PandemicFAQs

1. Where can I get more information about the coronavirus pandemic?

Dietitians can consult their employer’s organizational protocol for operating during a pandemic. Dietitians, including those who are employers can also keep informed with daily updates from the Ministry of Health and Ministry of Long-Term Care and Public Health Ontario

The  guidance for the health sector(i.e. Acute Care, Primary Care, Home & Community Care and Long-Term Care Settings) provides important updates for health workers and health sector employees. A Healthcare Provider Hotline is also available for more information 1-866-212-2272 (toll-free).

On March 21, 2020, the order made under the Emergency Management and Civil Protection Act states that health service providers are authorized to take, with respect to work deployment and staffing, any reasonably necessary measure to respond to, prevent and alleviate the outbreak of the coronavirus (COVID-19) for patients. This means that Health Service Providers have the authority to identify staff priorities and develop, modify and implement redeployment plans including the following:

  1. redeploying staff within different locations in (or between) facilities of the particular Health Service Provider;
  2. redeploying staff to work in COVID-19 Assessment Centres;
  3. changing the assignment of work, including assigning non-bargaining unit employees or contractors to perform bargaining unit work;
  4. changing the scheduling of work or shift assignments;
  5. deferring or cancelling vacations, absences or other leaves, regardless of whether such vacations, absences or leaves are established by statute, regulation, agreement or otherwise;
  6. employing extra part-time or temporary staff or contractors, including for the purposes of performing bargaining unit work;  
  7. using volunteers to perform work, including to perform bargaining unit work; and
  8. providing appropriate training or education as needed to staff and volunteers to achieve the purposes of a redeployment plan.

 Dietitians should work with their manager and organization, if they are redeployed to ensure the following:

  • they have the necessary knowledge and skill required (or receive necessary training) to work in any new capacity
  • infection prevention and control measures are taken for patient safety and dietitian safety as per the Ministry of Health’s guidelines/organization guidelines  
  • when completing tasks beyond scope of practice under another health care professional’s supervision, consider the Role & Task Framework and the Delegation Standard and document in the health records, as required
  • when completing other tasks, e.g., tasks related to COVID-19 screening, document as per the employer’s directions
  • appropriate liability insurance is in place in the expanded role and responsibilities performed  
  • Dietitians only perform controlled acts if delegated by a health professional who has the authority to delegate the specific controlled act(s).  See Delegation Standard.

In these extraordinary times, thank you for providing these vital services to Ontarians. You and your colleagues are valued and appreciated in stepping up and filling the need for additional support.

2. Will my obligations and accountabilities change if caring for clients diagnosed with (or suspected of having) COVID-19?

Dietitians’ obligations and accountabilities do not change, and they have a fundamental responsibility to act in an ethical manner. Dietitians are accountable to all the standards of practice. Key resources to keep in mind are the Code of Ethics and the Collaborative Care Guidelines. Dietitians must use professional judgement to make decisions in the best interests of their clients.

3. How can dietitians remain aware of infection risks?

Dietitians must remain conscious of the need to be risk-aware and to identify any potential type of harm when practicing dietetics, including infection risks, as applicable.  Dietitians can become aware of infection risks by:

  • Applying proper hand hygiene principles;
  • Wearing personal protective equipment, as appropriate to prevent and control the transmission or spread of infection
  • Developing and ensuring appropriate protocols are in place and where applicable, collaborating within teams and working with your employer to review organizational policies;
  • Using evidence-based decision making to inform practice;
  • Understanding and following workplace organizational policies about infection prevention and control; and
  • Being aware of  precautionary measures to minimize the risk of infecting themselves, colleagues, clients and others as described on the  Public Health Ontario’s Coronavirus information page.

4. Can I refuse to provide dietetic services with an infected client?

There are two possible scenarios a dietitian may face regarding refusing work during the pandemic:
 
  1. A dietitian is concerned about their own health and safety and/or 
  2. A dietitian is concerned they do not have the knowledge, skill, or judgment to do a task that may be out of their professional and/or individual scope. 

And, there are no simple answers to these scenarios. 
 
Decisions will vary depending on work context and circumstances. As a regulated health professional, dietitians have an obligation to provide the best possible care and find solutions for the client’s best interest. Refusing work assignments can be problematic if not addressed appropriately. 
 
We are providing some guiding questions for dietitians to consider when faced with the scenarios above. The list of questions is not intended to be exhaustive.
 
Concern about health and safety 
 
  1. Have I reviewed organizational policies; Public Health Ontario/Ministry guidelines related to infection control? 
     
  2. If I have concerns, have I consulted with my employer about my specific concern? 
     
  3. Have I considered the Occupational Health and Safety Act ? This act includes provisions that permit an individual to refuse to work related to unsafe equipment or work environments. However, the legislation goes on to explain that the “refusal to work” provision does not apply where the circumstances related to risk is inherent in the worker’s job; or where the worker’s refusal to work would directly endanger the life, health, or safety of another person.
     
Ask yourself
  • Is the risk inherent in my job?
  • Is there an unacceptable risk to my health and safety?
  • If I refuse this work, would it endanger the life, health, or safety of another person? 
Additional supports can be found through your organization’s Human Resources Department, the Ministry of Health’s Healthcare Provider Hotline 1-866-212-2272, the Ministry of Labour or by consulting a lawyer versed in employment law.
 
Concern about lack of competence (knowledge, skill, judgment)  
 
  1. Have I reviewed the Role and Task Framework? This provides guidance when facing new tasks in practice. 
     
  2. If I do not have the necessary knowledge, skill, and judgment to perform the assignment, how can I acquire the competence? Have I worked with my employer to find a solution?
     
  3. Have I reached out to a mentor for assistance? 
     
  4. Have I reviewed or discussed with my employer any relevant organizational policies and protocols related to client prioritization, staffing and/or workload to help find a solution for safe, competent, ethical care?
 
We know that dietitians are dealing with evolving issues during this pandemic. The reality is that each dietitian must make decisions using principles in the Code of Ethics, employing reflective practice and good professional judgment with interprofessional collaboration

5. Can my employer direct me to do other tasks (e.g. outside of dietetic scope) during a pandemic?

There are no simple answers to this question. During an infectious disease outbreak, demands for care may result in health care providers being asked to perform other tasks in their organization. In some cases, dietitians may be asked to provide care in an area of dietetic practice they do not commonly work in, or to assist in area that is outside of the dietetic scope of practice. 

Individual circumstances will vary depending on the practice setting and nature of professional practice. Consider your personal competence (knowledge and skill). The College’s Role and Task Framework may be helpful when considering opportunities for assuming new tasks, roles,  and responsibilities during a pandemic. 

Example: How to Use the Role and Task Framework to Perform a Temperature Screen 

a. Is the new task or role within the dietetic scope of practice?

Temperature checks can be within dietetic scope of practice when it is being measured as part of a nutrition assessment (i.e. the assessment of fluid status, consideration of energy requirements/stress factor assessment). However, if the RD is taking temperature checks for circumstances that do not relate to their nutrition care plan, e.g. for purposes of routine screening, an organization would need to determine if this is considered a diagnostic procedure/treatment. Depending on how the temperature check is being used and the practice setting, different circumstances may apply.

b. Are there any legal barriers restricting an RD from performing the task (e.g., performing a Controlled Act)? For example, would an authority mechanism be needed for an RD to perform the task?

Temperature checks are not a controlled act. If an organization determines that temperature checks are screening and not diagnostic procedures/treatment, authority mechanisms would not be required to permit dietitians to perform temperature checks. If deemed a diagnostic procedure/treatment, dietitians may be delegated to perform the task as necessary per the applicable legislation (i.e. in a public hospital).

c. Do I have the required skills and competence to perform the new task? If not, how can I obtain what is necessary to become competent?

Dietitians would need to have the appropriate skills and competence to perform temperature checks. Dietitians could be easily trained by a colleague on how to use the thermometer and how to perform a reading. 

It would also be important for dietitians to be trained on the steps involved in the screening and to know the protocol to follow depending on the temperature reading result.

Dietitians will also need to be careful to avoid violating the controlled act of communicating a diagnosis. Dietitians may indicate that the temperature is elevated, but they are not permitted to label it as a clear medical diagnosis.

d. What are the interprofessional care team possibilities? Given all of the local circumstances, who is the most appropriate person(s) to perform the task (e.g., an RD, or another health care provider/team member, or both)?

 Dietitians performing temperature checks may be helpful in some circumstances. This may reduce the pressure and demand on the health care system as the pandemic evolves. Dietitians are asked to use their professional judgement and continue to seek direction from their employer.  

6. What are my accountabilities as a dietitian manager during a pandemic?

Employers are responsible for establishing a safe work environment that supports safe and effective client care. This includes appropriate staffing coverage, infection control measures and personal protective equipment, as applicable including proper training and fitting. Access and share up to date, evidence-based information with your staff.  Provide staff with clear policies, as required.
 
Act when client care may be compromised. This includes identifying strategies to prepare for, reduce and resolve situations that may leave clients without the dietetic services needed.

To ensure a safe environment, consider the following questions:

  1. Have you employed strategies to prioritize client care needs?
  2. Have you explored concerns with staff and communicated your organization’s plan to address these concerns?
  3. Have you included front line staff in the creation and implementation of strategies?
  4. Is there a readily available system for replacement staff?
  5. Are strategies in place to facilitate the reorganization of workload, if needed?
  6. Are there clear policies and lines of communication for dietitians to follow when staffing is short?
  7. Do staff have the necessary competence (knowledge, skill and judgment) to complete the task? If not, what additional training is needed?
  8. Have I provided my staff with relevant training/upskilling based on best practice and evidence?

7. What are the responsibilities for private practice dietitians?


Effective May 26, 2020, the Chief Medical Officer of Health has amended Directive #2, which allows dietitians to gradually resume, “All deferred and non-essential and elective services”. This refers to both virtual care and in-person visits.

What does this mean for private practice dietitians returning to non-essential and elective services, both in- person and virtually?

This directive does not mean that dietitians may return to non-essential in-person practice as they did before the pandemic. The return to non-essential care for both virtual and in-person care is intended to be gradual and with stringent conditions in place to mitigate the spread of disease. You must adjust your practice according to Directive #2 and the Ministry’s COVID-19 Operational Requirements: Health Sector Restart, which specify:

Wherever feasible, client visits must be conducted virtually. Dietitians are urged to use professional judgement in determining which clients can be treated virtually and, if not feasible, which could be seen in-person.
  • You must have in place strict protocols, as required, around risk assessments, including an organizational risk assessment and a point of care risk assessment as per the Ministry of Health’s direction COVID-19 Operational Requirements Health Sector Restart. In addition, hierarchy of hazard controls, infection prevention and control, screening, personal protective equipment, and client scheduling to ensure physical distancing and safe care.
  • Decisions about client visits must be in keeping with the principles set out in Directive #2: Proportionality; Minimizing Harm to Patients; Equity; and Reciprocity.

What Should Dietitians Know

As you gradually resume non-essential virtual and in-person care, you must adhere to the measures outlined in the documents below. Please read them carefully. Note that guidance may change overtime. Check the College’s website frequently for updated information.

If you provide virtual care:

  • Consider working by phone or other technologies
  • Confirm that your professional liability insurance covers you for virtual practice. Ensure your billing is transparent and your invoice indicates that you provided the service remotely.
  • If providing care to a client outside of Ontario, contact the regulatory body in the jurisdiction where the client is located to confirm the requirements during this time. While circumstances may change during a pandemic, we cannot speak for other jurisdictions. 
For additional information, please see the article on Telephone and Web-Based CounsellingSocial Media and Dietetic PracticeProfessional Communications Online and on Social Media, FAQs #8-10 and #18-19 for guidance.  Please contact the Practice Advisors for additional assistance.

8. When working remotely, how do I obtain consent via phone/web?


A dietitian’s professional obligations are the same for services delivered in-person or via virtual practice. This includes obligations for consent and others (i.e. documentation, access to records, privacy, confidentiality, security and retention of records. Please refer to Telephone/Web-Based Counselling and to Professional Communications Online and on Social Media).
 
With regards to obtaining consent for virtual practice (telephone or web), here are a few considerations:

9. What are the requirements for health care providers (regulated health professionals or persons who operate a group practice of regulated health professionals)?


As per the Ministry of Health, COVID-19 Directive #2 Revised May 26, 2020 under Section 77.7 of the Health Protection and Promotion Act (HPPA), R.S.O. 1990, c. H.7 the following steps are required immediately:

  1. All deferred and non-essential and elective services carried out by Health Care Providers may be gradually restarted, subject to the requirements of the Directive.
  2. In the gradual restart of services, Health Care Providers must comply with the requirements as set out in COVID-19 Operational Requirements: Health Sector Restart (May 26, 2020 or as current), including, but not limited to, the hierarchy of hazard controls.
  3. Health Care Providers must consider which services should continue to be provided remotely and which services can safely resume in-person with appropriate hazard controls and sufficient PPE.
  4. Health Care Providers should be sourcing PPE through their regular supply chain. PPE allocations from the provincial pandemic stockpile will continue. PPE can also be accessed, within available supply, on an emergency basis through the established escalation process through the Ontario Health Regions.
  5. Subject to the requirements of this Directive, Health Care Providers are in the best position to determine which services should continue to be provided remotely (online, by telephone or other virtual means) and which should be provided in-person. This should be guided by best clinical evidence. Health Care Providers must also adhere to the guidance provided by their applicable health regulatory college, and the following principles:
    • Proportionality. Decision to restart services should be proportionate to the real or anticipated capacities to provide those services.
    • Minimizing Harm to Patients. Decisions should strive to limit harm to patients wherever possible. Activities that have higher implications for morbidity/mortality if delayed too long should be prioritized over those with fewer implications for morbidity/mortality if delayed too long. This requires considering the differential benefits and burdens to patients and patient populations as well as available alternatives to relieve pain and suffering.
    • Equity. Equity requires that all persons with the same clinical needs should be treated in the same way unless relevant differences exist (e.g., different levels of clinical urgency), and that special attention is paid to actions that might further disadvantage the already disadvantaged or vulnerable.
    • Reciprocity. Certain patients and patient populations will be particularly burdened as a result of our health system’s limited capacity to restart services. Consequently, our health system has a reciprocal obligation to ensure that those who continue to be burdened have their health monitored, receive appropriate care, and be re-evaluated for emergent activities should they require them. Decisions regarding the gradual restart of services should be made using processes that are fair to all patients.

10. What does “return to non-essential services with conditions” mean?


With the amendments to Directive #2, dietitians can gradually resume all deferred non-essential service if they are prepared. This means that your practice will not be the same as it was before the pandemic, as now is to have stringent conditions in place to mitigate the spread of disease. You must adjust your practice according to Directive #2 and the Ministry’s COVID-19 Operational Requirements: Health Sector Restart, which specify:

Wherever feasible, client visits must be conducted virtually. Dietitians are urged to use professional judgement in determining which clients can be treated virtually and, if not feasible, which could be seen in-person.

You must have in place strict protocols, as required, around risk assessments, including an organizational risk assessment and a point of care risk assessment as per the Ministry of Health’s direction COVID-19 Operational Requirements Health Sector Restart. In addition, hierarchy of hazard controls, infection prevention and control, screening, personal protective equipment, and client scheduling to ensure physical distancing and safe care.

Decisions about client visits must be in keeping with the principles set out in Directive #2: Proportionality; Minimizing Harm to Patients; Equity; and Reciprocity. The principles for prioritizing client need and risk of harm, described below, will help you assess the essential from non-essential services for your clients.

Four Principles for Prioritizing Client Needs

  1. Proportionality: the decision to eliminate non-essential services should be proportionate to the real or anticipated limitations in capacity to provide those services,
  2. Minimizing Harm to Clients/Patients: refers to minimizing harm to clients/populations, considering benefits and available alternatives to relieve pain and suffering,
  3. Equity: requires that all persons be treated in the same way, and
  4. Reciprocity: certain individual clients/patients and client/patient populations will be particularly burdened because of cancelling non-essential services. 

Services should be provided virtually whenever possible.

This includes essential services that are currently being provided as well as non-essential services that have been deferred.

In-person services must only proceed when virtual service is not feasible and the anticipated benefits of such in-person services outweigh the risks to the client and the dietitian. Just because a dietitian can provide in-person service does not mean they should.

Ask yourself – Can I safely provide care and how?

Dietitians should remain aware and keep updated as guidance may change. This information may be updated periodically as Ontario progresses through each phase of its recovery, and as new guidance or recommendations a are made by the provincial government. Dietitians should regularly check for updates.

Consider Risk of Harm and Hierarchy of Hazards

It is a requirement that dietitians conduct risk assessments of their practice including an organizational risk assessment and a point of care risk assessment as per the Ministry of Health’s direction COVID-19 Operational Requirements Health Sector Restart.

Dietitians need to apply the hierarchy of hazard controls as per the Ministry of Health’s guidance COVID-19 Operational Requirements Health Sector Restart.

Step 1 - Elimination and Substitution

Consider virtual practice first to eliminate risk. Can your service be provided virtually? Use your professional judgment.

Step 2 - Engineering and System Control Measures

If you must provide in-person service, plan your physical environment to reduce exposure for clients and staff (e.g. maintain physical distancing, consider plexiglass barriers, etc.).

Step 3 - Administrative Control Measures

If you must provide in-person service, implement policies, procedures, training, and education with respect to infection prevention and control (IPAC).

Step 4 - Personal Protective Equipment (PPE)

Dietitians can only provide in-person service, if they have the appropriate PPE for the task, along with necessary education and training. Dietitians can source PPE through their regular supply chain or establish one.

For PPE suppliers see Workplace PPE Supplier Directory. Public Health Ontario has a document that provides recommendations on the use of PPE for suspected or confirmed COVID-19 cases.
 
For more details, dietitians may find The Framework for Identifying and Managing Risk in Dietetics helpful when prioritizing essential versus non-essential services. s
 
Other helpful resources include the Collaborative Care Professional Practice Guidelines and the Code of Ethics for Dietitians in Ontario.
 
For questions, please feel free to contact the College’s Practice Advisory Service
practiceadvisor@collegeofdietitians.org
416-598-1725 / 1-800-668-4990, ext. 397

11. What is virtual home care during COVID-19?

The Ministry recently amended O. Reg. 386/99 under the Home Care and Community Services Act (HCCSA), 1994 to clarity that professional services, including dietetics may be provided virtually. 
These recommendations apply to all professional services, including nursing, physiotherapy, occupational therapy, dietetics, and social work.

Local Health Integration Networks (LHINs) have been directed by the Ministry to scale up existing, proven virtual care models where they exist, and consider other models as appropriate. Professional services defined under HCCSA are eligible for immediate deployment of virtually delivered care as per the Ministry. 

For guidance on expansion of virtual health delivery during COVID – 19, please see COVID-19 Directive #2 Issued March 19, 2020
 
What is included in virtual care

Virtual care delivery includes the meaningful communication of a patient’s health status and/or the treatment/intervention needed to support their care needs via: 

  • Phone calls
  • Video conferencing
  • Secure messaging
  • Remote monitoring 

Eligible virtual delivery includes:

  • Wellness and health checks, including monitoring of conditions/symptoms
  • Remote clinical consultation or intervention related to client care plan goals
  • Support for assessment and reassessment of treatment plan 
  • Videoconferencing for visual assessments
  • Caregiver education/training to support patient care and/or self-isolation efforts
  • Patient education/training related to care
  • Complement essential hands-on care
  • Replacing in-person care when a physical visit isn’t possible, or necessary
  • Any other service aligned with the goals of this guidance and approved by the LHIN or approved agency

Virtual delivery does not include practices that are normally conducted virtually as part of regular home care, such as scheduling and case management or issues management calls with patients and caregivers.

Technology, Privacy and Consent
When implementing virtual care in home and community care dietitians should consider use of technology, privacy and consent:

Technology
Dietitians should work with their employers who may leverage existing virtual care technologies, including the secure videoconferencing tools provided through the Ontario Telemedicine Network (OTN) to support virtually delivered care. Patients and caregivers will work with their care providers to determine whether they may leverage patient-owned devices to support virtual care. LHINs, approved agencies and provider partners may review the Digital Health Playbook for guidance on the use of technologies to support virtual care and further guidance on technology standards for virtual visit solutions will be available on OTN’s website.   

Privacy and Consent
 Like all home and community care services, virtual delivery must continue to comply with consent and privacy requirements outlined in the Personal Health Information Protection Act, 2004 (PHIPA) and the Health Care Consent Act, 1996. In situations where providers are working from home or other non-standard locations, they must ensure that virtual communication is done in a private setting (unless in emergency situations).

​Refer to the Telephone and Web-Based Counselling for guidance, or contact the Practice Advisors.

12. I want to volunteer my time to help in the pandemic. How do I get involved? Is there someone to contact?

The Ministry of Health has launched a website where current and former members of regulated health professions can indicate that they are interested in getting involved to prevent and control the spread of COVID-19. Specifically, they are looking for health care providers who have the capacity to get involved or former health care providers (e.g., retired or currently inactive) who want to get involved. The aim is to understand regional capacity and coordinate the deployment of health human resources throughout the system. The College is fully supportive of this effort and is working with the Ministry to help enable registration of individuals where it makes sense to do so.

For health care facilities who are requesting help: If you are a representative from a health care facility requesting dietetics related help, please see the website for matching assistance.  

13. What about charting during the pandemic? What’s the expectation?

Dietitians should implement the documentation method that makes practical sense for their practice setting while also achieving the College’s Professional Practice Standards for Record Keeping  (i.e. the minimum expectations dietitians must meet in practice). In addition, the Record Keeping Guidelines provide best practice suggestions.  

During re-deployment:

  • Dietitians must follow organization’s policies regarding documentation (e.g. if you are screening, tracking through check boxes may be enough)
  • As a guideline, if the original health care provider (e.g. nurse, speech language therapist) was required to document the intervention, then document in the same way 
  • If you are unclear – ask your organization

Good record-keeping is important to maintain, not solely for meeting the standards as records may be used later for research and debriefing about the pandemic.   

To summarize, dietitians’ obligations and accountabilities do not change, and they have a fundamental responsibility to act in an ethical manner. Dietitians are accountable to all the standards of practice. In addition, dietitians must use professional judgement to make decisions in the best interests of their clients.

14. What’s the College advice on use of Personal Protective Equipment (PPE)?

In terms of information on the types of Personal Protective Equipment (PPE) to use and when, the College does not issue this type of guidance.  Please refer to Public Health Ontario’s PPE recommendations. There is a technical brief on updated Infection Prevention and Control (IPAC) Recommendations for Use of PPE for Care of Individuals with Suspect or Confirmed COVID-19 and applicable directives from the Chief Medical Officer of Health.  Please continue to monitor these resources regularly, as recommendations may change. 

We know the current environment is stressful for many of you, and we thank you for your efforts to support safe patient care. If you have concerns, speak to the broader health care team to discuss strategies on how to encourage the appropriate use of PPE. Work with your employers to assess the patient, situation, and the environment for the appropriate use of PPE; not every patient situation may require the same precautions.

If you continue to have concerns related to PPE, see the Ministry of Health update on COVID-19 Preparations: Supplies and Equipment and the Ontario Chief Medical Officer of Health’s directive for hospitals and LTC. 

We know that dietitians are dealing with questions that are evolving as the nature of this outbreak evolves. The reality is that there will be critical decisions that require good professional judgement and collaboration in the moment.

15. I’m a dietitian working in public health. I’ve been asked to assist in providing COVID-19 test results. Do I need a medical directive?

We are aware that dietitians may be re-deployed to assist with tasks that are not typically part of the dietetic scope in any workplace setting, for example like calling clients with COVID-19 test results and providing guidance. 

Using the College’s Role and Task Framework we can help when considering new work tasks for dietitians:

  1. Is the new task or role within the dietetic scope of practice and practicing dietetics? No, this would not be within dietetic scope, however, dietitians can be re-deployed to assist with tasks that are not typically part of the dietetic scope and this may be helpful in some circumstances. This may reduce the pressure and demand on the health care system. Dietitians are asked to use their professional judgement and continue to seek direction from their employer.  
  2. Are there any legal barriers restricting an RD from performing the task (e.g., performing a Controlled Act)? For example, would an authority mechanism be needed for an RD to perform the task? Dietitians need to consider the controlled act of communicating a diagnosis.  If your organization determines that communicating test results is a controlled act of communicating a diagnosis, then authority mechanisms (direct order or medical directive) would be required to permit dietitians to perform this task. Dietitians should work with their employers and other team members to ensure that this is done safely, ethically and competently. 
  3. Will the dietitians be required to have additional skills and competence to perform the new task? Your organization should ensure proper training on atypical tasks for dietitians, including resources to ensure the dietitians obtain what is necessary to become competent (what is the necessary knowledge, skill and judgment). 
  4. What are the interprofessional care team possibilities? Given all the local circumstances, who is the most appropriate person(s) to perform the task (e.g., an RD, or another health care provider/team member, or both)? Dietitians should work with their employers and other team members to ensure that this is done safely, ethically and competently. Individual circumstances will vary depending on the practice setting and nature of professional practice.  

Employers are responsible for establishing a safe work environment that supports safe and effective client care. This includes appropriate staffing coverage, infection control measures and personal protective equipment, as applicable including proper training and fitting and providing staff with clear policies, as required. 

In addition, dietitians are required to hold professional liability insurance when practicing dietetics that aligns with the College's requirements (this can be through their employer’s coverage or through an individual policy). Please see FAQ #16 for details.

16. What about insurance when I’m re-deployed?

Dietitians are required to hold professional liability insurance when practicing dietetics that aligns with the College's requirements. (this can be through their employer’s coverage or through an individual policy).

Dietitians should inquire about coverage if they are being re-deployed. If the re-deployment task is out of scope, the dietitian (or the employer) needs to inquire if the dietitian will be covered for the out of scope task. Also, if the task is in scope and not in the dietitian’s typical practice, it will also be helpful to let the insurer know and to confirm coverage exists in the newly re-deployed area of practice.  

Dietitians also need to inquire if the employer will cover them if they encounter a personal injury in the workplace that was not caused by a third party (i.e. a dietitian transfers a client and injures their back at work). It may be you may be covered by Workplace Safety & Insurance Board of Ontario (WSIB) insurance and need to check, you (or your employer) can investigate this option through the WSIB website or contact WSIB by phone at: 1-800-569-7919 or 416-344-4526.

If you a contracted employee you need also check for coverage, as you may not be covered under the facility’s WSIB insurance plan. There are some employers that require contracted dietitians to have some form of independent personal injury/disability coverage.  Another option is to obtain personal injury/disability insurance through an independent insurance company. Dietitians can investigate rates from many insurance companies to determine the most economical option. The insurance company (ProLink) that offers the Professional Liability Insurance through Dietitians of Canada offers such insurance. 

17. I am asked to do tasks in the ICU, and I have only ever worked in outpatient settings. What should I do?

We are aware that dietitians may be re-deployed to assist with tasks that are not typically part of the dietetic scope or other roles within the profession of practicing dietetics (e.g. working in ICU when you have only worked with outpatients).  Please review FAQ #4-5, 13, and 16 and consider the following information:

  • When practicing dietetics, dietitians should always practice within their personal scope of practice so they can provide safe, ethical and competent nutrition services. 
  • Treating or attempting to treat a condition that was beyond a dietitian’s competence is professional misconduct (Professional Misconduct Regulation). 
  • As a dietitian, you have a professional obligation to ensure that you have the appropriate knowledge, skills & judgment to perform a role or task within your dietetic practice. 

Dietitian should recognize the limits to their competence and take the steps to improve their knowledge and skills in the area of practice to best serve their client. 

Dietitians should work with their employers and other team members to ensure that this is done safely, ethically and competently by:

  • Being transparent, open and honest
  • Checking organizational policies
  • Consulting with colleagues and/or interprofessional team members as appropriate
  • Considering a collaborative, interprofessional approach to providing services 
  • Acquiring new knowledge

Continued learning and education are essential in order to be able to provide evidenced-based decision-making, up-to-date information and advice. Ask for the appropriate training, competencies and knowledge. 

You can also ask to be coached by another health professional on the team who has more experience. This coaching could be given by another dietitian, or any other health professional with the appropriate skills and knowledge.

The College’s Role and Task Framework and Collaborative Care Guidelines may also be helpful to assist dietitians to consider requests and opportunities for assuming new tasks and roles, including taking on new responsibilities, if needed during a pandemic.

Dietitians performing roles they may not typically provide, like ICU coverage may be helpful in some circumstances. This may reduce the pressure and demand on the health care system as the pandemic evolves. Dietitians are asked to use their professional judgement and continue to seek direction and appropriate supports, as applicable from their employer.  

18. I’m providing essential care virtually. What platforms can I use during virtual care?


We do not advise on the types of platforms; the technology is constantly evolving and there are many options - we cannot say what is considered secure and encrypted etc.  We encourage dietitians to research. We acknowledge the need for flexibility in a public health emergency. However, a dietitian needs to take reasonable steps to ensure that the personal health information in their custody or control is protected against theft, loss, unauthorized use or disclosure. One way this is accomplished is using secure, encrypted technologies.  If you are employed, ask your employer first. 

If you are in private practice, you may want to search Canadian service providers and check service agreements for compliance (e.g. is the application encrypted, are they compliant with legislation etc.?).  In addition, the Dietitians of Canada COVID-19 Pandemic Page may be helpful. This link to ProLink Insurance was posted. We encourage dietitians to check with their insurance providers. A lawyer can assist you in determining if a platform is compliant with the legislative requirements. 

You may also wish to contact both the Information and Privacy Commissioner of Ontario and Federal Privacy Commissioners for further information. You can conduct a privacy impact assessment (PIA) regarding the collection, use and disclosure of personal health information for the purposes of deciding to use an app/platform. A PIA is an organizational risk management tool and a process used to identify the effects of a given process or other activity on an individual’s privacy. 

NOTE – The Ministry of Health Emergency Operations Centre released a Cyber Advisory - Zoomy to make all health practitioners aware of security issues and vulnerabilities that are being exploited in Zoom conferencing software.

19. I am providing virtual care to mitigate the spread of disease. What should i do?

Wherever feasible, client visits must be conducted virtually. Virtual care (also called telepractice) for the purpose of this FAQ is defined as:

Communication of a client’s health status and/or the treatment/intervention needed to support their care needs via: 

  • Phone calls
  • Video conferencing
  • Secure messaging
  • Remote monitoring 

In the context of dietetic practice, this may include: 

  • Nutrition assessments and re-assessments
  • Nutrition treatment interventions, including any monitoring and evaluation related to the treatment or intervention 
  • Videoconferencing for assessments, as required 
  • Client/Caregiver education/training to support client care and/or self-isolation efforts
  • Client education/training related to nutrition care
  • As a compliment to essential dietetic “hands-on” care
  • Replacing in-person care when a physical visit isn’t possible, or necessary
  • Any other service aligned with the goals of this guidance and approved by employer or government agency 

As this area is vast, we encourage you to consider a few principles when providing care virtually during this time.   Please feel free to reach out to the Practice Advisors to discuss any questions you may have. 

Ask yourself

  • Is there a need for virtual care for this client right now? Is the client interested in receiving virtual care at this time? Have I obtained informed consent?
  • Where is your client located? If the client is outside Ontario, have you contacted the regulatory body where the client resides? We cannot speak for other jurisdictions and advise you to seek guidance if providing care outside of Ontario. If you choose to provide virtual care in another jurisdiction, you are expected to follow the professional obligations of the regulatory body if one exists, and all relevant laws and regulations of the jurisdiction. Dietitians must be transparent with clients to identify where they are registered. 
  • If you are offering virtual care, ensure that your liability insurance covers you to practise virtually. If you are providing virtual care outside of Ontario/Canada, ensure you have liability insurance coverage and have accounted for any currency exchange. 
  • Ensure you provide care in private setting and the client is in a private setting to maintain confidentiality. 
  • Billing should be transparent. The invoice should indicate that virtual care was provided.

20. Why consider virtual care during COVID-19?

The return to non-essential care for both virtual and in-person care is intended to be gradual and with stringent conditions in place to mitigate the spread of disease. Dietitians and other regulated professionals must adjust their practice according to Directive 2 and the Ministry’s COVID-19 Operational Requirements: Health Sector Restart, which specify:

Wherever feasible, client visits must be conducted virtually. Dietitians are urged to use professional judgement in determining which clients can be treated virtually and, if not feasible, which could be seen in-person.

Consider asking yourself the following questions:

  • Should I provide virtual care for this client or groups of clients?
  • What is the right type of contact at the right time?
  • Would this client benefit from a virtual session or does the visit need to be in-person? Or can dietetic service be hybrid (partially virtual/partially in-person) for any dietetic care that you determine cannot be done virtually for whatever reason using your judgment, considering the technology you have available and your practice environment, client risk etc. (e.g. physical examination).

If you provide virtual care

  • Consider working by phone or other technologies. Consider how easy the technology is for you to use and how easy it is for the client. What is the client’s comfort, interest/desire for virtual care? What is the client’s available technology and history of use? What other client specific factors should be considered (e.g. hearing and vision abilities, comprehension, cognition, literacy etc.). In addition, how can you keep client information private and secure? What are the benefits, risks and limitations of virtual care?  You must have the technical competence to use the technology effectively to provide virtual care (e.g. knowledge and skill) and dietitians are expected to use their professional judgment to determine the appropriateness of virtual care for each client at all stages of nutrition care.
  • Confirm that your professional liability insurance covers you for virtual practice.
  • Ensure your billing is transparent and your invoice indicates that you provided the service remotely.
  • If providing care to a client outside of Ontario, contact the regulatory body in the jurisdiction where the client is located to confirm the requirements during this time. While circumstances may change during a pandemic, we cannot speak for other jurisdictions. 
  • If you proceed with in-person care, you must have in place strict protocols, as required, around risk assessments, including an organizational risk assessment and a point of care risk assessment as per the Ministry of Health’s direction COVID-19 Operational Requirements Health Sector Restart. In addition, hierarchy of hazard controls, infection prevention and control, screening, personal protective equipment, and client scheduling to ensure physical distancing and safe care.
  • Decisions about client visits must be in keeping with the principles set out in Directive #2: Proportionality; Minimizing Harm to Patients; Equity; and Reciprocity.

Additional information


Please contact the Practice Advisors for additional assistance.
practiceadvisor@collegeofdietitians.org
416-598-1725 / 1-800-668-4990, ext. 397