Clinical Nutrition

Nutrition Care Process Overview

January 11, 2017   /

The Nutrition Care Process (NCP) was developed by the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) as a systematic approach to providing high-quality nutrition care. The NCP consists of four distinct, interrelated steps, sometimes referred to as ADIM/E, which stands for assessment, diagnosis, intervention, and monitoring/evaluation.

The steps of NCP

Assessment: The registered dietitian (RD) collects and documents information such as:

  • Food or nutrition-related history
  • Biochemical data
  • Medical tests and procedures
  • Anthropometric measurements
  • Nutrition-focused physical findings
  • Client history

Diagnosis: Data collected during the nutrition assessment guides the RD in selection of the appropriate nutrition diagnosis (ie, naming the specific problem).

Intervention: The RD selects the nutrition intervention that will address the root cause (or etiology) of the nutrition problem and aim at alleviating the signs and symptoms of the diagnosis.

Monitoring/evaluation: The final step of the process is monitoring and evaluation, which the RD uses to determine if the patient/client has achieved, or is making progress toward, the planned goals. 

Standardized language
When NCP was developed, work began on developing a standardized language for nutrition care. Using standardized terminology allows dietitians in all settings to use the same words to describe things, which results in more precise and effective communication. 

The cost of NCP
The main cost of the NCP is taking the time necessary to implement and adjust to a new way of approaching nutrition care and becoming familiar with the standardized language. Resources are available on the Academy Web site to help with training and implementation. Many resources, including slides, sample case studies, and audit forms, are available at no cost to Academy members. The International Dietetics and Nutrition Terminology (IDNT) Reference Manual, IDNT Pocket Guide, and Online IDNT and NCP Toolkits are available for purchase from the Evidence Analysis Library, http://andevidencelibrary.com/store.cfm?cid=0&cat=0.

The Academy strongly recommends incorporation of the NCP by RDs in all care settings. It is a required part of dietetic education and the RD and dietetic technician, registered exams, but RDs are not required to use the NCP. It is hoped that, once the value of the NCP is realized, RDs will choose to adopt it in their care setting.  

The Academy is working with health care accrediting agencies, such as The Joint Commission, so that when they evaluate nutrition services they will use the NCP to guide evaluation of nutrition services. They are also working with the informatics community to incorporate terms used in the NCP into electronic health records. 

 

References and recommended readings

Nutrition Care Process. Academy of Nutrition and Dietetics Web site. http://www.eatright.org/HealthProfessionals/content.aspx?id=7077. Accessed July 29, 2013.

Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition Care Process and Model part I: the 2008 update. J Am Diet Assoc. 2008;108(7):1113-1117. doi:10.1016/j.jada.2008.04.027.

Writing Group of the Nutrition Care Process/Standardized Language Committee. Nutrition Care Process part II: using the International Dietetics and Nutrition Terminology to document the nutrition care process. J Am Diet Assoc. 2008;108(8):1287-1293. doi:10.1016/j.jada.2008.06.368.