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Regulation Matters 2019 - Issue 1

Do dietitians need a co-signature or medical directive to implement a diet order for residents in a LTC home?

Professional Practice Question

The Long-Term Care Homes Act, 2007, does not require an order for diets in long-term care (LTC) homes, but dietitians should consult their organizational policies.
UNDERSTAND LEGISLATION AND POLICIES GOVERNING YOUR PRACTICE AREA
In many workplaces, dietitians recommend diets and set nutrition treatment plans based on a complete assessment of a client’s nutritional status and need. It is well within the dietetic scope of practice to do this unless legislation specific to work settings or employer policies state otherwise. For example, in public hospitals, under the Public Hospitals Act, 1990, only physicians, nurse practitioners, dentists or midwives may order diagnostic and treatment procedures, unless authority mechanisms are in place. As such, in public hospital settings, dietitians may only order nutritional treatment through a direct order from an authorized provider or via medical directives.

Although the Long-Term Care Homes Act, 2007, has no restrictions on ordering treatment or requiring co-signatures for implementing diet orders, oral energy supplements (e.g. Ensure), or vitamins and minerals, a LTC home may have an organizational policy that states otherwise.
LTC HOMES HAVE THE RIGHT TO IMPOSE LIMITATIONS
Facilities have the right to impose limitations on what their staff does. If a Dietitian is associated with a LTC facility, they should follow all organizational protocols. If there are no specific policies prohibiting Dietitians from writing and implementing diet orders in LTC, then a Dietitian may do so under the dietetic scope of practice. Consulting facility policies, collaborating and providing education to fellow colleagues on the dietetic scope of practice helps to ensure effective and efficient resident care and risk management.

For any further questions or concerns, please don’t hesitate to contact us.

Practice Advisory Service: practice.advisor@collegeofdietitians.org
416-598-1725; 1-800-668-4990 ext. 397