Embracing the international agenda 
                The Nutrition Care Process 
      Vera Todorovic 
      Consultant Dietitian 
      Doncaster and Bassetlaw Hospitals NHS Foundation Trust 
      Vera.todorovic@dbh.nhs.uk 
      11/12 
                                 Linking the processes 
             
       Nutrition care process 
       Nutrition diagnosis (Problem Etiology Signs and 
            symptoms (PES) statements ) 
       IDNT terminology 
             
       •    To standardise the processes that are used for describing the nutritional activities  
            relating to patient /client care so that information and data gathered during these 
            processes are clear ,consistent and meaningful. 
       •    To ensure that referring agents have a robust summary of the nutritional activities 
            and course of action taken with patients /clients they have referred  
             
             
      But this isn’t anything new is it? 
   No but……. 
    
    We haven't always used the same words to describe things 
       (standardised language- IDNT ) 
        
    We haven't always ‘named’ the nutrition problem that we are trying to treat 
       (nutrition diagnosis) 
        
    We haven't always structured our documentation to clearly link the assessment data to a 
     ‘problem’   
       (Nutrition Assessment Terms, PES (Problem,Etiology,Signs and Symptoms ) Statement 
       and Intervention Terms) 
       
    We haven't always identified what signs and symptoms we expected to change based on our 
     intervention 
      
    Our notes don’t always articulate whether the problem has improved or been resolved 
     according to our plan. 
       (Intended outcomes, Monitoring and Evaluation – Terminology )  
                                                                                                                          ADA Nutrition Care Process and model                                                                                                                                                              
                                                                                                                                                                                                                                                                                                                                                                        
                                                                  
                              
                         
                                                                      
                                                        
                                                                                                                                                                                                    Nutrition Diagnosis 
                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                          
                                                                                                                                                                                                          Identify  and label problem 
                                                                                                                        Nutrition Assessment                                                                                                            
                                                                                                                                                                
                                                                                                                                                                                                     Determine cause/contributing risk  
                                                                                                                                                                                                        
                                                                                                                             Obtain/collect timely and  
                                                                                                                                                                                                     factors    
                                                                                                                                                                                                                      
                                                                                                                          appropriate  data                                                                             
                                                                                                                                                        
                                                                                                                                                          
                                                                                                                                                                                                     
                                                                                                                                                                                                          Cluster signs and symptoms/  
                                                                                                                                                                                                        
                                                                                                                             Analyze/interpret with  
                                                                                                                                                                                                          defining characteristics     
                                                                                                                          evidence -         based standards   
                                                                                                                                                                                                   
                                                                                                                                                                                                       Document  
                                                                                                                                                                                                        
                                                                                                                                                                                                                          
                                                                                                                          Document 
                                                                                                                                              
                                                                                                                                
                                                                                                                                                                     Relationship   
                                                                                                                                                                        Between   
                                                                                                                                                                    
                                                                                                                                                                     
                                                                                                                                                                   Patient/Client/Group                                         Nutrition Intervention   
                                                                                                                                                                                                                                                                                  
                                                                                                                                                                      Dietetics                                                  Plan nutrition intervention 
                                                                                                                                                              &                            
                                                                                                                                                                                                                                 •   
                                                                                                                                                                       Professional                                                      Formulate goals and  
                                                                                                                                                                                                   
                                                                                                                                                                                                   
                                                                                                                                                                                                                                                                                      
                                                                                                                                                                                                                                          determine a plan of action 
                                                                                                                                                                                                                                 Implement the nutrition intervention 
                                                                                                                                                                                                                                                                                             
                                                                                                           Nutrition Monitoring and                                                                                              •      Care is delivered and actions  
                                                                                                                                                                                                                                                    - 
                                                                                                                                                                                                                                                       
                                                                                                       Evaluation                                                                                                                       are carried out   
                                                                                                           Monitor progress                                                                                                    Do cumen t 
                                                                                                           Measure outcome indicators                                                                                        
                                                                                                           Evaluate outcomes   
                                                                                                          Document