April/March 2019 Monthly Update
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This Update includes information on the following items:
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- Public Register of Dietitians
- Announcements
- Virtual Dietetic Practice Update
- Reminder: Continuing Competence Program
- Website Updates
- You Asked About…
- Questions? Comments?
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Public Register of Dietitians
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The Public Register must be reflective of current and accurate registrant information. Per the
CDBC bylaw s.
54
,
“A registrant must immediately notify the registrar of any change of … name…previously provided to the registrar.”
We invite you to review your name as it appears on the
public register
. Your name on the register must be your legal name. Please review your information and inform the College of any inaccuracies at
[email protected]
.
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Announcements
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1- Save the date for the CDBC's 15
th
AGM. The
CDBC Annual General Meeting
will take place on
Friday, June 14, 2019
,
from 2:30 to 4:30pm, at the CDBC office. Dietitians will be able to attend in-person or via webcast. Dr. Tanis Fenton, RD, will be presenting on evidence-based practice.
Please RSVP by June 7, 2019.
2- The CDBC is pleased to welcome Sabrina Lauser as CDBC’s new Registration and Communications Manager. Sabrina has started her role at CDBC on May 1, 2019, and is a Registered Dietitian who completed her degree with UBC. She has worked in clinical nutrition, food service management, and post-secondary education. She is currently working on her Masters in Education and is looking forward to her new role with the CDBC.
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Virtual Dietetic Practice Update
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Effective April 1, 2019, the College of Dietitians of Ontario (CDO) requires dietitians registered outside of Ontario and who are providing virtual nutrition care to Ontario residents to be registered with the CDO. Please refer to the
CDO website
for more details.
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Reminder: Continuing Competence Program (CCP)
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This is a reminder to full registrants in the
2020 CCP Group
that starting September 1, 2019, CDBC will be accepting your 2020 Professional Development Plan (PDP).
Login to your online CCP
for more information
.
Remember that your submission should report on continuing education completed from April 1, 2017 to March 31, 2020. At least 3 learning plans should be marked “completed”. The legal completion date for the 2020 CCP group is March 31, 2020. The College requests copies of the PDP 6 months ahead of time (by October 31, 2019) to have the ability to review all submissions in time for the March 2020 registration renewal.
Look out for important information this June regarding changes to registration with Restricted Activities (for 2020 renewal) and CCP requirements (for all registrants starting in 2021).
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Website Updates
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Quality Assurance Committee
May 6, 2019 meeting minutes
are available now and Registration Committee meeting minutes will be available on May 31, 2019.
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You Asked About…
I want to be able to
help my patients manage their enterostomy tubes.
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Can I physically check the fluid volume and/or replace the volume in the balloon retention device? Can I use a Stoma Length measuring device to aid in selecting an appropriate low profile button tube?
No.
Changing the fluid volume/replacing fluid in a balloon retention tube and using a Stoma Length measuring device are not clearly defined as part of scope in the
Dietitians Regulation
. In other words, the Dietitians Regulation does not state that a dietitian is permitted to perform a procedure “below the dermis” though a gastrostomy. Therefore, procedures below the dermis are not permitted.
Although there is room in the regulation around the word “administer” to interpret changing fluid volume/replacing fluid in a balloon gastrostomy as being within scope, the legislation does not support this at present. Additionally, the CDBC has developed standards and guidelines for feeding tubes insertions, which are limited to naso/oro gastric or post-pyloric tubes. The
practice guidelines
for tube feeding insertions are clear in excluding enterostomy tubes.
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How can I aid in ensuring that the balloon retention tube remains appropriate to use if I cannot check the volume?
You may teach family and patients how to check and/or replace balloon volume by description/demonstration (
on a tube that is not connected to the patient
). Similarly, you may teach the use of a Stoma Length Measuring Device as long as it is not directly applied to a patient’s stoma. Please consider whether these activities are within your personal scope before performing such tasks. You may choose to consult the
Decision Tool for New Aspects of Dietetic Practice
, specifically regarding your personal competencies.
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What role do I play in troubleshooting enterostomy tube issues? (As a dietitian, I am often the first healthcare professional contacted by patients)
Ultimately, it is important to consider the risk associated should the procedure go unexpectedly. Is it within your scope professionally and personally to safely resolve any issues related to a pierced balloon, a balloon that is difficult or from which it is impossible to remove the fluid, a tube that may need replacement after an attempt to refill the balloon, or complications arising from using a Stoma Length measuring device? Could this procedure be best handled by another health professional whose scope includes intervention and removal/re-insertion of the balloon gastrostomy if needed?
It is important to consider a working partnership in your practice in order to align yourself with someone (e.g., Registered Nurses) whose scope includes working with enterostomy tubes when procedures below the dermis are required. This partnership will be particularly useful when certain aspects of tube troubleshooting need to be addressed. Per the Restricted Activities Interpretive Guide, dietitians registered with Restricted Activity C are allowed to “physically manipulate or adjust the enteral device or system”, as well as teaching enteral nutrition administration and tube maintenance (i.e., unblocking, maintaining patency). However, dietitians are not permitted to perform tasks (instillation/infusion) below the dermis, unless it involves enteral nutrition as defined by the Interpretive Guide.
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What is the CDBC doing to clarify these seemingly unclear areas of practice?
CDBC recognizes a gap in legislation that allows dietitians to teach, while not being able to perform, certain tasks. As such, the College is looking to develop a Position Statement that may include a question/answer section on the topic of maintenance of balloon retention tubes and use of Stoma Length Measuring Devices, similar to the one that exists for
Insulin Dose Adjustment
. You will note that dietitians have the ability to counsel and teach patients in insulin dose adjustment, while not being allowed to physically administer the insulin to their patients. The CDBC is also working to update the
Restricted Activities Interpretive Guide
to include examples specific to maintenance of balloon retention enterostomy tubes.
The CDBC continues to collaborate with the Ministry on a regular basis on aspects of legislation that affect professional regulation.
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Please contact College staff if you have questions about items in this Monthly Update or
if you’d like to schedule a CDBC liaison session.
Call 604.736.2016 or toll-free in BC to 1.877.736.2016, or email us at
[email protected]
We look forward to hearing from you!
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