342

Part III Standards for Compliance

Using the tool will help the RDN and NDTR determine whether or not the activity is within his or her individual scope of practice. If it is not, the tool suggests alternatives for consideration:

●

Seek options for RDN activity to be included in extended care medical staff bylaws or organiza- tion policies and procedures.

●

Seek options for attaining the knowledge, skills, and competence to perform this activity.

●

Continue through the decision analysis process using the online tool to determine whether the activity could be within the RDN or NDTR scope of practice (20).

To actually perform the activity, the RDN and NDTR would need to obtain the necessary education, training, and credential, if needed, along with demon- strating and documenting competence in practice. As the RDN and NDTR continue through the tool, answering all pertinent questions about the activity, he or she may find the activity is within his or her scope of practice for the extended care settings. The tool pro- vides further guidance before performing the activity:

●

Ensure that this activity is included in the RDN or NDTR job description for the extended care setting.

●

Ensure that the RDN or NDTR personnel file con- tains documentation of education, training, cre- dentials, if applicable, and competence.

●

Consult the Academy Definition of Terms list in performing this activity (1).

●

Investigate your organization’s liability insurance coverage and need for additional personal liability insurance if the RDN is in a consultation business practice and is granted ordering privileges per the extended care setting organization.

The tool is a great self-assessment device for gauging an RDN’s or NDTR’s level of knowledge, skill, and involved judgment. Take time to reflect when choosing career options, expanded scope of practice, and enhancement services provided in long-term care (20). The RDN must take an active role to ensure that he or she follows “right” guidelines when caring for the older adult—remember to provide the right per- son-centered safe care, using the right efficient deliv- ery, at the right cost-effective price, with the right equitable quality, and at the right time.

STANDARDS OF PRACTICE AND STANDARDS OF PROFESSIONAL PERFORMANCE FOR REGISTERED DIETITIAN NUTRITIONISTS IN

EXTENDED CARE SETTINGS Standards of Practice (SOP) relate directly to client/ patient/resident/customer care and correlate to the Nutrition Care Process (NCP) steps: nutrition assess- ment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation. The Standards of Professional Performance (SOPP) represent six domains of professionalism: quality in practice, com- petence and accountability, provision of services, application of research, communication and application of knowledge, and utilization and management of resources (21). The SOP and SOPP are companion documents for RDN use in self-evaluation. They are to be utilized as part of the Commission on Dietetic Registration’s Professional Development Portfolio and selection of individualized Practice Competencies to develop goals and to focus continuing education efforts. The standards are not regulations. They are consensus standards. Consensus is group opinion based on expert knowledge and experience (21). The SOP and SOPP in Extended Care Settings are RDN-specific guides for self-assessing skills, main- taining currency, and expanding practice within this focus area. The companion documents are a means of identifying areas for professional development and demonstrating competence in delivering nutrition care services to the older adult. If this is a new focus area for an RDN, he or she may use the SOP and SOPP in Extended Care Settings to assist in transitioning his or her knowledge and skills. An emphasis on using the standards needs to be stressed in this practice area. Business contracting and independent consulting in nutrition care of the older adult specialty is not an easy venture. It must be done to ensure that all essential parts are understood by the RDN, with an emphasis on management and leadership skill sets, awareness of regulations impacting practice (22), and field expertise in older adult nutrition and dietetics care. In the article entitled “American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Extended Care Settings,” Figure 5 delineates practice role examples in clinical, home health, management, and research using the quality and performance indicators. Each of these roles is further defined and characterized between the three levels of practice: competent, proficient, and expert (23). The article (specifically Figure 1) reviews