Nutritionists: new activities authorized on the menu

Nutritionists: new activities authorized on the menu

Recognition of dietitians/nutritionists’ clinical judgment and their role in ensuring more accessible care is reflected in the three new activities they are now authorized to perform. This is a promising advance. We discussed these developments with Marie-Joëlle Valiquette, Director of professional affairs for the Ordre professionnel des diététistes du Québec (OPDQ).

We salute the determination of the OPDQ and the openness of the Québec College of Physicians, whose combined efforts produced the long-awaited Regulation respecting certain professional activities that may be engaged in by dietitians, which came into force on September 13, 2018. Under this regulation, dietitians/nutritionists1 are now authorized2 by decree (order) to:

  • permanently remove a feeding tube
  • administer medications or other substances, orally or enterally
  • prescribe nutritional formulas, vitamins and minerals, and enteral feeding material or pancreatic enzyme solutions.

“These activities are directly related to their expertise and field of practice and enable dietitians/nutritionist to fully play their role on interdisciplinary teams and provide quality services to the public,” explained Marie-Joëlle Valiquette. In order to perform these activities, dietitians/nutritionists must complete 15 hours of training on activities associated with prescribing, and 15 hours on feeding tube removal. “As training was not available until January, dietitians/nutritionists have only been performing these activities since then. Today at least 500 dietitians/nutritionists have been trained (or are in the process), and 200 or so have obtained a prescriber number.”

Dietitians have nonetheless been allowed to administer medications and other substances orally or enterally since the regulation came into force in September 2018, as mandatory prior training is not required.

Transition period

Organization of care in the various settings still has to be adapted to integrate these new options, to be sure. Most managers see this as added value, both in terms of removing feeding tubes (which would otherwise require a visit to the emergency room) and in terms of writing prescriptions, which previously involved having a physician validate the recommendation of a dietitian, who is the one with the expertise.

The training budget is one of the constraints limiting the application of the regulation. The new fiscal year starting on April 1 nonetheless opens up the possibility of training new cohorts.

The choices that are made between the various training options required to perform the new activities will depend on the clinical context. “At the moment, training for prescribing has generated a lot of enthusiasm,” said the Order’s director of professional affairs. “It’s no surprise, as this is a key aspect of the role of dietitians/nutritionists. Also, being able to remove a feeding tube is particularly advantageous for homecare teams. Because it requires completing a 5-hour supervised practical workshop plus 10 hours of online training, only 15 people have been trained so far.”

For those who have taken the courses, skill maintenance to preserve the skills acquired in these training courses will be incorporated in the continuing education process and will be evaluated as part of the Order’s professional inspection process. Although a new three-year period for obtaining the 60 mandatory training credits in continuing education is only just beginning, we can expect to see a popular wave of registrations for these new courses, as they’ll give dietitians greater leeway in exercising their clinical judgment.

“The training courses will be provided for at least three or four years,” said Marie-Joëlle Valiquette. In that time frame, universities should be able to integrate the new authorized activities in their training programs.

“We’re just starting to implement these changes, and we have to invest a lot of effort in communications to reach everyone concerned,” concluded the OPDQ director. “But the collaborative approach we’ve established with the College of Physicians leads us to believe that this is our profession’s first step toward greater autonomy. After all, it’s in the interests of our patients.”

The Ordre professionnel des diététistes du Québec has created a video on the process that culminated in the Regulation respecting certain professional activities that may be engaged in by dietitians.

In tandem with the Québec College of Physicians, the OPDQ is also circulating a very helpful explanatory guide. It contains frequently asked questions questions with clear answers addressing specific situations.

1The titles of dietitian and nutritionist both refer to the same profession recognized under the Professional Code.

2These are authorized activities, not reserved acts. An authorized activity is an activity that the Québec College of Physicians authorizes other professionals to perform.