SOPP)

STANDARDS OF PRATICE/STANDARDS OF PROFESSIONAL PERFORMANCE (SOP/SOPP) Joyce T. Price, MS, RD, LDN American Dietetic Association Quality Management Co...
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STANDARDS OF PRATICE/STANDARDS OF PROFESSIONAL PERFORMANCE

(SOP/SOPP) Joyce T. Price, MS, RD, LDN American Dietetic Association Quality Management Committee March 6, 2009 South Carolina Dietetic Association Annual Meeting

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Objectives The participants will be able to: • Define SOP/SOPP • Explain the relationship of the SOP/SOPP to the standards for CMS and TJC • Explain where the SOP/SOPP fits within the Scope of Dietetics Practice Framework MSOffice5 • List at least two SOP/SOPP • Explain the difference in the SOP/SOPP for the DTR and the RD 2

Slide 2 MSOffice5 Do you mean practice-specific documents or at least 2 of the indicators? , 11/7/2008

What is the SOP/SOPP SOP: • Set of four standards: 1. 2. 3. 4.

Assessment Diagnosis Intervention Monitoring and Evaluation

SOPP: Set of six standards: • Relate to professional behaviors • Provision of Services • Application of Research • Communication and Application of Knowledge • Management of Resources • Quality in Practice • Accountability

History of the SOP/SOPP Standards of Practice: A practitioner’s guide to implementation: July 1986 The Standards of Professional Practice for Dietetics Professionals: 1998 Standards of Practice in Nutrition Care and Updated Standards of Professional Performance: April 2005 Revised 2008 Standards of Practice in Nutrition Care and Standards of Professional Performance for RDs and DTRs : Sept 2008 MSOffice6

Slide 4 MSOffice6 Since you talk about the differences from 2005 to 2008, I thought it was important they were both mentioned in this slide, especially as many members don't know either exist , 11/7/2008

What prompted the update? Directive from the American Dietetic Association BOD to the QMC in November 2006………. “…formulate a clear and precise definition of the term ‘supervision’ as it applies to the Scope of Dietetics Practice Framework’s Standards of Practice for the RD and DTR and to revise these documents for accuracy and consistency with federal regulations and national standards.”

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Phase 2 Education Task Force Report “Confusion and misinformation about the role of the DTRs among members” Phase 2 Education Task Force Report, pg 88

Charge from the HOD to the Education Task Force – “Identify the roles/function of the support practitioner needed to assist the professional of the future.” 6

Three SODPF building blocks Block One: Foundation Knowledge

Block Two: Evaluation Resources

Block Three: Decisions Aids 7

The Framework

Scope of Dietetics Practice Framework: Gives structure to all tools that together describe full range of safe, sanctioned dietetics practice Provides step-by-step process to help us methodically work with professional resources

The SOP/SOPP fits within the Scope of Dietetics Practice Framework in…

Block Two: Evaluation Resources    

Code of Ethics SOP in Nutrition Care Standards of Professional Performance RD specialty or advanced practice

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Definition of the Standards of Practice

Minimum level of competence for RDs and DTRs • • • •

RD or DTR providing direct patient care Guide to practice The standard NOT regulations

Improvement Since 2005

• More consistency with national regulations • “Supervision” of the DTR defined • Clarifies the SOP and SOPP for the RD and DTR • Acknowledgement of the best use of SOP and SOPP

Improvements from 2005

2005 SOP Nearly identical roles and responsibilities except…… • RD - Complicated conditions • DTR - Uncomplicated conditions

2008 SOP Describes the unique roles and responsibilities of the RD/DTR • DTR works under the supervision of the RD • RD determines DTR support based on documented DTR competencies

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Improvements for SOP since 2005

Clarifies responsibilities of the RD and DTR within the Nutrition Care Process (NCP) • Assessment: DTR supports RD • Diagnosis: Assessment and Dx is the responsibility of the RD • Intervention: RD assigns interventions to DTR • Monitoring and Evaluation: DTR participates in monitoring and evaluation 13

2008 SOP

Key points to remember… • Nutrition screening; MDS – Is outside the Nutrition Care Process = NCP

• No references to “complicated” and “uncomplicated” conditions • No references to low, moderate, and high risk – Clients either have nutrition diagnosis or do not

have nutrition diagnosis – Define risk levels through protocols and guidelines 14

Crafted Around CMS Interpretive Guidelines “A qualified dietitian must supervise the nutritional aspects of patient care… • Approving patient menus and supplements • Patient, family and caretaker dietary counseling • Performing and documenting nutritional assessments….” – Responsibilities of a Hospital Dietitian:

CMS State Operations Manual, Survey protocol, regulations, and interpretive guidelines for hospitals. Section 482.28(a)(2) Published 05-21-04 15

NEW! Definition of Supervision as it relates to the RD/DTR team  Applies to nutrition care of patients in various healthcare settings  Maybe direct or indirect • Determined by regulatory and facility policies and procedures

State licensure statutes vary and may include definition of supervision and scope of practice. Federal rules may specify the “qualified dietitian”. 16

Definition of Supervision IS NOT synonymous with…..

Managerial supervision Clinical supervision (peer to peer) Supervision of dietetic interns and students Supervision of provisional licensees

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WHY IS THIS IMPORTANT?  Ensures RDs are accountable to employers, clients and payors for the care they provide  Reduces the possibility of adverse regulatory actions for RDs and ADA  Stresses the importance of the RD/DTR team strengths • Adds clarity and support to the role of the DTR

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Standards of Professional Performance

• Address behaviors related to professional role • Outside the realm of direct patient/client care • Apply in all practice settings • Six domains of professional behaviors • Reflect RD/DTR responsibilities and accountabilities

Standards of Practice and Standards of Professional Performance SOP: Follows the NCP • • • •

Assessment Diagnosis Intervention Monitoring and Evaluation

SOPP: Relates to professional behaviors • Provision of Services • Application of Research • Communication and Application of Knowledge • Management of Resources • Quality in Practice • Accountability

How can I use these documents? TO:  Market an expectation of dietetic care and service delivery  Provide a professional guide for the RD and DTR  Use as a basis for self-evaluation and improvement  Provide a framework for educators  Use as a basis for the relationship between practice and outcomes 21

How can I use these documents? TO:  Clarify roles of RD and DTR  Describe unique contributions of RD and DTR to healthcare team  Describe minimum expectations for practice  Provide consistency in practice and performance  Reflect applicable federal laws and regulations

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Why Use the SOP/SOPP?

One of the Pillars of Quality Dietetics Practice  Integral part of the Scope of Dietetics Practice Framework  Describes a minimum level of competent practice

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The Code of Ethics

The TheStandards Standardsof ofPractice Practiceand andthe the Standards of Professional Performance Standards of Professional Performance Lifelong Lifelong Learning Learningand and Professional Professional Enhancement Enhancement Professional Professional Development Development Portfolio Portfolio

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Chicago Tribune Thursday, August 7 2008 / West

Breaking news and more at chlcagotrjbune.com

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Mistakes to cost hospitals

To boost quality and cut costs, insurer won't pay for medical errors called 'never events'

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The broader trend is for payers to pay for good performance and not pay for extremely poor performance •CMS – Centers for Medicare and Medicaid Servcies •“Never Events” • No payment for avoidable patient complications • wrong limb, falls

•Blue Cross Blue Shield of Illinois •Three other Blue Cross plans that operate under the Illinois plan's parent, Chicago-based Health Care Service Corp. •Aetna, Inc. •The Leapfrog Group, a national coalition of large health-care purchasers such as Chicagobased Boeing Co., General Motors Corp. and General Electric Co. •Minnesota, which requires hospitals and surgery centers to report such events, counted 125 last year out of more than 8 million admissions. • The most common were severe bedsores, surgeries performed at the wrong site and foreign objects left in patients after surgery. 28

Thank You

Questions Comments Concerns

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