Registered Dietitian Scope of Practice Act
Missouri Registered Dietitian’s have a scope of practice act defined in their licensure. The following outlines what entails an RDs scope of practice:
- Provide Medical Nutrition Therapy (MNT) in direct care of medical diseases and conditions across the continuum of care
- Apply the Nutrition Care Process (NCP) and workflow elements to provide individualized nutrition care of individuals
- Perform assessment of a patient’s nutrition status via in-person, or facility assessment application, or HIPPA complaint video conferencing telehealth platform
- Complete a Nutrition-Focused Physical Exam (NFPE) through an evaluation of body systems, muscle and subcutaneous fat wasting, feeding ability, oral health, skin condition, appetite and affect.
- Recommend, perform and/or interpret test results related to nutrition status: blood pressure, anthropometrics, indirect calorimetry, laboratory tests.
- Order and monitor nutrition-related laboratory tests, if granted by institution or under the supervision from a referring physician
- Order and monitor nutrition interventions to meet individualized nutrient and energy needs, including but not limited to: prescribed diets, medical foods, dietary supplements, OTC medications, nutrition support therapies such as, enteral nutrition and parenteral nutrition support, nasogastric feeding tube placement, and provide feeding therapy
- Initiate, implement and adjust protocol or physician order driven nutrition related medication orders and pharmacotherapy plans in accordance with established policy and procotols within the organization
- Assist in the development, promotion and adherence to enhance recovery after surgery protocols, including elimination of preoperative NPO diet order, intraoperative nausea/vomiting prophylaxis and goal-directed fluid therapy and early postoperative nutrition
- Provide nutrition counseling, nutrition behavior therapy, lactation counseling, health and wellness coaching, and nutrition, physical activity, lifestyle and health education and counseling as components of preventative, therapeutic and restorative health care.
- Assess and counsel for the treatment of food allergies to prevent consumption of allergens, prevent over restriction, prevent nutrient deficiencies, and promote optimal growth and/or weight maintance
- Evaluate, educate, and counsel related to nutritional genomics, gene-diet and disease interactions; genetic, environmental, and lifestyle factors; and food-drug, drug-nutrient, and supplement drug nutrient interactions.
- Manage nutrition care, collaborate with other health and nutrition professionals and as members of interprofessional teams, contribute to rounds or care conferences; to be part of palliative and hospice care coordination; and refer to appropriate nutritional resources, programs, or health professionals
- Determine appropriate quality standards in foodservice and nutrition programs
- Train nutrition and dietetics personnel and NDTRs and mentor nutrition and dietetic students and interns in the provision of nutrition services.
- Delegate to and supervise the work of the NDTR or other professional, technical, or support staff who are engaged in direct patient/client nutrition care.
Other professional entities that breach the RDs scope of practice will be reported to the State Committee of Dietitians for review and repercussion, if appropriate, and reported to their own board of practice, if applicable.
REFERENCE: The Academy Quality Management Committee. Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist. Journal of the Academy of Nutrition and Dietetics. 2018; 118 (1): 141-165.