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Scope of Practice for UWHC and AFCH Clinical Nutritionists, Registered Dietitians and Nutrition Technicians (1.1)

Scope of Practice for UWHC and AFCH Clinical Nutritionists, Registered Dietitians and Nutrition Technicians (1.1) - Policies, Administrative, UWHC, Department Specific, Clinical Nutrition, Administrative

1.1

1





Effective Date:
September 5, 2004
Revision Date:
September 4, 2015

Administrative Manual
 Nursing Manual
 Clinical Nutrition Services

Policy #:
1.1

 Original
 Revision

Page 1
Of 5

Title:
Scope of Practice for UWHC and AFCH
Clinical Nutritionist, Registered Dietitians
and Nutrition Technicians


I. PURPOSE

To establish the scope of practice of the clinical nutritionists, registered dietitians and nutrition
technicians with direct patient care responsibility at the University of Wisconsin Hospital and
Clinics (UWHC) and American Family Children’s Hospital (AFCH).

II. POLICY

The role of the clinical nutritionist, registered dietitian and nutrition technician with direct
patient care responsibility is to function as a member of the interdisciplinary health care team
utilizing the Nutrition Care Process and Standardized Language, a structured method for
providing consistency and documentation, monitoring and evaluating progress.

The clinical nutritionist or registered dietitian develops and oversees the system for delivery of
nutrition care activities, often with input from others, including the nutrition technician.
Components of the nutrition-care delivery system may include the following: policies and
procedures, standards of care, forms, documentation standards, and roles and responsibilities
of support and technical personnel participating in the nutrition care process.

The clinical nutritionist or registered dietitian is responsible for completing the nutrition
assessment, determining the nutrition diagnosis(es), implementing the nutrition intervention,
and evaluating the patient’s response. The clinical nutritionist or registered dietitian supervises
the activities of support, administrative, and technical personnel.

The clinical nutritionist and registered dietitian fulfill minimum education and experience
qualifications for the classification. They must be a registered dietitian as delineated by the
Commission on Dietetic Registration and a certified dietitian in the State of Wisconsin.
Performance measures demonstrate technical skill, clinical knowledge, and age specific care.

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Other organizational abilities include patient safety, teamwork, communication, initiative,
customer service, leadership, supervision, and quality improvement. The professional performs
his/her job demonstrating technical ability, understanding of job expectations and compliance
with organizational policies and procedures. The mission, values, and code of ethics for
Hospital Authority Employees and the code of ethics for the Academy of Nutrition and
Dietetics/Commission on Dietetic Registration profession of dietetics are maintained.

III. PROCEDURES

The clinical nutritionist and registered dietitian assign duties to the nutrition technician and
include: nutrition screening for assigned units/patients; performing routine activities based on
the diet order and protocol, policies, and procedures; completing the intake process for a new
clinic client and reporting to the clinical nutritionist or registered dietitian when a patient’s data
suggests the need for a nutrition assessment. The nutrition technician actively participates in
nutrition care by contributing information and observations, guiding patients in menu
selections, providing nutrition education on prescribed diets and reporting to the clinical
nutrition or registered dietitian the patient’s response, including documenting outcomes or
providing evidence signifying the need to adjust the nutrition care plan.

Clinical nutritionist, registered dietitians and nutrition technicians with direct patient care
responsibility carry out the following essential duties when appropriate:
A. Review nutrition risk screening information obtained by the admitting nurse on the core
or full health assessments for all newly admitted patients and review the
appropriateness of admission diet order.
B. Provide basic nutrition services to all patients.
C. Implement nutrition interventions under the direction of a clinical nutritionist or
registered dietitian.
D. Provide individualized nutrition education to patient and/or family. As appropriate,
provide counseling and information about drug-nutrient interactions. Patient education
is documented in the medical record.
E. Provide appropriate diet therapy plans and menus to ensure compliance with the diet
order written by the physician, Nutrition Care Manual, Pediatric Nutrition Care
Manual, the Dietary Reference Intakes (DRI), Dietary Guidelines for Americans, My Food
Plate, and the patient's food allergies and preferences.
F. Monitor and evaluate nutritional status of patients based upon the effectiveness and
appropriateness of individualized medical nutrition therapy and progress toward
attainment of desired outcomes. The monitoring may include as appropriate:
1. Review of nutrient intake for oral feeding, enteral tube feeding and/or
parenteral nutrition support;
2. Review of patient's tolerance to the medical nutrition therapy care plan;
3. Review of the patient's body weight and laboratory tests;
4. Review of fluid hydration status as appropriate; and
5. Review of medical record as condition changes or at least every ten days.

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G. Plan menus and nourishments for inpatients and select outpatient settings according to
physician’s diet orders.
H. Participate in relevant in-service education programs for hospital, department, and
campus staff.
I. Enhance the positive public relations outreach between the hospital and the
community. Provide nutrition information and services to the community at large
through presentations, programs, classes, health fairs, and media activities.
J. Demonstrate a commitment to courteous, sincere, and sensitive customer service.
Serve as role models by practicing exemplary behaviors when working with patients,
visitors and fellow staff members.
K. Meet performance expectations as stated in his/her job description and demonstrate
the knowledge and skills necessary to adapt care to the physical, psychosocial, cultural,
and age-related needs of patients.
L. Document nutrition care in patient's medical record according to policy and
procedures. Chart specifically, clearly, and concisely.
M. Provide continuity of nutrition care through appropriate referrals and outpatient
nutrition counseling. Educate outpatients on nutrition, diet, and meal planning for
chronic disease management, disease prevention, and/or health promotion.
Clinical nutritionists and registered dietitians with direct patient care responsibility are also able
to carry out the following essential duties when appropriate:
A. Determine the nutrition diagnosis.
B. Perform a comprehensive nutrition assessment and develop individualized nutrition
care plans for patients by interpreting medical history and current medical/surgical
problems, laboratory values, respiratory data, drug profile, anthropometric
measurements, and other pertinent data and by interpreting diet/nutrition history
of the patient and/or family. Ensure appropriate, safe, and cost effective nutrition
care.
C. Reassess needs as appropriate or as condition changes. Facilitate ongoing
assessment of individual patient progress during hospitalization through patient
interview, patient care rounds, meal observations, consultation with team members,
and review of medical history and documentation.
D. Plan and implement a nutrition intervention using evidence-based nutrition practice
guidelines.
E. Monitor and evaluate an individual’s progress toward goals.
F. Advise physicians and other healthcare team members on the medical nutrition
therapy care plan of patients. Attend and participate in patient care rounds as the
nutrition expert.
G. Per patient care protocol (s), perform delegated acts specified in the protocol
approved by the Medical Board and Hospital Administrative Policy and Procedure.
H. Interpret and apply current nutrition research and literature to develop and/or
revise nutritional care component of medical programs.

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I. Recommend appropriate nutrition support modality and specific substrate,
micronutrients, trace elements, and when necessary, electrolyte content.
Formulations are prepared according to established guidelines for safe, aseptic, and
effective nutrition therapy. With specialized training and demonstrated competency,
participate in an interdisciplinary process for ordering of parenteral nutrition, and
recommendation, placement and management of enteral access devices.
J. Participate in an interdisciplinary process for recommending placement and
management of enteral access devices. With specialized training, demonstrated
competency, and delineated clinical privileges may place and maintain naso-enteric
access devices.
N. Contribute to and interpret clinical nutrition quality and excellence. Develop, collect,
and analyze CQI indicators that help facilitate and improve continuity of care
throughout the health care system.
O. Advise in the development of the nutritional component of research protocols.
Collaborate with CTRC and researchers for nutrition related protocols as appropriate.
P. Function as clinical faculty member for the UWHC Dietetic Internship Program and in a
teaching role for other healthcare professionals and students. Support an environment
that allows for structured and progressive learning in dietetics.
Q. Collaborate at all organizational levels through unit specific and interdepartmental
committee and council meetings. Collaborate with Surgical Nutrition Support
Consultative Service, Pediatric Nutrition Support Consultative Service, Inpatient and
Outpatient Diabetes Management Services, Wisconsin Dialysis Inc., and other
interdisciplinary committees. Serve on various Medical Board Hospital Committees and
Nursing Councils.

IV. REFERENCES

Comprehensive Accreditation Manual for Health Care Networks, The Joint Commission
Conditions of Participation and Interpretive Guidelines: Food and Dietetic Services, CMS

State of Wisconsin Dietitian Certification, DRL

Comprehensive Scope of Practice Standards for the Registered Dietitian and the Nutrition
Technician, Journal of Academy of Nutrition and Dietetics, 2013.

Position of the ADA: cost-effectiveness of medical nutrition therapy.

Position of the ADA: role of registered dietitians in enteral and parenteral nutrition support.

Nutrition Care Manual, Academy of Nutrition and Dietetics

Pediatric Nutrition Care Manual, Academy of Nutrition and Dietetics

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Code of Ethics for the Profession of Dietetics, AND and CDR
Clinical Nutrition Performance Standards, UWHC
ASPEN Standards of Practice, ASPEN Core Curriculum, ASPEN Nutrition Support Practice
Manual, ASPEN Guidelines, and ASPEN website.

International Dietetics and Nutrition Terminology (IDNT) Reference Manual - Standardized
Language for the Nutrition Care Process, Fourth Edition, AND

VI. COORDINATION

Sr. Management Sponsor: Chief Nursing Officer and Senior Vice President Patient Care Services
Author: Director Clinical Nutrition Services
Review/Approval Committee(s): UWHC Medical Board Nutrition Committee

SIGNED BY:

Director, Culinary and Clinical Nutrition Services

Associate Chief Nursing Officer and VP Nursing and Patient Care Services