RE: The Nutrition Care Process and Model

[Guest guest]

Tried reading it, didn't get far, waiting for a couple of my RDs to attend a

workshop at the California Dietetic Assoc Annual meeting and then we'll decide

how to implement.

Digna Cassens, MHA, RD

http://groups.msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

The Nutrition Care Process and Model

Has anyone read through the 292 pages of " Nutrition Diagnosis and

Intervention: Standardized Language for the Nutrition Care Process " ? This is

located on the American Dietetic Association website. Have you adopted this in

your practice?

Margie Hirsch,MFCS,RD,LD

---------------------------------

Get your own web address.

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[Guest guest]

Yes (the Nutrition Diagnosis part) and Yes (the Nutrition Diagnosis part).

In fact, I'll be presenting a 2 hour workshop at our state's annual meeting

later this month (gasp!!!!) and then at the southern district in June.

We'll be adding the Nutrition Intervention part next year.

Margie Hirsch wrote:

Has anyone read through the 292 pages of " Nutrition Diagnosis and

Intervention: Standardized Language for the Nutrition Care Process " ? This is

located on the American Dietetic Association website. Have you adopted this in

your practice?

.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

Nevada Dietetic Association President 2006-2007

Las Vegas, NV www.nevadard.org

---------------------------------

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[Guest guest]

I attended a workshop, but have not considered implementing it. However, I

recently participated in an ADA-reaccreditation site visit for my internship and

we had the opportunity to ask questions from the ADA site visitors. One of the

questions was regarding a time frame as to when we should get serious about

implementing this. Their advice was to " hold off " because things are always

changing, and things may be different by the time it is mandated that we start

using the Nutrition Care Process.

So, who knows. I think the new model can really help RDs, especially those in

the hospital setting. But, as for myself, I work in corporate wellness and I

haven't made any changes yet.

Jillian McMullen, RD, LDN

hl brewer wrote: Yes (the

Nutrition Diagnosis part) and Yes (the Nutrition Diagnosis part).

In fact, I'll be presenting a 2 hour workshop at our state's annual meeting

later this month (gasp!!!!) and then at the southern district in June.

We'll be adding the Nutrition Intervention part next year.

Margie Hirsch wrote:

Has anyone read through the 292 pages of " Nutrition Diagnosis and

Intervention: Standardized Language for the Nutrition Care Process " ? This is

located on the American Dietetic Association website. Have you adopted this in

your practice?

.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

Nevada Dietetic Association President 2006-2007

Las Vegas, NV www.nevadard.org

---------------------------------

Bored stiff? Loosen up...

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[Guest guest]

Read it and worked on the committee that developed it. The NCP is

nothing new for dietetics practice. We've assessed nutrition status

since the mid-1970s, identified a " problem " , done something, and then

monitored. What the process does is put it on paper and say to the

world that yes, RDs can become a diagnosing profession. That elevates

us to the level of the other diagnosing professions. Not a bad deal.

Will it increase your salary tomorrow? No. Only you can do that. Will

it improve your image? No, only you can do that.

I've done workshops on the NCP across the country. Next week I'll be

in Albany NY and Little Rock, AR then will be in Idaho the following

week.

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Seattle, WA

> Yes (the Nutrition Diagnosis part) and Yes (the Nutrition Diagnosis

> part).

> In fact, I'll be presenting a 2 hour workshop at our state's annual

> meeting later this month (gasp!!!!) and then at the southern

> district in June.

>

> We'll be adding the Nutrition Intervention part next year.

>

>

> Margie Hirsch wrote:

> Has anyone read through the 292 pages of " Nutrition Diagnosis and

> Intervention: Standardized Language for the Nutrition Care

> Process " ? This is located on the American Dietetic Association

> website. Have you adopted this in your practice?

>

> .

>

> Holly Lee Brewer, MS RD CDE

> Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

> Nevada Dietetic Association President 2006-2007

> Las Vegas, NV www.nevadard.org

>

> ---------------------------------

> Bored stiff? Loosen up...

> Download and play hundreds of games for free on Yahoo! Games.

>

>

[Guest guest]

What interesting comments coming straight from ADA! Gives me even more to think

about before considering implementation. I dread the amount of training to be

done, and in the meantime, the exposure for the company and risk to the

resident. Certainly productivity will suffer as everyone learns also.

Digna Cassens, MHA, RD

http://groups.msn.com/RDForum

Start by doing what's necessary, then what's possible, and suddenly you are

doing the impossible. St. Francis Assis

Re: The Nutrition Care Process and Model

I attended a workshop, but have not considered implementing it. However, I

recently participated in an ADA-reaccreditation site visit for my internship and

we had the opportunity to ask questions from the ADA site visitors. One of the

questions was regarding a time frame as to when we should get serious about

implementing this. Their advice was to " hold off " because things are always

changing, and things may be different by the time it is mandated that we start

using the Nutrition Care Process.

So, who knows. I think the new model can really help RDs, especially those in

the hospital setting. But, as for myself, I work in corporate wellness and I

haven't made any changes yet.

Jillian McMullen, RD, LDN

hl brewer wrote: Yes (the Nutrition Diagnosis part) and

Yes (the Nutrition Diagnosis part).

In fact, I'll be presenting a 2 hour workshop at our state's annual meeting

later this month (gasp!!!!) and then at the southern district in June.

We'll be adding the Nutrition Intervention part next year.

Margie Hirsch wrote:

Has anyone read through the 292 pages of " Nutrition Diagnosis and

Intervention: Standardized Language for the Nutrition Care Process " ? This is

located on the American Dietetic Association website. Have you adopted this in

your practice?

.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

Nevada Dietetic Association President 2006-2007

Las Vegas, NV www.nevadard.org

---------------------------------

Bored stiff? Loosen up...

Download and play hundreds of games for free on Yahoo! Games.

[Guest guest]

What's the exposure to the company and risk to the resident from

using a standardized care process? I suggest you read " To Err is

Human " to see other information about the issues you discuss.

Implementation of the NCP should decrease the risk to the resident

and exposure for the company.

Respectfully,

Pam

> What interesting comments coming straight from ADA! Gives me even

> more to think about before considering implementation. I dread the

> amount of training to be done, and in the meantime, the exposure

> for the company and risk to the resident. Certainly productivity

> will suffer as everyone learns also.

>

> Digna Cassens, MHA, RD

> http://groups.msn.com/RDForum

> Start by doing what's necessary, then what's possible, and suddenly

> you are doing the impossible. St. Francis Assis

>

> Re: The Nutrition Care Process and Model

>

> I attended a workshop, but have not considered implementing it.

> However, I recently participated in an ADA-reaccreditation site

> visit for my internship and we had the opportunity to ask questions

> from the ADA site visitors. One of the questions was regarding a

> time frame as to when we should get serious about implementing

> this. Their advice was to " hold off " because things are always

> changing, and things may be different by the time it is mandated

> that we start using the Nutrition Care Process.

>

> So, who knows. I think the new model can really help RDs,

> especially those in the hospital setting. But, as for myself, I

> work in corporate wellness and I haven't made any changes yet.

>

> Jillian McMullen, RD, LDN

>

> hl brewer wrote: Yes (the Nutrition Diagnosis

> part) and Yes (the Nutrition Diagnosis part).

> In fact, I'll be presenting a 2 hour workshop at our state's annual

> meeting later this month (gasp!!!!) and then at the southern

> district in June.

>

> We'll be adding the Nutrition Intervention part next year.

>

> Margie Hirsch wrote:

> Has anyone read through the 292 pages of " Nutrition Diagnosis and

> Intervention: Standardized Language for the Nutrition Care

> Process " ? This is located on the American Dietetic Association

> website. Have you adopted this in your practice?

>

> .

>

> Holly Lee Brewer, MS RD CDE

> Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

> Nevada Dietetic Association President 2006-2007

> Las Vegas, NV www.nevadard.org

>

> ---------------------------------

> Bored stiff? Loosen up...

> Download and play hundreds of games for free on Yahoo! Games.

>

>

[Guest guest]

Pam,

I'm concerned about the learning curve for the RDs that will transition to the

new process and what happens in the meantime. Since we are not skilled in this

area, the consultants that audit, train and mentor, will be at a disadvantage;

we've just not practiced it sufficiently ourselves to be well versed in it, so

how are we going to audit? And during the transition process, how is

productivity affected? If it is, either everyone will be working overtime, or

some evals may be late in getting done. That is a risk to residents and exposure

for the company if it does happen. Furthermore, I wonder about the error rate we

may experience at the beggining. These concerns are not only mine; they're a

consolidated summary of concerns expressed by many of my RDs when we've

discussed the subject.

I'd appreciate some guidance from those that have already implemented the

process and I might not be as worried about it then. However, if this proces

too may change, then I question the benefits of making the effort.

I'm not sure about your reading suggestion. Where do I find it?

Digna

Re: The Nutrition Care Process and Model

>

> I attended a workshop, but have not considered implementing it.

> However, I recently participated in an ADA-reaccreditation site

> visit for my internship and we had the opportunity to ask questions

> from the ADA site visitors. One of the questions was regarding a

> time frame as to when we should get serious about implementing

> this. Their advice was to " hold off " because things are always

> changing, and things may be different by the time it is mandated

> that we start using the Nutrition Care Process.

>

> So, who knows. I think the new model can really help RDs,

> especially those in the hospital setting. But, as for myself, I

> work in corporate wellness and I haven't made any changes yet.

>

> Jillian McMullen, RD, LDN

>

> hl brewer wrote: Yes (the Nutrition Diagnosis

> part) and Yes (the Nutrition Diagnosis part).

> In fact, I'll be presenting a 2 hour workshop at our state's annual

> meeting later this month (gasp!!!!) and then at the southern

> district in June.

>

> We'll be adding the Nutrition Intervention part next year.

>

> Margie Hirsch wrote:

> Has anyone read through the 292 pages of " Nutrition Diagnosis and

> Intervention: Standardized Language for the Nutrition Care

> Process " ? This is located on the American Dietetic Association

> website. Have you adopted this in your practice?

>

> .

>

> Holly Lee Brewer, MS RD CDE

> Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

> Nevada Dietetic Association President 2006-2007

> Las Vegas, NV www.nevadard.org

>

> ---------------------------------

> Bored stiff? Loosen up...

> Download and play hundreds of games for free on Yahoo! Games.

>

>

[Guest guest]

" To Err is Human " is the initial report from the late 1990's that

discussed problems with patient safety and made suggestions for

addressing said problems.

I'm not surprised your staff are reluctant. Change is hard and noone

likes to change. Yes, it does take some time to get to speed, but

you'll find that following implementation, productivity actually

increases as RDs are more focused and able to get to the heart of the

problem faster. What error rate are you worried about? Are they

perfect now?

I'd suggest taking the time to learn the process yourself and then

make some decisions. How are you going to be well-versed if you don't

take some time to learn it?

> Pam,

>

> I'm concerned about the learning curve for the RDs that will

> transition to the new process and what happens in the meantime.

> Since we are not skilled in this area, the consultants that audit,

> train and mentor, will be at a disadvantage; we've just not

> practiced it sufficiently ourselves to be well versed in it, so how

> are we going to audit? And during the transition process, how is

> productivity affected? If it is, either everyone will be working

> overtime, or some evals may be late in getting done. That is a risk

> to residents and exposure for the company if it does happen.

> Furthermore, I wonder about the error rate we may experience at the

> beggining. These concerns are not only mine; they're a consolidated

> summary of concerns expressed by many of my RDs when we've

> discussed the subject.

>

> I'd appreciate some guidance from those that have already

> implemented the process and I might not be as worried about it

> then. However, if this proces too may change, then I question the

> benefits of making the effort.

>

> I'm not sure about your reading suggestion. Where do I find it?

>

> Digna

>

> Re: The Nutrition Care Process and Model

> >

> > I attended a workshop, but have not considered implementing it.

> > However, I recently participated in an ADA-reaccreditation site

> > visit for my internship and we had the opportunity to ask questions

> > from the ADA site visitors. One of the questions was regarding a

> > time frame as to when we should get serious about implementing

> > this. Their advice was to " hold off " because things are always

> > changing, and things may be different by the time it is mandated

> > that we start using the Nutrition Care Process.

> >

> > So, who knows. I think the new model can really help RDs,

> > especially those in the hospital setting. But, as for myself, I

> > work in corporate wellness and I haven't made any changes yet.

> >

> > Jillian McMullen, RD, LDN

> >

> > hl brewer wrote: Yes (the Nutrition Diagnosis

> > part) and Yes (the Nutrition Diagnosis part).

> > In fact, I'll be presenting a 2 hour workshop at our state's annual

> > meeting later this month (gasp!!!!) and then at the southern

> > district in June.

> >

> > We'll be adding the Nutrition Intervention part next year.

> >

> > Margie Hirsch wrote:

> > Has anyone read through the 292 pages of " Nutrition Diagnosis and

> > Intervention: Standardized Language for the Nutrition Care

> > Process " ? This is located on the American Dietetic Association

> > website. Have you adopted this in your practice?

> >

> > .

> >

> > Holly Lee Brewer, MS RD CDE

> > Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

> > Nevada Dietetic Association President 2006-2007

> > Las Vegas, NV www.nevadard.org

> >

> > ---------------------------------

> > Bored stiff? Loosen up...

> > Download and play hundreds of games for free on Yahoo! Games.

> >

> >

[Guest guest]

Digna Cassens wrote:

What interesting comments coming straight from ADA! Gives me even more

to think about before considering implementation. I dread the amount of training

to be done, and in the meantime, the exposure for the company and risk to the

resident. Certainly productivity will suffer as everyone learns also.

Digna Cassens, MHA, RD

.

_._,___

The NCP doesn't change what you do. We continue to assess,

implement/intervention, monitor and follow/reassess! As Pam said, it allows us

to diagnose within the realm of nutrition (we do not diagnose any medical

problem, but we can diagnose a nutrition problem) and standardize the

terminology so we are more consistent from institution to institution (whether

you are hospital, outpatient or private practice). The codes right now can help

in tracking the type of problems you are dealing with (or you can just ignore

the coding all together).

There is NO risk to the patient/client. While initially you might take a few

extra minutes to figure out your wording, I have found my charting time is less

because I'm not worried about validating my nutritional status/risk assignment.

I just state my problem, etiology and signs/symptoms. Then state my goal

(related to improving the signs/symptoms or resolving the problem) with my

intervention (addressing the etiology). In a few weeks or months, I have a

handful of statements I find myself using over and over again so it's a much

faster documentation process.

Again, I don't change WHAT I do, nor how I provide the care I was always

doing. The change is in ONE sentence that starts my Assessment portion of my

institutions SOAP note.

Many of us provide nutrition education (both in and outpt) - and it's often

the same subject matter. You can create a standardized form with " Knowledge

deficit " as the nutrition dx and the intervention as a check off list (of course

include some blank lines for individualized needs). So there are applications

in the corporate wellness or healthclub setting. The USAF has already adopted

the NCP in all of their inpt & outpt templates.

What ADA is saying - this is like a new medication. You have your initial

test (small number of subjects making sure the drug won't have any nasty side

effects), then you have the next phase to see if it is effective, and what is

the effective dose. Then you release it and see what happens with large numbers

of folks using it. If there are any problems, you re-evaluate the recipe and

make adjustments. We are currently in that last phase. The more people who

start using it, the better it will become as we figure out what really works and

what doesn't. Are we missing some nutrition diagnoses that don't fit within any

other? (That is something that is being discussed within the Pediatric Dietetics

community). I'm sure the next version of the text " purple book " might have a

few new diagnoses.

When I was an intern I remember being taught (thanks Pam!!!) we should always

have a goal in our plan. But I have noticed in my career that other RDs haven't

been doing that. I know that when nurses give a pain med, they have to document

the effect. When we provide a nutrition internvention, shouldn't we also

document the effect? Well, what effect do you want to have? That should be

your goal. Now we have a more standardized approach that makes it easier for

another RD to understand the goal for your intervention (if someone else

re-assesses a patient you previously saw). The first line in my Plan is always

my goal (even something as simple as " Tol adequate Nutrition " - which is

appropriate for any " inadequate intake " diagnosis).

Change is hard. But it isn't always bad.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

Nevada Dietetic Association President 2006-2007

Las Vegas, NV www.nevadard.org

---------------------------------

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[Guest guest]

"

> I'm concerned about the learning curve for the RDs that will

> transition to the new process and what happens in the meantime.

> ....> Furthermore, I wonder about the error rate we may experience at the

> beggining. These concerns are not only mine; they're a consolidated

> summary of concerns expressed by many of my RDs when we've

> discussed the subject.

.

Yup, there is a learning curve anytime something new comes down the block.

In looking back at when our facility started using the NCP, we often used the

wrong diagnosis at times. And there are times that some of us still disagree

what to use (there is one RD who seems to always pick something that doesn't

make sense to me, but she has always had a very verbose writing style that

drives the rest of us bonkers). The important part - we all had the appropriate

intervention (so no risk to the patient).

With time my use of the NCP to choose the appropriate diagnosis statement has

improved and it makes sense.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator, Wellness Nutrition

Nevada Dietetic Association President 2006-2007

Las Vegas, NV www.nevadard.org

---------------------------------

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[Guest guest]

Yep...we have been trying to adopt it. We still write SOAP notes, but use the

terminology from the document.

________________________________

From: rd-usa on behalf of Margie Hirsch

Sent: Fri 4/6/2007 11:47 AM

To: rd-usa

Subject: The Nutrition Care Process and Model

Has anyone read through the 292 pages of " Nutrition Diagnosis and Intervention:

Standardized Language for the Nutrition Care Process " ? This is located on the

American Dietetic Association website. Have you adopted this in your practice?

Margie Hirsch,MFCS,RD,LD

---------------------------------

Get your own web address.

Have a HUGE year through Yahoo! Small Business.