21 NCAC 17 .0401. INDIVIDUALS AIDING THE PRACTICE OF DIETETICS/NUTRITION

(a)  As used in this Section, the following terms and phrases, which have not already been defined in G.S. 90, Article 25, shall have the meanings specified:

(1)           "Certified Dietary Manager" means an individual who is certified by the Certifying Board of the Dietary Managers.

(2)           "Dietetic Technician Registered" or "DTR" means an individual who is registered by the Commission on Dietetic Registration of the American Dietetic Association.

(3)           "Direct supervision" as referenced in G.S. 90-368(4) means that a licensed dietitian/nutritionist shall:

(A)          be available for consultation on delegated nutrition care activities being performed by the person being supervised, either through on-site or through electronic communication, and shall be available to render assistance when needed to the unlicensed personnel and patient or client, or shall have arranged for another licensee to be available in the absence of the licensed dietitian/nutritionist; provided that the licensed dietitian/nutritionist shall be on-site at the service delivery site and within audible and visual range of any unlicensed personnel person described in Subparagraph (b)(3) of this Rule for the provision of any nutrition care activities;

(B)          directly and personally examine, evaluate and approve the acts or functions of the person supervised; and

(C)          meet with the unlicensed personnel in a joint effort to establish, maintain and elevate a level of performance to ensure the health, safety and welfare of clients or patients during the provision of nutrition care activities, and provide sufficient guidance and direction as to enable the unlicensed personnel to competently perform the delegated activity or function.

(4)           "Nutrition care activities" means activities performed by unlicensed personnel which are delegated by licensed dietitians/nutritionists in accordance with Paragraphs (c) and (d) of this Rule and which support the provision of nutrition care services as referenced in G.S. 90-352(4). Nutrition care activities include the provision of nutrition care to address and mitigate a medical condition, illness or injury and the provision of weight control programs or services, as well as community nutrition, food service, and nutrition information or education.

(b)  Unlicensed personnel aiding the practice of dietetics/nutrition may include the following:

(1)           a Certified Dietary Manager;

(2)           a Dietetic Technician Registered; or

(3)           an individual who has met the academic requirements as referenced in G.S. 90-357(3)b.1, c.1 and d.

(c)  The licensed dietitian/nutritionist may delegate nutrition care activities to unlicensed personnel that are appropriate to the level of knowledge and skill of the unlicensed personnel. The licensed dietitian/nutritionist shall be responsible for the initial and ongoing determination of the competence of the unlicensed personnel to perform any delegated acts or functions. Delegation of nutrition care activities shall be in writing and shall identify the patient or client and the act or function assigned to the unlicensed personnel.  The licensed dietitian/nutritionist shall supervise the nutrition care activities of the unlicensed personnel and maintain responsibility for nutrition care activities performed by all personnel to whom the care is delegated.  The licensed dietitian/nutritionist shall not delegate the entire spectrum of nutrition care services, but may delegate specific acts and functions which support the licensed dietitian/nutritionist's provision of nutrition care services.  The licensed dietitian/nutritionist shall have the responsibility for clinical record keeping, and shall ensure that case notes and other records of services identify whether the licensed dietitian/nutritionist or the unlicensed personnel was the direct provider of the service. 

(d)  The following variables shall be considered by the licensed dietitian/nutritionist in determining whether or not an activity or function may be delegated to unlicensed personnel:

(1)           knowledge and skills of the unlicensed personnel which include both basic educational and experience preparation and continuing education and experience;

(2)           the competence of the unlicensed personnel for the activity or function;

(3)           the variables in each service setting which include:

(A)          the complexity and frequency of nutrition care needed by a given client population;

(B)          the acuity and stability of the client's condition; and

(C)          established policies, procedures, practices, and channels of communication of the facilities where the delegated activities or functions are being performed which lend support to the types of nutrition care activities being delegated, or not delegated, to unlicensed personnel; and

(4)           whether the licensed dietitian/nutritionist has the skills, experience and ability to competently supervise the unlicensed personnel for the activity or function.

 

History Note:        Authority G.S. 90-356(2); 90-368(4);

Eff. March 1, 1996;

Amended Eff. May 1, 2010; July 18, 2002.