November/December 2019 Monthly Update
This Update includes information on the following items:

  • Ministry of Health Consultation Paper
  • CDBC Fees for 2020-2021
  • Election Nominations are Open
  • Call for Registrants Interested in Participating on a CDBC Committee
  • Office Move
  • Holiday Closure
  • Website Updates
  • You Asked About Enterostomy Tubes
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Ministry of Health Consultation Paper
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On November 27 th , 2019 the Ministry of Health shared an announcement on an innovative proposal to modernize health profession regulation , putting a strong focus on protecting the public. The consultation paper is a follow-up to an Inquiry into the Performance of the College of Dental Surgeons of British Columbia that was published in April 2019. The report, written by Mr. Cayton, was also suggesting possible approaches to modernization of BC’s overall health regulatory framework.
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The CDBC welcomes the government’s announcement and commends the Steering Committee for their leadership and hard work. The College looks forward to participating in the government’s consultation process. CDBC registrants are also invited and encouraged to provide feedback, until January 10, 2020. The consultation website can be viewed here .
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The College remains committed to regulating Dietitians to deliver safe, ethical and competent services to the BC population. Members of the public and Dietitians can reach the College at any time with questions and concerns on dietetic practice.
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CDBC Fees for 2020-2021
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Each year, the CDBC Board of Directors reviews the need to change the College fees according to the CDBC’s financial capacity and to meet its mandate under the Health Professions Act . 
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This year, the Board approved to maintain the current CDBC fees for the 2020-2021 fiscal year.
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Directors considered the College’s current financial situation and the College Strategic Plan, as well as maintaining contingency for inquiry and discipline matters. The Board is sensitive to increasing costs of living for all BC registrants and decided that an increase was not necessary for the upcoming year.
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The Board of Directors will continue to review the need to apply a cost of living increase annually. This practice is consistent with other Colleges in BC and across Canada.
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Registrants who are registering for the first time with a restricted activity will see an administration fee of $27. This fee will not affect registrants who are renewing restricted activities they already have. The new fee schedule will be filed with the Ministry of Health with the goal of coming in effect for the 2020-2021 fiscal year. Please contact the CDBC if you have any questions about the fees.
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Election Nominations are Open
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Three terms on the CDBC Board of Directors end on March 31, 2020 . Nominations are open in the following Electoral Regions, for the April 1, 2020 to March 31, 2022 term:
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Interior/North (1)
Vancouver Coastal (1)
Vancouver Island (1)
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Prior to accepting a nomination, interested registrants need to review the 2020 Notice of Election to familiarize themselves with Board responsibilities and time commitments. CDBC Directors must always act in the public’s interest, and not with the goal of promoting dietitians, addressing employment or union issues, or pursuing personal practice issues . Desirable skills include strategic planning, financial literacy, risk management, governance and strong understanding of the College mandate.
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Any Full Registrant may nominate a maximum of two Full Registrants in good standing, for each vacant Director position in his/her Electoral Region. Nominations must be received by email, by December 15, 2019 . Please send all nominations to [email protected] . A Full Registrant nominating a candidate for election must also include the nominee's short biography or notify the nominee to forward his/her bio to the College. The 2020 Nomination Form i s available on the CDBC website.
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Call for Registrants Interested in Participating on a CDBC Committee
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The terms of some members on the College’s Committees end on March 31, 2020 and the Board will be determining reappointment and new appointments at their March 13, 2020 meeting. Reappointments create Committee stability and expertise while new appointments allow for fresh energy and ideas. Both are considered by the Board when appointments are made.
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Upcoming Committee terms ending:
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Inquiry Committee: Two full registrants
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Registration Committee: One full registrant
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Quality Assurance: Two full registrants
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Minutes and information about each Committee can be viewed on the CDBC website. If you’re interested in applying for a Committee position and are a Full registrant, who has not yet worked with the College, please submit a current resume and a brief statement explaining why you are interested in participating on a College Committee and the strengths you would bring. Previous applicants who have not yet served on a Committee are encouraged to re-apply with updated resumes. Please email your information by Friday, February 15, 2020 to [email protected] . We look forward to hearing from you!
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Office Move
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The Board and staff are happy to announce that the College will be moving to a new office space on January 1, 2020.The move is part of the Strategic Plan goal & strategies to increase capacity and deliver excellence in regulation, in the public’s interest. The CDBC will share the office space and other resources with ten other health Colleges at the “Hub”. The Hub started with the amalgamation of the three nursing Colleges into the BC College of Nursing Professionals (BCCNP). BCCNP invited other health Colleges to the shared office space and services, providing more opportunities for collaboration and economies of scale. This new arrangement will help us meet the goals of our Strategic Plan. The office is centrally located with easy access for the public, staff, and Board/Committee members.
New Mailing Address
(effective January 1):
College of Dietitians of British Columbia
900 – 200 Granville St
Vancouver, BC, V6C 1S4
 
New Contact Information
(effective January 1):
 Phone: 604.742.6200
Toll-free: 1.866.880.7101
Fax: 604.899.0794
Holiday Office Hours
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The College will be closed for the holiday season from December 24, 2019 through January 1, 2020 . If you have an urgent matter to discuss during this time, such as a complaint or registration query, please contact Joanie Bouchard, Registrar, by email at [email protected] .
For any other questions or concerns, please leave us a message at our regular contact information. We will follow-up as quickly as possible, upon our return.
You Asked About…
Clarity with respect to Enterostomy Tubes and your Scope of Practice
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The CDBC published an enterostomy-specific Monthly Update in April/May 2019 . Since then there have been additional questions, specific to the interpretation of Restricted Activity C. These questions are primarily related to the education of patients and caregivers on the safe use and maintenance of their enterostomy feeding tubes.
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The CDBC is currently consulting with the College of Physicians and Surgeons of BC on matters related to “movement” of certain types of enterostomy tubes (i.e. tube rotation), where this type of activity may be considered to be a procedure below the dermis and therefore outside of a dietitian’s legal scope of practice. The CDBC will communicate the result of the discussion in the New Year.
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Q: If a dietitian can't physically perform an activity because it is considered out of scope (e.g., adjusting balloon gastrostomy volume), are we allowed to advise/teach a patient how perform that same activity?
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This question is answered in the April/May Monthly Update .
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As a regulated health professional, you are responsible for determining if you are the right person to perform a specific task or activity. Consult the Decision Tool for New Aspects of Dietetic Practice for guidance on determining your individual scope of practice for Restricted Activity C. If you don't think that a certain activity is within your scope, you should refer patients to a health professional who is competent to help them ( CDBC Code of Ethics Principle 3 and Standard of Practice 2.3 and 3.2).
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Q: Are we liable if the patient misunderstands our advice and is compromised?
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As with any other activity, providing clear, plain language instruction is important (Standard of Practice 9), along with clear documentation of the intervention in the medical record (Standard of Practice 15 and  CDBC Standards for Record Keeping ).
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Once education and emergency contact information has been provided, it is the responsibility of the capable patient or caregiver, who consented to undertake an activity independently, to complete the task correctly. As in all other areas of dietetics, you are not responsible for a patient’s non-compliance to recommendations, guidelines and education provided.
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Q:   If I perform or teach others to perform an activity that is considered within scope, such as the administration of enteral nutrition (EN), what can I do to ensure that I am performing or teaching it correctly?
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Aside from establishing and enforcing entry-to-practice requirements for the practice of Restricted Activities, the CDBC Continuing Competence Program (CCP) ensures reflection of performance by the dietitian. Through this process, dietitians demonstrate ongoing growth and development of their professional knowledge and skills, while having a systematic way to document how their learning activities impact their practice. Employers may play a key role in offering continuing education opportunities in the form of courses, webinars and on-the-job training which ensures provision of a supportive environment where dietitians can work effectively. While the CCP doesn’t guarantee competence, self-reporting continuing education is an indicator of competence (1). Literature shows that self-reflection on practice, access to a variety of learning activities and development and maintenance of a learning portfolio are among the most important aspects of a continuing competence program (1-4).
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Q: Are dietitians able to ensure the enterostomy tube is optimized for administration of tube feeding? For example, measuring the external length of a feeding tube? Or adjusting the external bumper of the tube.
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Yes, a dietitian registered with Restricted Activity C can perform these activities, per the wording of Restricted Activity C as defined in the Restricted Activity Interpretive Guide :
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“If a substance is being administered by instillation through enteral means, the RD: … physically manipulates or adjusts the enteral delivery device or system.”
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The external bumper may be adjusted by the dietitian to support the maintenance of the correct position of the enterostomy tube within the stoma. The purpose of measuring the external length of the tube is to ensure that the tube has not migrated into or out of the stoma. If the position is not optimized (i.e. the tube appears to have moved), dietitians are not permitted to adjust the tube by moving it into or out of the stoma, since that would be deemed a procedure “below the dermis”. If the tube has migrated or there is another indication that it is not appropriate to use for feeding, a dietitian must recognize that any action taken will be outside of a dietitian’s scope and refer to another health professional (Standard of Practice 2.3).
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Q: Is a dietitian able to instruct a person to clean the skin around the feeding tube (basic stoma care)?
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Yes. This activity is directly related to the provision of nutrition by enterostomy tube, and so it falls within a dietitian’s scope of practice. Generally, nursing professionals are responsible for stoma care, but in some practice situations, you may be asked to provide instruction or care. You must determine if this is within your individual scope and if it is not, refer to another health professional who is competent to provide this type of care.
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Stoma care may include instructing patients/caregivers how to
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  • clean the stoma with warm soapy water and how to air dry the stoma,
  • apply over-the-counter agents (such as barrier creams) that were recommended by the healthcare team,
  • replace the dressings and any adhesive required for the dressings.
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Administration of scheduled medications is not part of a dietitian’s legal scope. Any troubleshooting required (leaking, irritated, swollen, infected stoma) must be referred to an appropriate healthcare team member and documented in the patient’s medical record.
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References
  1. Professional and Quality Assurance and Competency Assessment- a scoping review. March 2016. Accessed 02 Oct 2019.
  2. Lee, Nancy-Jane. (2010). An evaluation of CPD learning and impact upon positive practice change. Nurse education today. 31. 390-5. 10.1016/j.nedt.2010.07.012. Accessed 02 Oct 2019.
  3. APA task force on the assessment of competence in professional psychology: final report. American Psychological Association, 2006. Accessed 02 Oct 2019.
  4. Connecting Theory and Practice: exploring the risks and supports to the Competence of physiotherapists. March 2017. Accessed 02 Oct 2019.
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!