The purpose of this Q&A is to serve as a resource for you to identify sources of risks in your practice and understand how to navigate these situations. While it is not possible to eliminate all risks in dietetics, dietitians have a duty to protect clients from risk of harm as much as possible.
In dietetics, a risk can be defined as a situation or action that involves exposure to danger, physical or mental harm (including financial), or loss to a client/patient and/or to the dietitian. Risks, even when unintended, have the potential to adversely influence a dietitian’s ability to provide safe and ethical patient-centred care. Risk can occur at any time when dietitians practice dietetics, as defined in legislation as the assessment of nutritional needs, design, implementation and evaluation of nutritional care plans and therapeutic diets, the science of food and human nutrition, and dissemination of information about food and human nutrition to attain, maintain and promote the health of individuals, groups and the community. Therefore, whenever health advice and nutrition care are being offered, there is room for miscommunication, misunderstandings, and mistakes.
Risk management is the process of analysing risks mitigating or prevent harm from occurring. Risk management considers how likely a risk is to occur, what the potential for harm is, its gravity, and identifies strategies and processes informed by data to respond to situations that may place clients at risk of harm. Managing risk applies to dietitians in all practice settings, stages, and years of experience.
There are multiple steps you can implement to identify, monitor, and manage risks in your practice.
  1. Analyse your practice context and identify risks
Questions to ask yourself:
  • What is the source of this risk? Is it related to self, work, or environmental?
  • Is this within my professional scope? My personal scope?
  • How urgent is this? How likely is an adverse event to happen?
  • What is the type of harm? The likelihood and frequency of harm? The severity and duration of harm?
  • Is the harm perceived or rational? Define the worst- and best-case scenarios and identify the likely outcome.
  1. Explore solutions which best protect against risk
Questions to ask yourself:
  • What is the impact of the risk?
  • What is my competence (skills, abilities, judgement) to address the risk?
  • Who could I ask for help (a person or a place with resources relevant to the risk)?
  • Could my action or inaction cause harm to my client or the public?
  • Do I have inherent bias that affect this situation? (This may translate to learning needs)
  • Are some protective strategies already in place to prevent/mitigate the risk?
  • Would the solution protect the client’s autonomy, respect, confidentiality, dignity, and access to information?
  • Would the solution increase safety, effectiveness of treatment?
  1. Choose and apply most relevant solutions to safe, ethical, client-centred care.
Questions to ask yourself:
  • Is this approach evidence-based, safe, ethical and client-centred?
  • If I have chosen that no action is my current response, can I demonstrate that I did not ignore or avoid the risk?
  • Have I effectively communicated and documented?
  1. Evaluation decision-making process and outcomes
Questions to ask yourself:
  • Was the risk minimized or removed?
  • What was the impact on the services/care delivered? Was safe, ethical, and client-centred care maintained?
  • Is there a gap in my knowledge and skills that need to be addressed to mitigate future risk?
  • If anything went wrong, what can I learn from this experience?
While not an exhaustive list, the following provides a sample of practice settings, contexts, and activities, to consider as sources of risk.

Your work place set up:

  • Eating disorders
  • Refeeding syndrome associated with different conditions
  • Malnutrition
  • Complex care: renal, dysphagia, diabetes (i.e., insulin adjustment, managing hypoglycemia)
  • Long-term care, ICU, transplant, surgery, medicine, psychiatric care
  • Food production and distribution for therapeutic diets such as allergies, dysphagia or low potassium

Self (Dietitian-specific or intra-individual):

  • Lack of competence, experience or training in a practice setting, lack of recognition of limits in competence in certain practice areas
  • Lack of confidence and/or motivation
  • Poor emotional or mental wellbeing (e.g., burnout, exhaustion, compassion fatigue)
  • Personal stressors that affect work performance (e.g., grief, trauma, financial hardship)
  • Not understanding scope of practice or professional boundaries
  • Refusal to seek assistance when needed or make appropriate referrals

Work environment:

  • Poor communication among colleagues
  • Outdated dietetic practice guidelines and protocols that do not reflect patient centred care and current evidence-based practice
  • Lack of workplace support for personal well-being (i.e., not prioritizing personnel physical and mental health) and time to integrate professional development into practice
  • Lack of mentorship and limited resources for learning opportunities
  • Increased patient and/or acuity caseload, short-staffed workplace, lack of workload coverage when needed

If you practice competently and safely, yet a complaint is filed against you, documentation is your best objective and reliable defence, rather than relying on verbal recall. If a risk is identified and managed, report which strategies you used to help inform others and prevent future risk of harm (and protect yourself in the case of an investigation or a complaint from a client). Record keeping helps you understand the situation fully, strengthens communication with other healthcare professionals, minimizes errors, and supports safe and client-centred care.

The ability to communicate effectively is essential to all dietitians, regardless of work setting. Involving team members in decision making whenever possible helps glean additional insight that may have not been previously considered. Honest and clear communication strengthens relationships and lessens chances for misunderstanding. Always obtain informed consent and confirm that your client understands your recommendations.

It sounds as though a lot of risk in dietetic practice can be mitigated by successfully identifying gaps in knowledge and working towards goals to fill those gaps. Dietitians go through this type of reflection on a regular basis.

With all the risk management aspect of the business in place your clients expect care, expertise, and a truly personal service which they may held you liable should they feel they did not receive the expected service or outcome. As a top priority, you need protection – just in case something goes wrong.

To ensure protection of your business and for you to have peace of mind you require Professional Indemnity for Medical Professionals. With our Medical Malpractice cover you will also be automatically covered for Professional Indemnity and Public Liability under one policy

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