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E XPLORING THE N UTRITION C ARE P ROCESS Roxanne Davis-Cote, MPH, RD, LD Beaufort Memorial Hospital.

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Presentation on theme: "E XPLORING THE N UTRITION C ARE P ROCESS Roxanne Davis-Cote, MPH, RD, LD Beaufort Memorial Hospital."— Presentation transcript:

1 E XPLORING THE N UTRITION C ARE P ROCESS Roxanne Davis-Cote, MPH, RD, LD Beaufort Memorial Hospital

2 N UTRITION C ARE P ROCESS Today’s Objectives: Describe the 4 Components of the Nutrition Care Process (NCP) Devise a nutrition diagnostic statement in the PES format using standardized language Prepare at least 1 measurable goal that would positively affect the nutrition diagnosis identified by the interventions implemented

3 N UTRITION C ARE P ROCESS Acronym for components: ADIME Assessment (A) Diagnosis (nutrition diagnosis) (D) Intervention (I) Monitor/Evaluate (M/E)

4 A SSESSMENT In-depth review of the medical record Effective interviewing of patient, caregiver, family, groups (when appropriate) Attention to nutrition-focused physical findings Collaboration with other health care providers for additional insight

5 A SSESSMENT Domains to Review Food/Nutrition Related History Anthropometric Measurements (wt, ht, BMI, growth patterns, wt history) Biochemical Data, Medical Tests, Procedures (labs, medications, procedures) Nutrition-Focused Physical Findings (findings from evaluation of body systems to include muscle and subcutaneous fat wasting, oral health, suck/swallow/breath ability, appetite, affect) Client History (past medical history, social history, pertinent procedures)

6 A SSESSMENT Critical thinking during this step Determine necessary data to collect Distinguish between relevant and irrelevant information Validate the data Determine need for any additional information Select appropriate assessment tools Apply assessment tools in reliable and valid ways Ex: Predictive equations vs. Indirect calorimetry Nutrition Care Indicators

7 N UTRITION C ARE I NDICATORS Defined markers that can be observed and measured Incorporated in the Assessment Domains Ex: Food/Nutrition Related History: food/nutrient intake, medications, food/nutrition-related knowledge, food access, functional capabilities Determines what will be measured

8 D IAGNOSIS Nutrition Diagnosis (PES Format) “The identification and labeling of the specific nutrition problem that food and nutrition professionals are responsible for treating independently”- IDNT Reference Manual 3 rd Edition

9 D IAGNOSIS PES Statement Problem: Required to use EXACT WORDING as Standardized Language Actual or Predicted 5 New Diagnoses added using the word “predicted” Predicted Suboptimal Energy Intake (NI-1.6) Predicted Excessive Energy Intake (NI-1.7) Predicted Suboptimal Nutrient Intake (NI ) Predicted Excessive Nutrient Intake (NI ) Predicted Food-Medication Interaction (NC-2.4)

10 D IAGNOSIS Etiology: Explains WHY the Problem exists Do NOT need to use exact wording from IDNT references Can use another diagnosis (but if done, MUST use standardized language) Signs/Symptoms: Gives Proof as to why a nutrition problem exists Measurable data Potential outcome data

11 D IAGNOSIS Determining the Nutrition Diagnosis 3 Domains: Intake, Clinical, Behavior-Environmental When there are 2 equally acceptable choices for a problem from 2 different domains, choose from the intake domain The Intake Domain will likely have a nutritional etiology therefore likely will have a nutrient-directed intervention

12 D IAGNOSIS Considerations for determining Nutrition Problem: Assessment data Is there anything nutritionally abnormal? What can you as a dietitian affect? Go over the problem using your own words

13 D IAGNOSIS Examples: Inadequate oral intake related to (r/t) decreased appetite and mouth sores as evidenced by (AEB) pt eating <50% meals and often skipping meals Inadequate Enteral Nutrition (EN) infusion r/t nausea and vomiting AEB frequent feeding interruptions, 5 episodes of vomiting yesterday, and <50% infusion goal met over the past 3 days

14 P RACTICE T IME Formulate a Diagnosis Statement in the PES format using Standardized Language Split up into groups Review Case Study in your area 10 minutes Choose someone to present your diagnosis statement

15 I NTERVENTION The nutrition-related plan designed to improve the nutrition diagnosis/etiology/signs and symptoms 1 st step is Nutrition Prescription: Individualized statement of needs the patient has at a given moment May be adjusted as clinical picture changes Examples: 1800kcal, 65g protein/day Intake of 2gm K+/day Can include preventative interventions The main heading MUST use the standardized language

16 I NTERVENTION Examples: Meals and Snacks: Continue current diet. Will send snacks tid. Medical Food Supplements: recommend addition of oral supplement 2 times/day Vitamin and Mineral Supplements: MD please consider addition of MVI daily Nutrition-Related Medication Management: consider addition of appetite stimulant

17 M ONITOR /E VALUATE Helps the nutrition professional to determine whether there has been any progress made in the patient/client nutrition status and whether goals/expected outcomes are being met Monitors progress towards goals Compares nutrition care indicators against the patient’s baseline or evidence-based indicators

18 M ONITOR /E VALUATE 3 Steps to M/E: Monitor: Provide evidence showing if nutrition interventions are improving patient nutrition behavior or status Measure: Collect data on appropriate nutrition care indicators Evaluate: Compare current findings with previous nutrition information, goals, or reference standards and evaluate the impact of each intervention using measurable nutrition outcome indicators

19 M ONITOR /E VALUATE Characteristics of M&E: Measurable: Use of evidence-based standards or guidelines Related to PES Statement Guides nutrition intervention planning Communicates expected outcomes Patient-centered and individualized At least 1 goal for each nutrition diagnosis

20 M ONITOR /E VALUATE Examples: Weight: patient to maintain wt of ___+/- 2kg Liquid Meal Replacement or supplement: Patient will drink ____oral supplements/day Food and Beverage Intake: Patient will eat % of 3 meals/day Enteral Nutrition Intake: Patient will reach goal infusion rate within 24 hours

21 P RACTICE Identify at least 1 intervention be for the nutrition problem you diagnosed Review Same Case study Prepare at least 1 measurable goal that would positively affect the nutrition diagnosis identified by the intervention(s) implemented

22 R EASSESSING N UTRITION S TATUS Ways to document progress of a Nutrition Diagnosis in Reassessment Nutrition Diagnosis Progress Report Monitoring and Evaluating Data under Assessment- documented in assessment portion of note

23 R EASSESSING N UTRITION S TATUS Nutrition Diagnosis Progress Report Progress explained in the PES statement using words such as: Improved or progress toward resolution Continues or ongoing Resolved Worsened No progress No longer applicable

24 R EASSESSING N UTRITION S TATUS Monitoring and Evaluating: Evaluates progress towards goals How effective have the interventions been? M&E standards may change in reassessment Goals change according to evolving conditions Has initial diagnosis resolved but a new one developed? When a nutrition diagnosis is resolved, drop it in the next reassessment In Reassessments, designate new nutrition diagnosis under New Nutrition Diagnosis heading

25 W ORKING NCP INTO Y OUR P RACTICE How Can I incorporate NCP into the way I currently document? ADIME Assess, Diagnose, Intervene, Monitor, Evaluate PGIE (Problem, Goal, Intervention, Evaluation): Problem: PES Statement Goal: Nutrition Prescription Intervention: Nutrition Intervention/goal Evaluate: Evaluate SOAP S: Food/Nutr Related history, Any other data if self-reported O: Biochemical data, medical tests (data documented by RD or found in medical record) A: Comparative Standards Nutrition Diagnosis P:Intervention Monitor/Evaluate PIE (Problem, Intervention, Evaluation) P: PES Statement I: Nutrition Intervention E: Evaluation


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