SOP and SOPP Frequently Asked Questions

Following are sixteen questions and answers clarifying SOPs and SOPPS.

1. What is the difference between the Standards of Practice (SOP) in Nutrition Care and the Standards of Professional Performance (SOPP)?

A: The SOP and SOPP are companion documents. The SOP applies to those RDs and DTRs who have direct contact with patients/clients and is comprised of four standards representing the four steps of the Nutrition Care Process. The SOPP applies to RDs and DTRs in all settings and addresses behaviors related to the professional role. Both documents promote the RD and DTR working together as a team.

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2. What is the difference between the 2008 SOP and SOPP for RDs in practice-specific areas and the previously published SOP and SOPP?

A: The 2008 standards are formulated to be used as a resource for individual self-evaluation. The 2008 standards also serve as a blueprint for the development of practice-specific standards for RDs. Practice-specific standards are enhanced to include elements most relevant to that specific practice area. As of October 2007, four Dietetic Practice Groups of AND have published practice-specific standards for RDs. They are: Diabetes Care, Oncology Nutrition Care, Behavioral Health Care, and Nutrition Support. Several others are in the development phase which includes: Dietetics Education, Pediatric Nutrition Care, Nephrology Care, Management in Food and Nutrition Systems, and Sports Dietetics.

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3. In the 2005 SOP, the DTR independently performs nutrition assessments for uncomplicated patients whereas in the revised standards, performing assessments is the responsibility of the RD. Why the change?

A: The standards are crafted around the Centers for Medicare and Medicaid Services (CMS) interpretive guidelines that list nutrition assessment as the responsibility of the qualified dietitian. Some facilities have been cited by CMS for allowing DTRs to perform nutrition assessments. The 2008 document was revised to be consistent with state and federal regulations and to promote the RD and DTR working together as a team.

NOTE: Nutrition assessment for the purpose of these standards refers to the documented final assessment (noun) and not to assessing a situation (verb).

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4. I am a DTR in a Long Term Care facility and have been performing assessments for five years and have never been cited. Should I change my practice?

5. Can the SOP/SOPP be used in court to justify my actions in a malpractice case?

A: No. The standards are developed for the purpose of individual self-evaluation and for the development of practice guidelines. They are not intended to be used in any determinations of negligence or misconduct.

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6. Does this document apply to non-AND members since it is an AND document?

A: Yes. This document applies to both AND members and non-AND members who are credentialed RDs and DTRs. This document relates to the practice of dietetics.

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7. Does the SOP for the DTR apply to those dietetic technicians that have completed a four-year dietetics program and have the title “dietetic technician”?

A: The DTR Standard of Practice applies to all DTRs. That is all individuals with the DTR credential as defined by the Commission on Dietetics Registration (CDR) but not related to an individuals’ educational degree.

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8. I have been a DTR for 25 years and have been working independently in the clinical area. Our consulting RD visits once a month and reviews the high risk patients.

Will I now be restricted from assessing patients and providing clinical care?

A: The SOP is written as the minimum competency required for the entry level DTR. Since the DTR works under the license of the RD, it is the responsibility of the RD to assess the DTR competency and then assign clinical duties consistent with DTR competence, state and federal regulations, and facility policies. The Scope of Dietetics Practice Framework on the AND Web site www.eatright.org/scope will guide you and your consulting dietitian in determining if you may continue in your current clinical practice.

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9. With most of the nutrition screening and nutrition assessment data collection now automated, I feel that the 2008 SOP further restricts opportunities for DTRs. Is this true?

A: The DTR role is broader than the Nutrition Care Process and Standardized Language (NCP/SL). The SOPP clearly delineates expanded roles and opportunities for the DTR in the non-clinical settings. For example, a DTR may have several job responsibilities outside the NCP/SL such as patient satisfaction, food service management, dietetics research, informatics, performance improvement, and quality assurance.

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10. In my current situation, the DTR provides basic lows sodium education to all of our heart failure patients. Under this new SOP, it appears that only the RD can perform the nutrition assessment and diagnose the nutrition problem. It would be duplication for these patients to be seen by both professionals.

Can you provide some perspective on this type of situation?

A: The 2008 SOP/SOPP clearly states that the RD may assign the intervention to the DTR which in your case is nutrition education for the Heart Failure patient. This could be implemented by a standardized nutrition care pathway or protocol whereby all patients with a diagnosis of Heart Failure are routinely referred to the DTR for nutrition education. The RD/DTR works as a team with the RD ensuring that the education content follows evidence-based practice while the DTR provides the education and assesses understanding of the patient to follow the education plan.

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11. The SOP seems oriented toward the acute care setting. Is the SOP applicable to other practice settings?

A: Yes, the SOP/SOPP is applicable to other practice settings including ambulatory care, long-term care, community, and public health.

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12. Are these standards considered the “gold standard” for practice?

A: No, they represent the minimum competent level of dietetics practice and professional performance.

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13. Can the DTR be in a dietetic research position?

A: Yes. This document applies to both AND members and non-AND members who are credentialed RDs and DTRs. This document relates to the practice of dietetics.

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14. Should I rewrite my job description to include the same wording as the article?

A: Your job description should be institution specific, and use the institution's format and requirements. The sections can be used as a reference for tasks. For clinical tasks, use the SOP section. For professional areas, use the SOPP section.

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15. The wording and outline of the SOP and SOPP are different than former performance standards that I learned in my training. My job is not requiring that I change any documents or my daily tasks.

Why should I become familiar with andadopt these new guidelines to practice?

A: All healthcare professions progress and align with advances and trends in healthcare delivery and quality improvement. AND's role for the profession is to provide the tools or guides to assist members to maintain clinical responsibilities within the current regulatory confines defined by federal and state agencies.

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16. Are DTRs allowed to write nutrition diagnosis statements and plan the interventions?

A: Nutrition diagnosis is the responsibility of the RD with the DTR providing support for this step of the Nutrition Care Process. The RD plans the intervention and then may assign the DTR the implementation of the intervention. The Quality Management Committee patterned this determination after the nursing care process as depicted below:

Component of nursing process Assigned to support staff?
Assessment No, input is solicited
Diagnosis No
Planning No, input is solicited
Intervention Yes, within scope
Evaluation No, input is solicited

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