The National Kidney Foundation actively participates in developing and promoting KDOQI and its guidelines. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. This new role includes coordinating and monitoring the organization’s identified quality indicators, proactively supporting survey readiness, and analyzing and reporting routine surveillance and outcomes data. In these areas, it remains the consensus of the content experts that the distinctions are subtle, captured in the knowledge, experience, and intuition demonstrated in the context of practice at the expert level, which combines dimensions of understanding, performance, and value as an integrated whole. The 6 professional standards encompass the key characteristics of the dietetics profession. Opportunity knocks for consultant dietitians-aging inmates. This study aimed to explore the work roles, major tasks and core activities of advanced practice dietitians in Australia to define the Competency Standards for advanced practice. Family Caregiver Alliance: National Center on Care Giving website. An RDN working in a rehabilitation center was asked by the administrator to assume the responsibilities of QAPI coordinator. Practices include for example: Identifies local/state/national quality initiative efforts to support PALTC nutrition goals and best practices, Leads local/state/national and/or international quality initiative efforts to support PALTC nutrition goals and best practices, Leads interprofessional performance improvement initiatives within the organization, Participates in quality management (eg, quality assurance performance improvement [QAPI]) activities, including identifying performance improvement criteria, training, mentoring, data collection, evaluation of performance, and implementation of corrective actions, Develops implementation strategies for quality management activities (eg, identification/adoption of evidence-based practice guidelines/protocols, skills training/reinforcement, organizational support), Leads interprofessional performance improvement initiative(s) across the organization or system, Assists interprofessional team and other staff with development and implementation of appropriate quality measures for nutrition and dietetics care and services, Identifies quality outcome indicators to measure (eg, Centers for Medicare and Medicaid Services [CMS], NQF, organization-specific measures), Selects criteria for data collection, and advocates for and participates in the development of data collection tools (eg, clinical, operational, and financial), Uses and/or develops systematic quality improvement approach to collect data from multiple sources to measure quality of services against desired outcomes, Routinely assesses current services using culturally competent engagement processes considering identified performance criteria to evaluate nutrition care and services, Seeks out and uses or adapts, existing systems for evaluating nutrition and food/dining service structures, processes, and outcomes specific to the population and setting, Leads the development, monitoring, and evaluation of practice-specific benchmarks for use in evaluating nutrition quality of care and services, Using clinical quality measures applicable to setting, collects data on patient/client population risk factors, screening timeframes, number at risk or with malnutrition, and services provided (eg, nutrition assessment, menu adjustments, enteral or parenteral nutrition, discharge plan, post-discharge services), Documents outcomes per organization procedure, and participates in evaluation and reporting, Evaluates customer and service outcomes using identified criteria (eg, weight loss, number of pressure injuries/ulcers) to reinforce current practices or implement changes in care practices or services, Synthesizes and publishes effectiveness outcomes on programs and services, Actively promotes the inclusion of RDN-provided medical nutrition therapy and PALTC nutrition service components in local, regional, state, and/or national data registries, Evaluates and ensures safe PALTC food and/or nutrition services; seeks assistance as needed, Conducts and documents nutrition care and/or food/dining service audits at least monthly or per organization policy to identify performance deficiencies; works with organization staff to reduce errors and hazards, Identifies industry wide trends in food and nutrition deficiency areas to guide organization or foodservice practices to prevent errors, Contributes to developing systems to problem-solve and prevent errors (eg, medication and food/dietary supplement interactions, infection control, hyperglycemia, and hypoglycemia) in collaboration with interprofessional team, Prioritizes identified issues (eg, food safety) and with organization leaders develops a plan of correction, Leads interprofessional team in root-cause analysis of errors and hazards and persistent problems impacting achieving desired outcomes, Develops or revises plan of action in association with customers served, organization staff to meet expected outcomes, Benchmarks organizational performance with national programs and referring organization(s) standards, Participates in or conducts data analysis as part of quality management (eg, QAPI); develops or contributes to report of outcomes, and provides recommendations, Analyzes data and synthesizes results of action plans in reaching customer and organization/program outcome goals; communicates to key stakeholders, Guides the development, testing, and redesign of organization/ program evaluation systems, Systematically improves processes of nutrition care and services by identifying problem areas and recommending new/updated quality/safe practices, Investigates and develops or improves system processes and programs that support best practices in nutrition; shares within PALTC community through presentations and publications, Understands and uses the SOP and SOPP for RDNs in PALTC Nutrition; identifies areas in own practice to target for additional learning and skill development for quality practice and advancement, Reviews and recommends, or updates organization/program policies, guidelines, and/or human resource materials reflecting the SOP SOPP for RDNs in PALTC Nutrition, other focus areas; seeks assistance and approvals if needed, Uses practice experience and knowledge to define specific actions for levels of practice (competent, proficient, expert) reflecting the SOP and SOPP for RDNs in PALTC Nutrition, Develops and/or facilitates staff orientation/training on corporate/ organizational policies, guidelines, human resources policies and resources (eg, job-related competencies, acceptable performance levels) using applicable SOP and/or SOPP and other relevant setting or population-specific resources as a guide, Displays professionalism and strives for improvement in practice (eg, manages change effectively; demonstrates assertiveness, listening, and conflict resolution skills; demonstrates ability to build coalitions), Documents examples of expanded professional responsibility reflective of level of practice (eg, QAPI leadership responsibilities, corporate-/system-level role(s), state and/or national advisory board participation). Standard definitions, rationale statements, core indicators, and examples of outcomes found in the Academy of Nutrition and Dietetics: Revised 2017 SOP in Nutrition Care and SOPP for RDNs have been adapted to reflect three levels of practice (competent, proficient, and expert) for RDNs in post-acute and long-term care nutrition (see figure below). RDNs operate within the directives of applicable federal and state laws and regulations, as well as policies and procedures established by the organization in which they are employed. A PALTC RDN uses a person-centered process to provide medical nutrition therapy for malnutrition, pressure injuries/ulcers, unintentional weight loss, specialized nutrition care for chronic conditions (eg, diabetes, chronic kidney disease, heart failure, dysphagia and neurological disorders), and/or post-surgical care and other nutrition and dietetics services (eg, management of clients/residents receiving enteral or parenteral nutrition and/or management of food/dining services) required between the hospital and returning home. US Department of Health and Human Services, Centers for Medicare and Medicaid Services. A qualitative approach was used to review advanced dietetic practice in Australia involving experienced professionals, mostly dietitians. Uses analytical and critical thinking skills to prioritize nutrition interventions and plans that: Uses knowledge of the population and environment to develop creative approaches for clients/residents with multiple or complex care issues to meet needs and preferences for desirable outcomes, Provides professional, technical, support personnel with information and guidance needed to complete assigned activities, Monitors accuracy and completion of activities to assure compliance with program/organization quality standards and applicable regulations, Collaborates with interprofessional team in the collection of pertinent data, such as changes in food and fluid intakes, labs, skin condition, advance directives, and weights, Coordinates data and insight from other interprofessional team members to reflect on client’s/resident’s progress and potential need for change in nutrition care, meal plan, and/or discharge/transitions of care plan, Client/resident preferences/informed choices influencing optimal nutritional outcomes (eg, declines thickened liquids), Understanding/comprehension of risks and benefits, Influencing factors or barriers affecting ability and/or willingness to implement and adhere to nutrition care plan (eg, living environment, psychosocial factors, emotional intelligence, cognitive impairment, change in mental or physical ability, financial status), Determines barriers to understanding that are present and impacting the client’s/resident’s/advocate’s acceptance of the nutrition intervention/plan of care, Reviews the medical record documentation and consults with interprofessional team to determine whether recommendations have been acted upon and, if not, reason/rationale documented, Observes and discusses with client/resident/advocate and consults with staff for input to gain ideas for adjusting interventions to achieve desired outcomes, Determines whether tools and methods need to be tailored to ensure desired outcomes, Reviews and evaluates assessment data and the PES statement(s) to identify indicators and data for monitoring consistent with resolving the nutrition diagnosis and/or for monitoring status, Uses multiple data sources to assess progress, Monitors food intake, changes in appetite, and decreased ADLs when evaluating for unintentional weight loss, Considers client/resident-centered outcomes (eg, quality of life, functional status, socialization), Examines comorbidities related to the nutritional needs of the client/resident when progress not achieved (eg, blood glucose outside goal range, non-healing pressure injury/ ulcer, continued unplanned weight loss), Documents progress in meeting desired goals (eg, weight gain or maintenance/loss, improved meal/snack/ supplement intake, increased physical activity), Evaluates positive and/or negative effects related to interventions, complex problems, and related comorbidities, Uses knowledge of the population, experience, and critical thinking in evaluating complex changes in condition, impact of interventions, and other factors on achievement of outcomes, Completes a comprehensive analysis of the indicators for each problem referencing protocols and reference standards, client’s/resident’s/advocate’s goals, and determines change in interventions as needed, Evaluates impact of client’s/resident’s right to self-determination and its effect on the planned interventions and achieving desired health outcomes and/or quality of life, Assesses need for continuation of interventions based on outcomes and clinical data (eg, weight now within normal limits necessitating re-evaluation of need for supplement) with interprofessional team, Completes analysis and trending of indicators to evaluate complexity of problems and correlates one problem to another using advanced clinical judgment skills (eg, dialysis client/resident on therapeutic diet who persistently frequents the vending machines), Evaluates subjective responses from client/resident/ advocate and interprofessional team members; uses critical thinking skills to identify progress consistent with goals and seeks assistance as needed, Recognizes problems that are beyond the scope of nutrition that are interfering with interventions and achieving desired outcomes; makes referrals or consults with interprofessional team to address issues, Leads discussions with interprofessional team to address needs and plans for client/resident with complex needs (eg, non-healing stage IV pressure ulcer), Monitors and interprets laboratory and other data that may reflect a change in the client/resident behavior or status, Evaluates factors (physical, social, cognitive, environmental) that may influence response to nutrition intervention and consults with interprofessional team as needed, Consults with interprofessional team when nutrition outcomes are not being achieved to gain ideas for addressing with client/resident/ advocate and potentially for adjusting nutrition plan, Adjusts intervention strategies such as change in living/care situation; seeks assistance, if needed, Educates/counsels client/resident/advocate on the risks and benefits of suggested changes, of refusal, and offers alternative interventions, Makes adjustments in unpredictable situations (eg, death of spouse/family member/close friend), Leads in analysis of data and discussions with interprofessional team when outcomes are not achieved to revise nutrition diagnosis and plan/interventions, Communications with physician and/or interprofessional team, Participates on state regulatory boards to create regulations that may impact future PALTC, Incorporates scope of practice, defined by state and federal rules and regulations, accreditation, or other applicable standards in PALTC; reviews and assures job description/contract specifications comply with defined scope of practice, identified role, and professional responsibilities, Follows scope of practice requirements related to additional credentialing or employment position (eg, Board Certification as a Specialist in Gerontological Nutrition [CSG], Board Certification as a Specialist in Renal Nutrition [CSR], and/or Certified Diabetes Educator [CDE]), Develops an understanding of the payment and reimbursement environment for PALTC settings (eg, Medicare and Medicaid Services). 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