The Nutrition Care Process is a systematic method that dietetics and nutrition professionals use to provide nutrition care. It is comprised of four steps: nutrition assessment and reassessment, nutrition diagnosis, nutrition intervention and nutrition monitoring and evaluation.
Use of the Nutrition Care Process does not mean that all patients get the same care. Rather, the Nutrition Care Process provides a framework for practitioners to customize care — taking into account the client's needs and values and using the best evidence available to make decisions. Use of the Nutrition Care Process can lead to more efficient and effective care, nutrition research and greater recognition of the role of credentialed nutrition and dietetics practitioners in all settings.
The Nutrition Care Process Model
The Nutrition Care Process Model is a visual representation of the Nutrition Care Process that illustrates the workflow of practitioners in diverse individual and population care delivery settings. It shows the steps of the Nutrition Care Process, as well as internal and external factors that impact application of the Nutrition Care Process. Three themes are reflected in the Nutrition Care Process:
- use of concise language
- promotion of professionals' responsibility for outcomes management
- support for people-centered care
Nutrition Care Process Terminology (NCPT)
In order to clearly communicate the impact on individual client and population care, the Academy is dedicated to a standardized language that captures the specifics of what the nutrition and dietetics profession does — ensuring that practitioners can articulate the exact nature of nutrition problems and specifically describe what interventions were accomplished, along with the goals and approaches. Using a standardized language gives the ability to explore and understand the links between nutrition problems, interventions used and the associated outcomes. The CPT was developed with broad global input from professionals and researchers and contains more than 2,000 terms categorized to describe the four steps of the nutrition care process. Most of the terms have been mapped and modeled for inclusion in SNOMED CT (Systematized Nomenclature of Medicine—Clinical Terms) and LOINC® (Logical Observation Identifiers Names and Codes), which are clinical standardized terminologies in use in the United States and around the world in electronic health records. Designed for use in the electronic health record, the NCPT provides specific terminology for data collection, nutrition research, and documentation of quality measures.
The electronic Nutrition Care Process Terminology (eNCPT) is an online publication containing a narrative explanation of the Nutrition Care Process. Subscribers of the eNCPT have access to the most up-to-date terminology used in nutrition care, as well as reference sheets that provide clear definitions and explanation of all terms, including indicators, criteria for evaluation, etiologies, and signs and symptoms. Access to the E H R Toolkit is an added resource that is available as well for subscribers.
Nutrition Care Process Quality Evaluation & Standardization Tool (NCP QUEST)
The NCP QUEST is an audit tool used to evaluate dietitian documentation notes using the Nutrition Care Process. Developed through a joint study by the Academy and Advancing Practice Nutrition Consultants (APNC) of US Veterans Affairs, the NCP QUEST evaluates all components and links, especially outcomes as a result of continuous care (via evaluation of the full monitoring and evaluation step), new elements of the NCP Terminology such as status labels, and explicit documentation of the etiology category. The tool has high content validity, which suggests its usefulness in improving accuracy in charting and helping to ensure quality data collection. In conjunction with a comprehensive manual, the NCP QUEST can be used as a practical rubric to apply or teach the Nutrition Care Process effectively.
Are RDNs and NDTRs required to use the Nutrition Care Process?
The Standards of Practice in Nutrition Care and Standards of Professional Performance for RDNs and NDTRs include the use of the Nutrition Care Process. Per the Centers for Medicare & Medicaid Services’ Condition of Participation: Food and Dietetic Services that a qualified dietitian supervising aspects of nutrition care must maintain professional standards of practice. The CMS interpretive guidelines outline dietitian responsibilities incorporating the Nutrition Care Process. The Academy works with a number of accreditation organizations — such as DNV GL Healthcare Accreditation, the Accreditation Commission for Health Care and The Joint Commission — to use the Nutrition Care Process in guiding survey evaluation of dietetic services’ standards and elements of performance. In addition, the Nutrition Care Process and Model are an integral part of dietetics education and credentialing criteria for the RDN and NDTR exams.
Does the Nutrition Care Process only apply to clinical practitioners?
Based on the scientific problem solving method, the Nutrition Care Process and Model’s primary use is for the practitioner. As a framework used for critical thinking and decision making, the Nutrition Care Process can be utilized by RDNs in all work settings — including clinical, management, food service, research, community health and education. Every member of the profession should be able to articulate the Nutrition Care Process and Model, which describes what nutrition and dietetics practitioners do every day.
Does the Nutrition Care Process affect charting?
The Nutrition Care Process can be used in any charting or documentation system. For example, many RDNs are using the ADI or ADIME format, which directly parallels the Nutrition Care Process. RDNs may not always have the authority to change the format for documentation; however, using the Nutrition Care Process allows RDNs to focus their chart notes and make documentation more concise.