Linking Quality and Measurement

Linking Quality and Measurement Nutrition and dietetics practice must balance various aspects of quality. Linking Quality and Measurement

Nutrition and dietetics practice must balance various aspects of quality, especially when directing and leading evaluation of quality measurement and improvement in performance to meet national health objectives and when ensuring that RDNs and NDTRs are quality providers of care, treatment and services.

The RDN cannot manage and improve what he or she does not measure.

Quality nutrition and dietetics practice encompasses the six pillars of quality care as outlined by the Institute of Medicine. Health care providers and organizations coordinate care that is:

  • Safe
  • Effective
  • Patient/Person-Centered
  • Timely
  • Efficient
  • Equitable

Resources to consider for hospital practitioners when delivering nutrition and dietetic services to the patients.

Definitions

Quality Management:

Quality management is a systematic process with identified leadership, accountability, and dedicated resources for the purpose of meeting or exceeding established professional standards.

Quality management ensures that an organization, product or service is consistent. It has four main components: quality planning, quality assurance, quality control and quality improvement. Quality management is focused not only on product and service quality, but also on the means to achieve it. Quality management, therefore, uses quality assurance and control of processes as well as products to achieve more consistent quality.

Nutrition Care Process:

The Nutrition Care Process is a systematic approach to providing high quality nutrition care. The NCP consists of four distinct, interrelated steps: Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention and Nutrition Monitoring and Evaluation.

Nutrition Screening:

Nutrition screening is the process of identifying patients, clients, or groups who may have a nutrition diagnosis and benefit from nutrition assessment and intervention by an RDN. Patients/clients enter nutrition assessment, the first step of the NCP, through screening, surveillance systems data and/or referral, all of which are outside of the NCP.

Nutrition Assessment:

Nutrition assessment is a systematic method for obtaining, verifying and interpreting data needed to identify nutrition-related problems, their causes and significance.

Nutrition Diagnosis:

A nutrition diagnosis identifies a nutrition problem that a food and nutrition professional is responsible for treating independently.

Nutrition Intervention:

Nutrition intervention is purposefully planned actions intended to positively change a nutrition-related behavior, environmental condition or aspect of health status for the patient/client (and his/her family or caregivers), target group or the community at large.

Nutrition Monitoring and Evaluation:

Nutrition monitoring is the preplanned review and measurement of selected nutrition care indicators of patient/client's status relevant to the defined needs, nutrition diagnosis, nutrition intervention and outcomes. Nutrition evaluation is the systematic comparison of current findings with the previous status, nutrition intervention goals, effectiveness of overall nutrition care or a reference standard.

SOP and SOPP

These excerpts from the SOP in Nutrition Care for RDNs and SOP in Nutrition Care for NDTRs that may be utilized by RDNs and NDTRs to demonstrate the NCP and nutrition screening and other selection methods in accomplishing best hospital patient identification for completing a comprehensive assessment, intervention and plan of care with follow-up re-assessments.

Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitians

"The RD assigns duties to the DTR that are consistent with the DTR's individual scope of practice. For example, the DTR might initiate standard procedures, such as completing and following up on nutrition screening for assigned units/patients; performing routine activities based on diet order, policies, and procedures; completing the intake process for a new clinic client; and reporting to the RD when a patient's/client’s data suggest the need for a nutrition assessment. The DTR actively participates in nutrition care by contributing information and observations, guiding patients/clients in menu selections, providing nutrition education on prescribed diets, and reporting to the RD on the patient's/client's response, including documenting outcomes or providing evidence signifying the need to adjust the nutrition care plan."

Revised 2012 Standards of Practice in Nutrition Care and Standards of Professional Performance for Dietetic Technicians, Registered

"The RD may assign certain tasks for the purpose of attaining needed information (e.g., screening data, diet history) or communicating with and educating patients. An RD may assign to DTRs interventions within their scope of practice and demonstrated competence, such as nutrition education, monitoring consumption of meals and medical food supplements and referring patients/clients to community agencies and programs. The DTR and other support, administrative and technical staff can contribute valuable information and observations to the RD that supports quality patient/client-centered care."

Standards of Practice for Dietetic Technicians, Registered in Nutrition Care

Standard 1: Participates in Nutrition Screening and Provides Support to Nutrition Assessment

"The dietetic technician, registered (DTR) participates in the nutrition screening of patients/clients and populations and obtains and verifies relevant data and information for support of nutrition assessment under the supervision of the registered dietitian (RD)."

Rationale:

"Nutrition screening is the preliminary step that precedes the first step of the Nutrition Care Process – nutrition assessment. Although nutrition assessment and reassessment is the responsibility of the RD, the DTR takes an active role in obtaining and verifying relevant data and information for the RD to complete the assessment."