Scope Of Practice And Controlled Acts

The Dietetic Scope of Practice Statement as defined in the Dietetics Act, 1991 is: “The practice of dietetics is the assessment of nutrition and nutritional conditions and the treatment and prevention of nutrition related disorders by nutritional means.”

The Scope of practice of dietetics includes the area of expertise of dietitians as a profession. This reflects what dietitians are trained to do through their educational programs and, to a lesser extent, the evolution of the profession as its role develops. The dietetic scope of practice includes the activities that dietitians as a profession are legally permitted to do under the Dietetics Act, 1991 and the Regulated Health Professions Act, 1991 and an individual dietitian’s area of competence.

Controlled Acts

The 14 Controlled Acts Under the RHPA

Controlled acts are health care actions that are considered potentially harmful if performed by unqualified persons. The Regulated Health Professions Act, 1991, sets out fourteen controlled acts that should only be performed by someone with the legal authority to do so. Dietitians have been granted the legal authority under the Dietetics Act, 1991 to perform only one controlled act, skin pricking, which falls within the controlled act of performing a procedure below the dermis. This authority allows RDs to take blood samples by skin pricking for the purpose of monitoring capillary blood readings while practising dietetics:

• Standard for Dietitians Practising Through Delegation of Controlled Acts
• Collecting Capillary Blood Samples through Skin Pricking & Monitoring the Blood Readings (Point of Care Testing)
• Medical Assistance in Dying for Registered Dietitians in Ontario
• Position Statement & Practice Guidelines: Insulin Dose Adjustments for RDs in Ontario

Definition of Practising Dietetics

College’s Definition of Practising Dietetics

The authority to perform most of the controlled acts can be delegated to another person including a regulated health professional as long as the delegation is made “in accordance with any applicable regulations under the health profession Act governing the member’s profession” (Regulated Health Professions Act, 1991, 1991, S28. (1))

Dietitians can also be given the authority to order diagnostic procedures (e.g. laboratory tests) and treatments. This authority is transferred through a medical directive.

The College of Dietitians of Ontario supports the delegation of controlled acts to Registered Dietitians and the development of medical directives giving them additional authorities as long as the dietitians have the competencies to perform the controlled acts or other authorized tasks safely.

Delegation, Directives and Orders

• Health Profession Regulators of Ontario: Guide to Medical Directives & Delegation
• Medical Directive Needed for Skin Pricking in a Public Hospital Setting
• Therapeutic Diet Orders and Medical Directives
• Therapeutic Diet Orders
• Scope of Practice: Request For Laboratory Test Ordering Authority For Dietitians 
• Do dietitians need a co-signature or medical directive to implement a diet order for residents in a LTC home?

Reg Talks Webinar— Delegation Standard (March 2021)

• Recording
• Handouts

Assessment of Roles and Tasks

• Role & Task RD Framework
• Is this Beyond Your Scope of Practice?
• Keeping Pace with Innovation in Dietetic Practice

Acting as an Evaluator

• RDs Have Authority to Act as Evaluators
• Assessing Capacity to Consent to Long-Term Care Homes

Dysphagia

• Dysphagia Policy: Scope of Practice for Registered Dietitians Caring for Clients with Dysphagia in Ontario
• Competencies for Dysphagia Assessment and Management in Dietetic Practice

Insulin Adjustments

• Position Statement & Practice Guidelines: Insulin Dose Adjustments for RDs in Ontario
• Insulin Adjustments: What to Expect from a Dietitian (for the public)

Psychotherapy

• Update on Psychotherapy
• Is Dietetic Counselling Psychotherapy?

Recommending vs Prescribing

• Vitamins & Mineral and the RD Scope of Practice
• Cannabis: What you need to know
• Cannabis and the RD Scope of Practice
• Insulin Adjustments: What to Expect from a Dietitian (for the public)

Scenarios

• Redeployment and Taking on New Roles
• Communicating a Diagnosis
• Administering Glucagon
• Is Exercise Training Within the Dietetic Scope of Practice?
• Beyond Personal Scope of Practice
• Approaching a New Task when Practising Dietetics Blenderized Tube Feedings
• The Role of Dietitians in Medical Assistance in Dying
• Client with Visual Impairment Seen Driving