Regulation Matters 2019 - Issue 3

Quality Assurance: Addressing Risk in Practice

The College has focused on strategies for mitigating risk of harm in dietetic practice for several years now. The Quality  Assurance  Program is an important part of this work.

The College defines risk of harm as the potential for an event, action or inaction to cause harm to clients. The harm can be intended or unintended, and can stem from factors such as:
  1. Personal circumstances, such as a dietitian’s lack of knowledge, skills and judgement, or feeling highly stressed.

  2. The work context, such as issues with co-workers, challenging interprofessional dynamics, heavy workloads and a lack of resources.

  3. The environment and system limitations, such as outdated dietetic standards, increased client quotas and lack of funding.

The SDL Tool: An Important Public Protection Piece

The Self-Directed Learning (SDL) Tool provides dietitians with an opportunity to reflect on their practice every year when they complete their registration renewal. In 2015, a section was added to the SDL Tool to guide dietitians in their reflection about risk in their practice. Dietitians are asked to consider a high-risk area in their practice and, once they have identified the risk, they are asked to answer the two questions below to address it. Note that the questions focus on the factors stated above: personal circumstances, work context and environment.
SDL Tool Risk Questions

Question 1. Which aspect of your personal competency if developed would help mitigate this risk? Choose all that apply:

a) Knowledge, skill or judgment
b) Interprofessional collaboration, communication
c) Policy development, organizational management, leadership
d) Other (please describe)

Question 2. Will at least one of your learning goals relate to areas identified above

Yes / No

High Risk Practice and Knowledge

The 2019 SDL Tool results show that 97% of dietitians chose to write a goal related to risk in their practice. Of those, 80%  identified knowledge, skill or judgment as the area that they would need to improve to mitigate the risk.

Most of these goals relate to one of the three high-risk practice areas identified in the 2014 College risk survey:
  1. Nutrition Support -- Parenteral and Enteral Nutrition;
  2. Swallow Assessments and Dysphagia Management; and
  3. Diabetes Management


Developing goals to address risks in dietetic practice can decrease potential harm to clients. This is an important public protection piece for self-regulation. 

The  Framework for Managing Risks in Dietetic Practice (2014) is another important tool designed by the College to help dietitians assess risk of harm in their practice. It can be used in conjunction with the SDL Tool.

What happens with the risk information collected from the SDL Tool?


The Practice Advisory Program reviews the data from the risk questions in aggregate form to confirm the risk areas identified in the research. The data collected from the SDL Tool also points to other risk areas. This information is used by the College to develop policies, standards and other resources to support safe dietetic practice.

SDL Tool Audit

Each year, the Quality Assurance Program randomly screens 2.5% of the SDL Tools to make sure that they are complete and that their learning  goals are SMART (Specific, Measurable, Achievable, Realistic and Timely). The SDL Tools with goals that do not meet the requirements are referred to the Quality Assurance Committee. 

SDL Tool Audit Results for 2018-19

  SDL Tools Reviewed   237 
  Resubmission of SDL Tool Required   114 (48%)
  RD Must Attend Mandatory SMART Goals Webinar   42 (3%)