Learning Works: 7 Research-Based Principles for Smart Teaching by S. Ambrose and colleagues, Jossey-Bass, San Francisco, CA (2010) | www.wiley.com/en-us/How+Learning+Works%3A+Seven+Research+Based+Principles+for+Smart+Teaching-p-9780470484104 | This book addresses how students learn and provides evidence-based principles, such as student motivation and how students develop mastery for effective teaching. |
Interprofessional Education Collaborative (IPEC) | www.ipecollaborative.org | IPEC is an organization that works in collaboration with academic institutions to support efforts to prepare future health care professionals. The IPEC provides resources, such as Core Competencies for Interprofessional Collaborative Practice and learning modules. |
Interprofessional Education Development: A Road Map for Getting There | www.scirp.org/journal/PaperInformation.aspx?PaperID=34953 | This journal article describes the benefits of interprofessional education (IPE) and how to get started implementing IPE, and describes the cultural changes that may need to occur. |
Guidelines for the Evaluation of Distance Education (Online Learning) | http://download.hlcommission.org/C-RAC_Distance_Ed_Guidelines_7_31_2009.pdf | The Guidelines for the Evaluation of Distance Education (Online Learning) were developed by the Council of Regional Accrediting Commissions for institutions to use as a resource when planning distance education. The guidelines provide an assessment framework for institutions already involved in distance education. |
Mastering Simulation: A Handbook for Success by Beth Ulrich and Beth Mancini, Sigma Tau Theta International, Indianapolis, IN (2014) | www.nursingknowledge.org/mastering-simulation-a-handbook-for-success.html | This book provides information on using simulation as an effective teaching tool and how to respond to changing technology. Topics covered include creating simulation scenarios, designing program evaluations, managing risk, and quality improvement. |
National Center for Interprofessional Practice and Education | https://nexusipe.org/ | The National Center is charged to provide the leadership, evidence, and resources needed to guide the nation on interprofessional education and collaborative practice. The Resource Center houses a digital library of interprofessional practice and education-related content. |
Quality Matters | www.qualitymatters.org/ | Quality Matters is an organization that promotes and certifies quality design for online courses through training and review. |
Resources for Preceptors | ||
ACEND Preceptors and Mentors website | www.eatrightpro.org/preceptors | ACEND offers information on how to become a preceptor in addition to resources for preceptors and mentors, such as a preceptor training program. |
CDR Campus website | www.cdrcampus.com | This website offers continuing professional education activities for RDNs and Nutrition and Dietetics Technicians, Registered and also provides a link to a free Dietetics Preceptor Training Program (provides 8 Continuing Professional Education Units). |
Mastering Precepting: A Nurse's Handbook for Success by Beth Ulrich, Sigma Tau Theta International, Indianapolis, IN (2012) | www.nursingknowledge.org/mastering-precepting-a-nurse-s-handbook-for-success.html | This book gives detailed information about the role of a preceptor, provides information on creating a preceptor development plan, and describes the preceptor’s role as a health care leader. It can be used by both program directors and preceptors for planning and improving preceptor training. |
Determining Qualified Faculty through HLC’s Criteria for Accreditation and Assumed Practices. Higher Learning Commission website. http://download.hlcommission.org/FacultyGuidelines_2016_OPB.pdf. Accessed November 19, 2018.
Nutrition and Dietetic Educators and Preceptors—Same name, even greater commitment. http://www.ndepnet.org. Accessed November 19, 2018.
Academy Revised 2018 SOPP for RDNs (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners
- •identify the competencies needed to provide EONDP;
- •self-evaluate whether he or she has the appropriate knowledge, skills, experience, and judgment to provide safe, effective, and quality nutrition and dietetics education 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 nutrition and dietetics education;
- •provide a foundation for public and professional accountability in nutrition and dietetics education;
- •support efforts for strategic planning, performance improvement, outcomes reporting, and assist management in the planning and communicating of nutrition and dietetics education and resources (see Figure 3);
- •enhance professional identity and skill in communicating the nature of nutrition and dietetics education;
- •guide the development of nutrition and dietetics education programs and related continuing education opportunities, job descriptions, practice guidelines, protocols, clinical models, competence evaluation tools, and career pathways; and
- •assist educators and preceptors in teaching knowledge, skills, and competencies needed to work in nutrition and dietetics education, and the understanding of the full scope of this focus area of practice.
Application to Practice
Role | Examples of use of SOPP documents by RDNs in different practice roles |
---|---|
Director, ACEND nutrition and dietetics program | The nutrition and dietetics education program director uses the Revised 2018 Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Education of Nutrition and Dietetics Practitioners (EONDP) as a guiding document along with the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Standards of Education to assure academic courses and supervised practice experiences provide the students/interns with the necessary core knowledge and practice competencies for supervised practice that leads to entry-level practice. The program director collaborates with and mentors other nutrition and dietetics faculty, other health professions’ faculty, and supervised practice preceptors on the purpose and expectations of the Revised 2018 SOPP for RDNs in EONDP. In addition, the nutrition and dietetics education program director provides guidance to faculty and preceptors on the value and application of using the Revised 2017 SOP in Nutrition Care and SOPP for RDNs and Revised 2017 Standards Of Practice (SOP) in Nutrition Care and SOPP for Nutrition and Dietetics Technicians, Registered (NDTRs), and other applicable focus area SOP and SOPP. The EONDP SOPP and other focus area SOP and SOPP serve as references when designing course content, supervised practice and learning activities, and to illustrate how knowledge and skills learned apply to practice as a credentialed practitioner. |
RDN faculty, nutrition and dietetics education program | An RDN faculty member teaching nutrition and dietetics courses refers to the Revised 2018 SOPP for RDNs in EONDP to understand the competence expectation for educators (ie, in-person or distance). The RDN also accesses other focus area SOPs and/or SOPPs (eg, Nutrition Support, Pediatrics, Oncology Nutrition, Nephrology Nutrition, Diabetes Care, Adult Weight Management, Integrative and Functional Medicine) to identify practice roles and outcomes for entry-level competent practice; and focus area resources to use in development of lectures and assignments. The RDN reviews the Revised 2018 SOPP for RDNs in EONDP to evaluate knowledge and skills, and to set goals for strengthening competence in this area of practice. |
RDN researcher/educator (eg, may work as a faculty member in a nutrition and dietetics program or other related college-level program) | An RDN has a faculty appointment that includes research responsibilities. The RDN develops a research proposal with an aim of building capacity and increasing diversity of the RDN workforce. The RDN uses the Revised 2018 SOPP for RDNs in EONDP and other resources to identify areas for nutrition and dietetics students/interns contributing to the research experience (eg, design research protocol, submission to institutional review board, obtain consent, collect and analyze data, and draft the research report). In addition, the RDN may consider guiding the students/interns through culturally relevant approaches in the recruitment phase of the research, such as offering culturally appropriate informational sessions to recruit new students who may be interested in the field of food, nutrition, and dietetics. |
RDN preceptor (eg, may work in a clinical, foodservice management, public health/community, or other setting) | An RDN serving in a clinical role that provides care to individuals and/or groups, such as hospital clinical practice, public health/community, or foodservice management has agreed to serve as a preceptor for a nutrition and dietetics education program. The RDN who is unfamiliar with the specific role and responsibilities of being a preceptor reviews the Revised 2018 SOPP for RDNs in EONDP to prepare for an orientation session with the nutrition and dietetics program faculty and/or program director. The RDN identifies skills and competencies for development and sets goals for improvement through reading, mentoring, and targeted continuing education activities including the Commission on Dietetic Registration Online Preceptor Training Course (www.cdrnet.org). |
RDN manager (eg, may participate as preceptor, mentor, or guest lecturer) | An RDN manager (clinical or other practice area) oversees several RDNs and NDTRs who agreed to participate as preceptors for nutrition and dietetics students/interns. The RDN, who is liaison to the nutrition and dietetics education program, works with the program director to use the Revised 2018 SOPP for RDNs in EONDP to orient staff, develop guidelines for student/intern experiences, and report student/intern progress. The RDN uses the Revised 2018 SOPP for RDNs in EONDP, and other identified resources to increase knowledge in educational methodologies and competency expectations for preceptors recognizing it is an important tool for staff to assess and develop skills in precepting nutrition and dietetics students/interns. |
Future Directions
Summary
Acknowledgements
Author Contributions
Supplementary Materials
Standards of Professional Performance for Registered Dietitian Nutritionists in Education of Nutrition and Dietetics Practitioners 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 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
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 | Implements quality practice by following an evidence-based/best practice approach to education and meeting credentialing, licensure, and regulatory requirements | X | X | X | ||||||
1.1B | Explains the Centers for Medicare and Medicaid Services regulations and interpretive guidelines (eg, Conditions of Participation for Hospitals, Long-Term Care Facilities), and health care facility accreditation standards and elements of performance (eg, The Joint Commission, Healthcare Facilities Accreditation Program) as key standards guiding quality patient care to achieve best practices | X | X | |||||||
1.1C | Leads a team to review other nutrition and dietetics education programs and assists the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Board in developing and/or revising standards for education | X | ||||||||
1.2 | Performs within individual and statutory scope of practice and applicable laws and regulations | X | X | X | ||||||
1.2A | Interprets and applies individual and statutory scope of practice at all program levels for the Education of Nutrition and Dietetics Practitioners (EONDP) | X | X | X | ||||||
1.2B | Ensures that curriculum and, where appropriate, supervised practice experiences include orientation to the Academy Scope of Practice, individual scope of practice, and statutory scope of practice for both RDNs and Nutrition and Dietetics Technicians, Registered (NDTRs) | X | X | X | ||||||
1.3 | Adheres to sound business and ethical billing practices applicable to the role and setting | X | X | X | ||||||
1.3A | Ensures the nutrition and dietetics program curricula and supervised practice experiences provide students/interns with the ability to learn and apply payer and organization-type billing policies and ethical billing practices; seeks input from experienced practitioners as needed | 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 | Orients students/interns to national quality and safety data resources applicable to nutrition and dietetics practitioner roles and practice settings | X | X | 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 | Identifies performance improvement measures to monitor quality of education services; seeks assistance if needed | X | X | X | ||||||
1.5B | Evaluates quality of nutrition and dietetics education in terms of pedagogy, ACEND standards, educational process, and student/intern learning outcomes | X | 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 | Monitors and conducts regular evaluations and provides feedback to colleagues and others involved in outcomes measurement consistent with role and responsibilities | X | X | |||||||
1.6B | Defines expected outcomes (eg, student/intern learning outcomes for didactic and/or supervised practice experiences) | X | X | X | ||||||
1.6B1 | Participates and/or leads in identifying expected student/intern learning outcomes applicable to didactic, experiential learning, and/or supervised practice experiences | X | X | X | ||||||
1.6B2 | Develops student/intern learning outcomes for assigned course(s) including experiential learning, if appropriate, and/or setting-specific supervised practice experiences | X | X | |||||||
1.6B3 | Operationalizes and advises faculty and preceptors on the identification of learning outcomes that meet ACEND standards, academic guidelines, and student/intern and other stakeholder expectations | 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 | Collects measurable data, and documents outcomes applicable to education of nutrition and dietetics practitioners and/or other area of research expertise | X | X | X | ||||||
1.6D1i | Develops and monitors systematic processes to determine, define, collect, and analyze measurable data comparing to expected outcomes | X | X | |||||||
1.6D2 | Measures educational services and identifies and addresses student/intern learning needs using educational processes/systems | X | X | X | ||||||
1.6D2i | Identifies and addresses potential problems in relation to diversity of student/intern learning needs that may compromise expected outcomes; variances evaluated include, but are not limited to:
| X | X | |||||||
1.6D2ii | Provides expertise in identification and evaluation of educational structures and processes to meet student/intern learning outcomes | X | ||||||||
1.6E | Incorporates electronic clinical quality measures (eCQM) to evaluate and improve care of patients/clients at risk of malnutrition or with malnutrition (www.eatrightpro.org/emeasures) | X | X | X | ||||||
1.6E1 | Ensures students/interns have opportunities for observation and participation in nutrition care and performance improvement activities addressing screening, assessment, and interventions for individuals with or at risk of malnutrition in health care settings and applicable community settings | X | X | X | ||||||
1.6E2 | Provides examples to students/interns of how eCQMs can be used to improve patient/client outcomes, reduce cost burden, and advance the role of the RDN | X | X | |||||||
1.6E3 | Identifies and provides examples to students/interns on requirements for reporting on quality measures using health information technology standards and eCQM-driven documentation | X | X | |||||||
1.6F | Documents outcomes and patient reported outcomes (eg, PROMIS) | X | X | X | ||||||
1.6F1 | Documents achievement of student/intern learning outcomes | X | X | X | ||||||
1.6F2 | Assesses and communicates program outcome measures | X | 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 | ||||||
1.6G1 | Leads students/interns in reviewing, developing, and/or publishing nutrition and dietetics-related benchmarking tools | X | X | |||||||
1.7 | Identifies and addresses potential and actual errors and hazards in provision of services and brings them to the attention of supervisors and team members as appropriate | X | X | X | ||||||
1.7A | Designs learning activities to provide students/interns with skills to evaluate potential hazards in provision of services (eg, food/drug interactions, charting accuracy) | X | X | X | ||||||
1.8 | Compares actual performance to performance goals (ie, Gap Analysis, SWOT Analysis [Strengths, Weaknesses, Opportunities, and Threats], PDSA Cycle [Plan-Do-Study-Act], DMAIC [Define, Measure, Analyze, Improve, Control], Lean/Six Sigma) | X | X | X | ||||||
1.8A | Compares actual performance to expected student/intern learning outcomes and competencies | X | X | X | ||||||
1.8B | Reports and documents action plan to address identified gaps in care and/or service performance at program and student/intern level | X | X | X | ||||||
1.8B1 | Documents actions taken when discrepancies exist between achievement and expected student/intern learning outcomes | X | X | X | ||||||
1.8B2 | Develops and monitors action plan for students/interns whose achievement and expected outcomes have discrepancies | X | X | |||||||
1.9 | Evaluates interventions and workflow process(es) and identifies service and delivery improvements | X | X | X | ||||||
1.9A | Continuously monitors processes and outcomes of course, rotation, and/or programs | X | X | |||||||
1.9B | Designs and tests interventions to improve the education process and service with the objective of improving quality and student/intern learning outcomes | X | 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 | Monitors and refines educational methodology based on measured student/intern learning outcomes | X | X | X | ||||||
1.10B | Implements an outcomes management system to evaluate the effectiveness and efficiency of education | X | X | |||||||
1.10B1 | Utilizes and applies collected data as part of a quality improvement process to improve student/intern learning outcomes | X | X | |||||||
1.10B2 | Leads in systematically improving processes of educational services to improve student/intern learning outcomes reflecting understanding of variations | X | ||||||||
1.10C | Leads in creating and evaluating systems, processes, and programs that support institutional, ACEND, and Academy core values and objectives | X | X | |||||||
1.10C1 | Serves in a leadership role to evaluate benchmarks of educational methodology (eg, theories of adult education, ACEND standards, and institutional standards) to positively influence curriculum planning and development | 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 Dietetic Registration (CDR), other national/international organizations, and/or employer code of ethics) | X | X | X | ||||||
2.1A | Interprets and shares ethics guidelines within the context of educating students/interns and practitioners in all practice settings | X | X | X | ||||||
2.1B | Assists or leads in developing codes of ethics; and/or sits on ethics board/council | 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 | ||||||
2.2A1 | Integrates applicable focus area(s) SOP and/or SOPP into the educational process | X | X | |||||||
2.2B | Uses the SOP and/or SOPP as a guide for quality practice, management and leadership | X | X | X | ||||||
2.3 | Demonstrates and documents competence in practice and delivery of customer-centered service(s) | X | X | X | ||||||
2.3A | Reviews and obtains guidance as needed to understand requirements of ACEND Accreditation Standards, and academic institution’s and/or supervised practice setting’s guidelines applicable to role and responsibilities (eg, program director, faculty, preceptor) | X | X | X | ||||||
2.3B | Documents program adherence to ACEND accreditation standards and academic institution’s and/or supervised practice setting’s requirements | 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 | Documents and reports errors, complaints, and problems as required by the organization or ACEND’s accreditation process | X | X | |||||||
2.5 | Conducts self-evaluation at regular intervals | X | X | X | ||||||
2.5A | Identifies needs for professional development | X | X | X | ||||||
2.5B | Reviews skills and knowledge to determine whether they meet future educational needs of practitioners, and to qualify for expanded role(s) in practice setting | 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 | ||||||
2.6A1 | Identifies and seeks out essential practice competencies to support continuing education needs as an educator and/or preceptor | X | X | X | ||||||
2.6A2 | Includes professional goals around key dimensions of nutrition and dietetics education, performance improvement, research, service, and leadership | X | X | |||||||
2.7 | Engages in evidence-based practice and uses best practices | X | X | X | ||||||
2.7A | Familiarizes self with best practices in education through faculty development, and/or through educational publications | X | X | X | ||||||
2.7B | Integrates evidenced-based practice and research in delivering quality education utilizing, but not limited to, scientific and point-of-care databases (eg, Lexicomp, Clinical Key, Dynamed, UptoDate, Cochrane Reviews) and Academy tools (see Figure 3 resources) in designing student/intern education experiences | X | X | X | ||||||
2.7C | Uses evidence-based educational theories and strategies (eg, problem-based learning, student-centered learning, and interactive learning) to inform appropriate curricula development and identify relevant educational methods | X | X | X | ||||||
2.7D | Promotes best practices both internally and externally with faculty, students, interns, preceptors, and practitioners | X | X | X | ||||||
2.7E | Uses planned change management principles to integrate research into practice | X | X | |||||||
2.7F | Integrates research findings and evidence into peer-reviewed publications and recommendations for educating nutrition and dietetics practitioners | X | ||||||||
2.8 | Participates in peer review of others as applicable to role and responsibilities | X | X | X | ||||||
2.8A | Provides feedback and evaluation of performance to preceptors engaged in EONDP | X | X | X | ||||||
2.8B | Addresses the educational domain in evaluation of self-performance, peer (preceptors) reviews, and/or fellow faculty members reviews | X | X | X | ||||||
2.8C | Trains and participates as a site visitor for nutrition and dietetics education program accreditation | X | ||||||||
2.9 | Mentors and/or precepts others | X | X | X | ||||||
2.9A | Participates and/or assists in mentoring students/interns | X | X | X | ||||||
2.9B | Serves as a preceptor in supervised practice settings | X | X | X | ||||||
2.9C | Promotes student/intern relationships with nutrition and dietetics practitioners who will mentor them and further their knowledge in nutrition and dietetics practice | X | X | X | ||||||
2.9D | Develops professional mentor/mentee knowledge, skills, and attributes with current students/interns, colleagues, preceptors, and future employers | X | X | |||||||
2.9E | Develops mentor/mentee programs with current students/interns, colleagues, preceptors, and future employers (eg, research collaboration opportunities) | X | X | |||||||
2.9F | Assists in the development of mentor/mentee relationships | X | X | |||||||
2.9F1 | Trains and mentors peers and preceptors about nationally recognized educational practices | X | X | |||||||
2.9F2 | Evaluates the teaching and training effectiveness of mentors and preceptors of students/interns | X | X | |||||||
2.9F3 | Coordinates internal and external reviews of the mentoring educational process utilizing input from students/interns, faculty, preceptors, and other stakeholders | 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 | Remains informed about practice-related laws (ie, state licensure and certification, telehealth) and regulations, and regulations that may impact distance education | X | X | X | ||||||
2.10B | Participates in interprofessional d education and collaborationInterprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, RDNs, pharmacists, psychologists, social workers, and occupational, physical therapists, faculty, preceptors, and academic administrators), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary. | X | X | X | ||||||
2.10C | Advocates and supports the educational advancement of credentialed nutrition and dietetics practitioners to achieve Masters- and Doctorate-level education | X | X | |||||||
2.10D | Seeks leadership roles at institutional, state, and national levels to advance the education of nutrition and dietetics practitioners | 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 identifying and securing appropriate didactic and/or supervised practice opportunities to achieve student/intern learning outcomes | X | X | X | ||||||
3.1A2 | Establishes administratively sound didactic and/or supervised practice programs (eg, curricula in accordance with ACEND standards, academic institution guidelines, and student/intern learning outcomes) | X | X | |||||||
3.1A3 | Fosters relationships with key organizations and businesses that support the program’s mission | X | X | |||||||
3.1A3i | Develops policies and procedures to maintain written agreements with institutions, organizations, and/or agencies providing supervised practice experiences to meet the competencies and/or performance indicators outlined in program curricula | X | X | |||||||
3.1A3ii | Evaluates selection, adequacy, and appropriateness of facilities to ensure sites are able to provide meaningful supervised practice learning experiences | X | X | |||||||
3.1A4 | Leads collaborative process for determining and monitoring program curriculum and/or supervised practice experiences to assure compliance with ACEND standards and academic institution guidelines with:
| X | X | |||||||
3.1A5 | Negotiates and/or establishes changes at systems level for new advances in education of practitioners (eg, leads initiative to establish a center for interprofessional education [IPE]) | X | ||||||||
3.1A6 | Leads strategic and operational planning and curriculum design | X | ||||||||
3.1B | Uses the needs, expectations, and desired outcomes of the customers/populations (eg, students/interns, preceptors, faculty, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service development | X | X | X | ||||||
3.1B1 | Routinely assesses needs, expectations, and desired outcomes of students/interns and potential employers to reflect in design of educational program (eg, curriculum, experiential learning, and supervised practice experiences) | X | X | X | ||||||
3.1B2 | Routinely assesses needs for the use of technology to meet the needs of customers/populations, and/or patients/clients, families | 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 and other education program resources that support student/intern education and practice activities, enrollment, and achievement of academic program and ACEND standards | X | X | |||||||
3.1D | Proposes programs and services that are customer-centered, culturally relevant, and minimize disparities | X | X | X | ||||||
3.1D1 | Applies trends (eg, public health, policy, clinical, management) and epidemiological data to professional practice and education programs | X | X | |||||||
3.1D2 | Insures that programs are routinely evaluated for cultural relevance, equity, and accessibility | X | ||||||||
3.2 | Promotes public access and referral to credentialed nutrition and dietetics practitioners (eg, RDN or NDTR) 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 | Participates as part of an interprofessional team in education, research, and practice, increasing awareness of the roles and responsibilities of qualified, credentialed nutrition and dietetics practitioners | X | X | X | ||||||
3.2A2 | Guides development or review of a referral system as part of a supervised practice experience for students/interns | 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 | Establishes and maintains campus, preceptor, stakeholder networks to support program and student/intern needs/interests | X | X | |||||||
3.2C | Monitors effectiveness of referral systems and modifies as needed to achieve desirable outcomes | X | X | X | ||||||
3.2D | Refers students, interns, and RDNs to the appropriate practitioners (eg, RDN, NDTR, nurse, physician, other health professionals) for purposes of mentoring, tutoring, and/or counseling | X | X | X | ||||||
3.2D1 | Maintains an updated referral system of RDNs and other credentialed practitioners who are willing to mentor students and interns | X | X | |||||||
3.2E | Advocates for credentialed nutrition and dietetics practitioners (eg, RDN or NDTR) representation as part of faculty | X | 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 | Acknowledges differences and solicits input from the customers/target populations when contributing to the design of services | X | X | 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 | Considers customer (eg, student and/or intern and/or preceptor) concepts of education and their cultural values, belief systems, and worldviews in didactic and/or supervised practice experience | X | X | X | ||||||
3.3B2 | Considers how culture, gender, sexual orientation, and previous educational and work experience might influence learning and experience expectations | X | X | X | ||||||
3.3B3 | Adapts methods to maximize learning potential for diverse populations (eg, counseling and teaching modalities, accessibility accommodations, and electronic methods, such as distance education) | X | X | X | ||||||
3.3C | Communicates principles of disease prevention and behavioral change appropriate to the customer or target population | X | X | X | ||||||
3.3C1 | Teaches students/interns to incorporate understanding of cultural safety in delivery of patient/client care and communications | X | X | X | ||||||
3.3D | Collaborates with the customers (eg, students and/or interns and/or preceptors) to set priorities, establish goals, and create customer-centered action plans to achieve desirable outcomes | X | X | X | ||||||
3.3D1 | Participates in or develops appropriate curricula and educational methods to ensure that the educational process provides the exposure, experience, and training necessary to meet the ACEND foundational knowledge, competencies, and/or performance indicators for entry-level RDNs and NDTRs | X | X | X | ||||||
3.3D1i | Evaluates the effectiveness of curricula and educational methods | X | X | |||||||
3.3D1ii | Conducts systematic assessment and evaluation of effectiveness of nutrition and dietetics education programs to ensure quality of services | X | X | |||||||
3.3D1iii | Leads interprofessional team on changes and process revisions as needed | X | ||||||||
3.3D2 | Demonstrates understanding of current pedagogical theory related to the customer-centered education of adult learners | X | X | X | ||||||
3.3D2i | Applies current pedagogical theory related to the education of a diverse audience of adult learners to practice | X | X | X | ||||||
3.3D2ii | Develops and implements educational systems based on current pedagogical theories related to adult learners | X | X | |||||||
3.3D2iii | Conducts ongoing systematic reviews of program, course, and training approaches/materials/resources and updates materials/resources (eg, books, modules) as indicated | X | X | |||||||
3.3D2iv | Leads in developing, evaluating, and communicating success related to the different theoretical frameworks for education (eg, problem-based learning) | X | ||||||||
3.3E | Involves customers in decision making | X | X | X | ||||||
3.3E1 | Involves customers (eg, students and/or interns and/or preceptors) in decision making, including the development, monitoring, evaluating, and reporting of learning outcomes in didactic and/or supervised practice experiences | X | 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 | Provides students/interns opportunities to participate in interprofessional team rounds, conferences, care plan, and/or discharge planning conferences | X | X | X | ||||||
3.4A2 | Uses input and feedback from collaborations in execution of programs/services | X | X | X | ||||||
3.4A3 | Leads nutrition/dietetics-related classes/lectures to other professions at the graduate or doctorate level | 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, grant management) | X | X | X | ||||||
3.4B1 | Understands and uses the concepts of nutrition screening and assessment processes and parameters for efficiency and effectiveness in didactic courses and/or supervised practice experiences | X | X | X | ||||||
3.4B2 | Understands and uses the concepts of the food/formulary delivery systems in terms of the nutrition status, health, and well-being of target populations in didactic and/or supervised practice experiences | X | X | X | ||||||
3.4B3 | Understands, applies, and educates others about the use of the Nutrition Care Process and workflow elements, standardized terminology, and electronic Nutrition Care Process and Terminology using appropriate educational pedagogy and technologies | X | X | X | ||||||
3.4B4 | Provides professional and technical expertise and new knowledge for ongoing revisions of programs and services (eg, participates in the development of a new nutrition screening system for a local health care institution) | 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, Health Insurance Portability and Accountability Act [HIPAA]–compliant telehealth platforms), and training materials that reflect evidence-based practice in accordance with applicable laws and regulations | X | X | X | ||||||
3.4C1 | Understands and uses the Nutrition Care Process and workflow elements and standardized terminology in didactic and/or supervised practice experiences | X | X | X | ||||||
3.4C2 | Understands and uses the concepts of nutrition protocols and policies within the Nutrition Care Process and workflow elements for target populations in didactic and/or supervised practice experiences | X | X | X | ||||||
3.4C3 | Participates in the development of policies and procedures using evidence-based guidelines | X | X | X | ||||||
3.4C4 | Implements education program and departmental policies and procedures consistent with evidence-based methods, pertinent federal and state regulations, and ACEND standards foundation knowledge, core competencies, and/or performance indicators | X | X | X | ||||||
3.4C5 | Incorporates into educational programs regulatory, accreditation, and reimbursement processes and standards for institutions and providers that are specific to nutrition care and education | X | X | |||||||
3.4C6 | Designs and implements best teaching/instruction methods following systematic review of literature and consideration of past student/intern program evaluations | X | X | |||||||
3.4C7 | Leads the process of developing and/or updating nutrition and dietetics program policies and procedures, protocols, guidelines, and 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 f -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.7,8 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.10,11 | X | X | X | ||||||
3.4D1i | Understands and applies processes related to order writing and other nutrition-related privileges, including decision making, autonomous practice, and all components of the assessment processes | X | X | X | ||||||
3.4D1ii | Includes teaching and/or mentoring on hospital privileging for order writing and/or with physician-delegated orders in hospitals or long-term care settings consistent with federal and state-specific regulations | X | X | 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 | ||||||
3.4D2i | Includes teaching and mentoring on clinical privileging for the provision of nutrition-related services | X | 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 | Ensures that in supervised practice settings, relevant billing and reimbursement processes and organization financial guidelines applicable to the RDN’s or NDTR’s practice are addressed | X | X | |||||||
3.4E2 | Oversees financial management of program and/or grant funding following established institutional guidelines | 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 | X | X | X | ||||||
3.4F1 | Teaches nutrition and dietetics students/interns about personal health records, electronic records, and online access and how patients could use them | X | X | X | ||||||
3.4F2 | Reviews HIPAA rules with students/interns, including application to nutrition and dietetics practitioners when using protected health information in health care facilities, private practice, community settings, or through telehealth technologies used to communicate with patients/clients | X | 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 | Ensures students/interns understand:
| X | X | X | ||||||
3.5A2 | Assigns educational and/or research activities to students/interns consistent with his or her qualifications, experience, and competence | X | X | |||||||
3.5B | Supervises professional, technical, and support personnel | X | X | X | ||||||
3.5B1 | Provides relevant training and supervision of teaching assistant or administrative staff assisting with the nutrition and dietetics education program | X | X | X | ||||||
3.5B2 | Guides and monitors student/intern interactions with professional, technical, and support personnel | X | X | X | ||||||
3.5B3 | Ensures preceptors meet qualifications (eg, education and experience within their areas of practice) to provide appropriate guidance in supervised practice experiences | 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 | Communicates the need for food delivery systems to address health care needs and outcomes, ecological sustainability, and to meet the culture and related needs and preferences of target populations | X | X | 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 | Teaches students/interns to develop food and fluid items, menus, medical foods, and nutritional supplements that address health, nutritional, and cultural needs of populations | X | X | X | ||||||
3.6B2 | Incorporates activities reviewing regulations and evidence-based guidelines that impact development of menus for specific populations (eg, hospitals [adult, pediatric], long-term care settings, senior feeding programs, schools, child and adult care centers, corrections facilities) into didactic and supervised practice | 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 | Reviews interprofessional process used by health care settings to identify and manage nutrition-related product formularies and delivery systems (eg, group purchasing processes, role of Food and Nutrition and Pharmacy, budget responsibility, equipment [eg, infusion pumps, feeding tubes]; ordering, storage and distribution; and billing, if applicable) | X | X | |||||||
3.6C2 | Leads and educates students/interns on review process for choosing/maintaining nutrition-related product formularies and delivery systems | 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 | ||||||
3.7A1 | Orients students/interns to types of manual and electronic health record systems | X | X | X | ||||||
3.7A2 | Oversees management of records related to student/intern/human resources within the nutrition and dietetics education program | X | ||||||||
3.7B | Implements data management systems to support interoperable data collection, maintenance, and utilization | X | X | X | ||||||
3.7B1 | Develops and/or uses data collection tools for analyzing process, performance, and outcomes | X | X | |||||||
3.7B2 | Leads interprofessional collaborations to identify or develop tools to support education program data management | 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 | Tracks student/intern learning outcomes and competency achievement according to ACEND, institution, and department policy to support revision, as necessary, in course or supervised practice learning activities | X | X | X | ||||||
3.7C2 | Implements and manages information systems to track student/intern progress | X | X | |||||||
3.7D | Uses data to demonstrate program/service achievements and compliance with accreditation standards, laws, and regulations | X | X | X | ||||||
3.7D1 | Conducts data analysis, develops report of outcomes and improvement recommendations, and disseminates findings using informatics skills and knowledge | X | X | |||||||
3.7D2 | Directs collaborative process for preparing data and reports for program accreditation and site visits | 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 | Actively initiates and/or participates in public policy initiatives on a local, national, or international level to advocate for quality nutrition services | X | X | X | ||||||
3.8A2 | Guides and encourages students/interns to develop advocacy skills to effectively engage stakeholders, legislators, and decision makers; and to communicate succinct messages that inform and gain support for desired outcomes | 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 | Leads advocacy activities/policy initiatives, conducts research, authors’ articles, and delivers presentations on topic | X | 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; and participation in various Academy committees, workgroups and task forces, Dietetic Practice Groups, Member Interest Groups, and State Affiliates) | X | X | X | ||||||
3.8C1 | Routinely reviews federal and state legislation related to education and nutrition and dietetics practice to contribute and influence issues (eg, submits comments [e-mail, phone, letters] to lawmakers, attends town halls or committee hearings [eg, testify], and participates in Affiliate and Academy Public Policy Workshops) | 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 | Formulates research questions pertinent to nutrition and dietetics practice and education of nutrition and dietetics students/interns (eg, using the PICO [Population; Intervention/Indicator; Comparison; Outcome] approach) | X | X | X | ||||||
4.1C | Recognizes research ethics and utilizes responsible conduct in research | X | X | X | ||||||
4.1C1 | Participates as a member of an Institutional Review Board (IRB) to apply knowledge of research ethics on human subjects | X | X | |||||||
4.1D | Uses systematic methods to extract answers that are based on scientific evidence | X | X | X | ||||||
4.1E | Mentors RDNs and other health care professionals in developing skills in accessing and critically analyzing research and applying to practice | X | X | |||||||
4.1F | Develops evidence-based tools as a basis for stimulating awareness and integration of current evidence | X | ||||||||
4.2 | Uses best available research/evidence and information as the foundation for evidence-based practice | X | X | X | ||||||
4.2A | Demonstrates understanding of interpretation and application potential of primary peer-reviewed publications for education and uses evidence-based practice guidelines and related resources to guide education of nutrition and dietetics practitioners | X | X | X | ||||||
4.2B | Uses evidence-based practice and education research and other data to reduce variation in nutrition and dietetics education practice and for design of student/intern educational experiences | X | X | X | ||||||
4.2C | Applies evidence-based research to the design of primary, secondary, and tertiary disease prevention approaches | X | X | |||||||
4.2D | Provides leadership in the creation of nutrition and dietetics program benchmarks using evidence-based research in education | 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 | Translates research findings into the development of policies, procedures, content, and guidelines for education of nutrition and dietetics practitioners | X | X | |||||||
4.4 | Contributes to the development of new knowledge and research in nutrition and dietetics | X | X | X | ||||||
4.4A | Participates in research and scholarly activity g to acquire new knowledge (eg, journal clubs, Academy’s research workgroups)Scholarly activity: Scholarly activity is defined differently across institutions of higher education; for example, from http://www.fresnostate.edu/academics/facultyaffairs/documents/apm/325.pdf: 1) as a teacher-scholar strengthening and updating professional expertise for classroom instruction (Scholarship of Teaching); 2) as a scholar strengthening and broadening the faculty member’s scholarly and academic credentials (Scholarship of Discovery); 3) as a practitioner engaging in both theory and application (Scholarship of Application); and 4) as an integrated scholar placing specialties in a broader context (Scholarship of Integration). | X | X | X | ||||||
4.4B | Contributes to the development of new knowledge and research in education of nutrition and dietetics practitioners, and/or other areas of expertise | X | X | X | ||||||
4.4B1 | Participates in nutrition and dietetics education of practitioners research studies and/or other area(s) of research | X | X | X | ||||||
4.4B2 | Participates as a member of an editorial board on peer-reviewed journals | X | X | |||||||
4.4B3 | Serves as principal investigator in nutrition and dietetics education of practitioners research studies and/or other area(s) of research expertise | X | X | |||||||
4.4B4 | Publishes nutrition and dietetics education research studies and/or other area of research expertise in peer-reviewed journals | X | X | |||||||
4.4B5 | Leads nutrition and dietetics students/interns in conducting nutrition and dietetics research, including problem development, literature review, research methodology, data analysis, and preparation of final reports | X | ||||||||
4.4C | Uses educational exemplars to generate new knowledge and develop new guidelines, programs, and policies in nutrition and dietetics education | X | ||||||||
4.5 | Promotes application of research in practice through alliances or collaboration with food and nutrition and other professionals and organizations (eg, including other colleges and universities) | X | X | X | ||||||
4.5A | Participates in research-focused service opportunities (eg, member of committees, task forces) | X | X | X | ||||||
4.5B | Collaborates in practice-based research networks (eg, contributes to data collection for multi-institutional studies) | X | X | |||||||
4.5C | Develops service opportunities within partnerships to broaden research opportunities (eg, partnering in development of multi-institutional studies) | 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 (eg, students/interns, preceptors, future employers) | X | X | X | ||||||
5.1A1 | Documents interpretation of relevant information and results of communication with students/interns, preceptors, future employers, and other key stakeholders | X | X | X | ||||||
5.1B | Seeks current and relevant information related to nutrition and dietetics education practice | X | X | X | ||||||
5.1B1 | Attends/presents at conferences and meetings to share information in peer-reviewed forums | X | X | X | ||||||
5.1B2 | Builds relationships between researchers and decision makers so that effective knowledge transfer can take place | X | X | |||||||
5.1B3 | Provides commentary and analysis of relevant information | X | X | |||||||
5.1B4 | Presents information to establish collaborative practice at a systems level (eg, a student/intern learning outcomes assessment program) | 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 | Orients students/interns to guidelines for the appropriate use of social media and other electronic platforms in professional practice | X | X | X | ||||||
5.2A2 | Designs learning experiences for nutrition and dietetics students/interns to gain skills in verbal communication (ie, facilitated discussion, motivational interviewing, professional presentations) | X | X | X | ||||||
5.2A3 | Oversees development of marketing materials to promote nutrition and dietetics education program recruitment | X | X | |||||||
5.2A4 | Leads efforts for campus wide and/or community outreach activities that highlight department, program and/or student/intern accomplishments (eg, social marketing campaign initiative, with a community nutrition focus as part of an advanced practice residency competency) | X | ||||||||
5.2B | Uses information technology to communicate, disseminate, and manage knowledge, and support decision making | X | X | X | ||||||
5.2B1 | Incorporates use of information technology into educational programs and curricula | X | X | X | ||||||
5.2B1i | Explains and applies concepts of nutrition informatics (ie, the effective retrieval, organization, storage, and optimum use of information, data, practice simulation software, and knowledge for food- and nutrition-related problem solving and decision making) to nutrition and dietetics students/interns, program faculty, staff, preceptors, and other customers, as appropriate | X | X | |||||||
5.2B2 | Effectively uses administrative software applications and technology (ie, accounting, publications, project management) to manage department-level activities | X | X | |||||||
5.2B3 | Develops education tools using web-based and other technologies that use interoperability across different settings | X | X | |||||||
5.2B4 | Provides expertise in creating and using electronic and web-based technology specific to practice setting environment and need, using interoperability across different care settings | 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 | Demonstrates the ability to integrate new knowledge of nutrition and dietetics education practice in varied contexts (eg, different education environments, such as undergraduate/graduate, students, interns, preceptors, colleagues); seeks assistance if needed | X | X | X | ||||||
5.3B | Understands health, culture, social sciences, communications, sustainability, management, nutrition, and informatics, which is necessary for data collection, analysis, and application of new knowledge | X | 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 | Develops learning modules on nutrition and dietetics skills (eg, nutrition-focused physical exam, behavior counseling) and demonstrates techniques for nutrition and dietetics students/interns to model | X | 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 | Oversees supervised practice placement for nutrition and dietetics students/interns and assures supervised practice experiences meet the need of the student, preceptor, placement site, and nutrition and dietetics education program | X | X | |||||||
5.4B2 | Establishes and maintains administratively sound nutrition and dietetics education programs (eg, curricula in accordance with institution mission, ACEND standards, and nutrition and dietetics student/intern learning outcomes) | X | X | |||||||
5.4B3 | Leads efforts to identify and secure appropriate and available resources and services | X | ||||||||
5.4C | Uses professional writing and verbal skills in all types of communications | X | X | X | ||||||
5.4C1 | Understands and demonstrates ability to write scientific peer-reviewed papers, proposals, reports, and other documents and present in oral formats | X | X | |||||||
5.4D | Reflects knowledge of population characteristics in communication methods | X | X | X | ||||||
5.4E | Exhibits knowledge related to the profession of nutrition and dietetics, including nutrition and dietetics education | X | X | X | ||||||
5.4F | Serves as invited reviewer, author, and presenter at local and regional meetings and media outlets | X | X | |||||||
5.4G | Serves as invited reviewer, author, and/or presenter at national and international meetings and media outlets | X | ||||||||
5.5 | Establishes credibility and contributes as a food and nutrition resource within the interprofessional academic, health care, and management team, organization, and community | X | X | X | ||||||
5.5A | Serves on planning committees/task forces to conduct program review and/or develop/revise courses or supervised practice experiences | X | X | X | ||||||
5.5B | Uses habits of good interfacing (communication, information gathering, and practices) to lead in nutrition and dietetics education practice | X | X | X | ||||||
5.5C | Serves as author for articles for consumers and professional groups | X | X | X | ||||||
5.5D | Develops innovative approaches to practice issues | X | X | |||||||
5.5D1 | Develops an appropriate academic remediation process to support at-risk nutrition and dietetics students/interns | X | X | |||||||
5.5D2 | Designs educational programs with multiple entry/admission points to enhance recruitment of nontraditional nutrition and dietetics students/interns | X | ||||||||
5.6 | Communicates performance improvement and research results through publications and presentations | X | X | X | ||||||
5.6A | Presents nutrition and dietetics practice and education research activities and results at the local level (eg, department meetings) | X | X | X | ||||||
5.6B | Presents innovations in nutrition and dietetics practice, education, and other research findings at the regional and national level, including, but not limited to, nutrition and dietetics meetings as well as scientific, academic, or professional conferences and practice forums (eg, Nutrition and Dietetics Educators and Preceptors [NDEP] meetings; Academy of Nutrition and Dietetics annual Food & Nutrition Conference & Expo, National Kidney Foundation, American Heart Association, American Diabetes Association) | X | X | |||||||
5.6C | Publishes nutrition and dietetics practice, education, and other research activities and results (eg, NDEP newsletter, education journals, and other peer-reviewed journals) | X | X | |||||||
5.6D | Provides leadership for content development of education-focused publications and national meetings | X | ||||||||
5.6E | Serves as an author of education-related publications and presenter for colleagues, preceptors, and future employers on topics related to educational theories and nutrition and dietetics practice | X | ||||||||
5.6F | Serves in leadership role for publications (ie, editor, editorial advisory board) and program planning committees | 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 nonprofit organizations serving the food insecure) providing food and nutrition expertise | X | X | X | ||||||
5.7A | Participates in associations related to nutrition and dietetics education planning, delivery, and evaluation with stakeholders | X | X | X | ||||||
5.7B | Seeks opportunities to share best practices related to nutrition and dietetics education planning, delivery, and evaluation with stakeholders | X | X | X | ||||||
5.7C | Serves as consultant and/or opinion leader to health care providers, business, industry, public, the Academy of Nutrition and Dietetics, and other national organizations regarding education needs of health care practitioners | X | X | |||||||
Examples of Outcomes for Standard 5: Communication and Application of Knowledge
| ||||||||||
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, and 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 | Follows the current ACEND Accreditation Standards for Nutrition and Dietetics Education Programs to guide planning, implementation, and evaluation of nutrition and dietetics education | X | X | |||||||
6.1B | Conducts a budget analysis to insure there are sufficient financial resources to meet goals and improve outcomes | X | X | |||||||
6.1C | Creates, maintains, and reports on department and/or program budget, keeping in mind organizational mission and vision and education needs of students/interns | X | X | |||||||
6.2 | Evaluates management of resources with the use of standardized performance measures and benchmarking as applicable (eg, documents use of measurable resources, such as personnel, monies, equipment, reference materials, and time in the provision of nutrition and dietetics education) | 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 | Participates in strategic and operational planning of education programming | X | X | |||||||
6.2C | Manages effective delivery of educational programs | X | X | |||||||
6.2D | Integrates program outcome evaluation into institutional planning and assessment | X | ||||||||
6.3 | Evaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and products (eg, student/intern educational courses and practice activities) | X | X | X | ||||||
6.4 | Participates in quality assurance and performance improvement and documents outcomes and best practices relative to resource management | X | X | X | ||||||
6.4A | Participates in data collection, collation, summarization, distribution, and/or reporting on findings; proposes possible resolution(s) to identified area(s) of concern to improve and/or maintain desired outcome(s) | X | X | X | ||||||
6.4B | Proactively recognizes needs, anticipates outcomes and consequences of different approaches, and makes necessary modifications to plans/services/programs to achieve desired outcomes | X | X | |||||||
6.4C | Engages in continuous quality improvement through the process of program outcomes assessment | X | X | |||||||
6.4D | Effects long-term thinking and planning; anticipates needs; fully understands strategic and operational plans and student/intern learning outcomes; and integrates justification into plans | X | ||||||||
6.5 | Measures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators) | X | X | X | ||||||
6.5A | Conducts surveys with students, interns, faculty, and preceptors to assess key stakeholder satisfaction | X | X | X | ||||||
6.5B | Identifies and develops a plan to address internal and external problems that may affect delivery of educational programs | X | X | |||||||
6.5C | Resolves internal and external problems that may affect delivery of educational programs | X | ||||||||
Examples of Outcomes for Standard 6: Utilization and Management of Resources
|
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. 183, 10-12-18); §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 November 19, 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. 183, 10-12-18); §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 November 19, 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. 183, 10-12-18); § 485.635(a)(3)(vii) Dietary Services; § 458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed November 19, 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 November 19, 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 November 19, 2018.
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Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.