This role statement was developed by members of the Nutrition Support Interest Group.

It lists the knowledge and skills of an Accredited Practising Dietitian (APD) working in the nutrition support practice area.

Knowledge

• Understanding the interrelationship between various medical conditions, medications and their impact on macro- and micro-nutrient digestion, absorption and metabolism.
• Knowledge of gastrointestinal anatomy and how it is affected by certain surgical procedures (for example, bariatric surgery, colorectal surgery).
• Up-to-date knowledge of the available range of oral supplements, enteral and parenteral nutrition formulations and the ability to select the most appropriate formulation based on a patient’s individual nutritional needs.
• Understanding of the appropriate indications and contraindications of nutrition support interventions available to patients (i.e. short-term vs long term requirements, gastric vs jejunal feeding, enteral vs parenteral nutrition)

Skills

• Monitoring and interpretation of anthropometric changes in patients who are mobile and immobile to assist with evaluating responses to the delivery of nutrition support. This includes completion of physical assessments to examine for signs of muscle and subcutaneous fat depletion.
• Interpretation of laboratory tests pertaining to nutrition and hydration status.
• Estimation of nutritional requirements (energy, macronutrients, micronutrients and fluid) in accordance with the underlying medical diagnosis/condition.
• Effective advocacy and communication skills with all relevant stakeholders including patients, families and the multidisciplinary team to assist in patient-centred decision making regarding nutritional needs.
• Development of appropriate recommendations for nutrition support interventions including route of feeding, duration, medical state, patient perspective and quality of life.
• Skills in food fortification techniques and micronutrient supplementation with the ability to provide tailored advice to achieve nutritional support goals.

Activities entry level APDs would conduct

• Nutritional screening, assessment including the diagnosis of malnutrition and development of nutrition care plans and monitoring.
• Identification of indications and contraindications for various nutritional support methods, including choosing an appropriate feeding formula, route of administration, and development of enteral and parenteral regimens. An entry level APD would not be expected to have TPN prescribing right additionally, joint care with a more senior dietitian would be expected for complex TPN patients.
• Provide education to other health care staff, the patient and carers/family, about the nutrition support regimen, administration of nutrition support and care of their tube/line and tube site.
• Discharge planning and post-discharge care where applicable (for example, Home Enteral Nutrition Service).

Activities APDs working at a higher level would conduct

• Identification of, insertion, care and removal of enteral feeding tubes/devices and tube sites.
• Measurement and interpretation of indirect calorimetry to measure energy expenditure and skills in the methods of body composition assessment including using handgrip dynamometers, ultrasound, and interpretation of CT images.
• Order writing of parenteral nutrition and nutrition related pathology to help monitor nutrition progress. This may include prescription of orders to adjust micronutrient and electrolyte dosing.
• Planning and coordination of dietetic services in the area of nutrition support across both the inpatient and outpatient setting. This includes ordering and stock maintenance of nutrition support products.
• Determining and monitoring clinical standards and benchmarks for nutrition support services, including the development of nutrition support resources and policies.
• Designing, implementing and disseminating nutrition support related research.

For more, download the full role statement. The full statement includes a list of document references.