Current through Register Vol. 39, No. 6, September 16, 2024
(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.
Authority
G.S.
90-356(2);
90-368(4);
Eff. March 1, 1996;
Amended Eff. May 1, 2010; July 18,
2002;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. October 4,
2016.
