1. College of Dietitians of British Columbia An Overview of Registrants’ Comments on Roles and Scope of Practice Fern Hubbard, Registrar

2. Introduction Overview and background Role/scope comments Specific concerns/issues Fundamentals for practice Miscellaneous “Delegation” and “transfer of function” Responsibility and liability Next steps Bottom Line Outline

3. Since June: Ministry of Health College of Pharmacists College of Physicians and Surgeons 5 registrant sessions - 32 cities/towns 133 individuals: - 130 RDs, 2 interns,1 hospital administrator Overview & Background

4. Masset Terrace Smithers Fort St. John Revelstoke Fernie Cranton Trail Chase/ Salmon Arm Oliver Penticton Merritt Port Hardy Campbell River Port Alberni Burnaby/ New West Chiliwack White Rock Langley/ Ridge Meadows Duncan Nanaimo Courtenay

5. Conversations on Health: “Primary Care” (2007) on health care system changes desired by the public… “…physicians… could not do it without support from nurses, dietitians and social workers.” on the need for collaborative practice… “…There is no way one person [the doctor] can posses all the knowledge required to act as a psychologist, dietitian, kinesiologist…” Overview & Background

7. Healthcare Evolution Physician centered care Patient centered care

8. Comments to date: Urban practice differs from rural Four groups of dietetic practice concerns: 1. Perceived barriers – public domain practice 2. Within RD role/scope of practice 3.“Grey” areas – require inter-professional agreements 4. Professional association matters – to DC Overview & Background

9. Are you ready for the future ?

10. Role/scope Comments – Specific Issues 1. Perceived barriers –Public domain practices –No regulatory barriers Examples: Finger pricks Blood pressure

11. Specific Concerns/Issues 2. Practices within RD role/scope of practice – may be defined (and restricted) in facility policies Examples: dysphagia assessment ordering lab tests for dietetic assessment writing on “doctor’s orders” part of the patient record taking verbal and telephone orders for dietetic practice

12. Specific Concerns/Issues 3. “Grey” areas –within the RD role/scope of practice –require inter-professional agreements for clarity, consistency and transparency Examples: recommending an adjustment from a previously established insulin dose hospital pharmacists accepting recommendations directly from RDs to adjust previously established enteral/parenteral and renal formulas

13. Specific Concerns/Issues Dietitians Regulation – Reserved Acts (Restricted Acts – HPA amendments) …a registrant who meets additional qualifications… may… (b) design therapeutic diets if nutrition is administered through parenteral means.

14. Specific Concerns/Issues Drug Schedules Regulation Schedule I – Prescription –includes vitamins for parenteral use Schedule IA - Controlled Prescription Program Schedule II – Professional Service Area –non-prescription; held behind the counter Schedule III – Professional Products Area –non-prescription; self-selection Schedule IV – Prescription by Pharmacist Non-scheduled www.bcpharmacists.org

15. Specific Concerns/Issues 4. Professional association matters – referred to DC Examples: salaries/wages – amount and consistency number of RDs in the workforce number of RD positions, particularly in long term care professional development time and money

16. Fundamentals for Practice Inter-professional Consultation Notification Documentation Informed Consent Communication Appropriate Services Dietitian’s Individual Competence

17. Miscellaneous “Delegation” and “transfer of function” not in current legislation (except for the insertion of feeding tubes) a term in previous legislation that no longer applies to dietitians

18. Miscellaneous Responsibility and liability Registered Dietitians are responsible and legally liable for all services provided

19. Next Steps… More consultations: Registrants Health Authorities Educators Employers Regulatory bodies CDBC Board Government

20. Summary Scope of practice  competence to practice Practice competently, ethically and safely in the public’s interest

21. Bottom Line If it’s working, and you’re meeting competence principles, keep doing what you’re doing.

22. Questions Fern Hubbard, Registrar College of Dietitians of BC Phone: 604.736.2016 Toll free in BC: 1.877.736.2016 info@collegeofdietitiansbc.org