Nutrition Care ProcessMaribel C. Balagtas, RND, DrPH

objectives

´Realize the importance of NCP ´Realize the individual and collaborative work of health

professionals in Nutrition Care Process´ identify guidelines in the implementation of Nutrition

Care Process in private and government hospitals´ Identify the steps of Nutrition Care Process

NUTRITION CARE PROCESS

´ is a systematic process to guide RNDs in providing high quality nutrition care

´Advantages:´Use of a common framework for nutrition care´Promotion of critical thinking´More-focused nutrition care documentation´Increased acknowledgement of the value of nutrition

care by other health care professionals´Improved application of evidence-based guidelines

Nutritionally-at-risk patients

-Poor nutrition prior to admission

- Good nutrition prior to admission

Study in Wuhan China

Novel Coronary Pneumonia(NCP)

good nutrition - hospitalization on the average was shorter by 12 days

-Yu, Y.. Et.al. J Nutr Health Aging 25, 369–373 (2021)

Timely nutrition interventions are important due to the prevalence of malnutrition in the hospital setting and when RD recommendations are implemented, important outcomes are improved.

COMPLICATIONS RELATIVE TO LOSS OF LEAN BODY MASS

Argiles, Josep et. Al. (2016). Skeletal Muscle Regulates Metabolism via Interorgan Crosstalk: Roles in Health and Disease. 10.1016/j.jamda.2016.04.019. Journal of the American Medical Directors Association

The Undernutrition Risk and Underfeeding Status among in-patients and out-patients in hospitals in the Philippines ("The UNRISK" Study)

One-Day Point Prevalence Survey on Malnutrition in DOH Hospitals (August 2007)

DOH Hospital Number of Patients Assessed

(n)

Underweight(n)

Prevalence

National Capital Region (NCR) (13 hospitals)

388 176 45.3%

Luzon (10 hospitals) 673 186 42%Visayas (2 hospitals) 673 130 19.1%Mindanao (6 hospitals) 502 161 47%TOTAL 2236 653 29.2%

Villaraza, E. E. A Retrospective Preliminary Report of the Prevalence of Hospital Malnutrition Among DOH Retained Hospitals Conducted Last 2007.

13%

Definition

Nutrition Care

Process

Systematic problem solvingmethod that dietetics professionals utilize to critically think and make decisions to address nutrition related problems and provide safe and effective quality nutrition care.-Academy of Nutrition and Dietetics

Nutrition Care Process

Purposes …

disease prevention

treatment

management

Collaborative work

Attending Physician

Registered Dietitian

Registered Nurse

Registered Pharmacist

Hospital health information management service worker

Implementing rules and guidelines

Administrative Order # 2019-0033 - Guidelines for the implementation of NCP in hospitals

DOH AO No. 2019-0033 Guidelines for the Implementation of Nutrition Care Process in Hospitals

´Mandate and direction for public and private hospitals to operationalize and institutionalize Nutrition Care Process ´Nutrition Screening´Nutrition Assessment´Nutrition Care Plan´Nutrition Intervention´Monitoring and Evaluation´Documentation

Subsequent steps in nutrition care algorithm

NUTRITION CARE PROCESS

1. Nutrition Assessmentcollection and analysis of health-related information

- medical record-physical examination- laboratory analyses- medical procedures-interview

NUTRITION CARE PROCESS

2. Nutrition Diagnosis- identifies existing and potential nutrition

problems- problem, etiology or cause, and signs and

symptoms that provide evidence of the problem

PES statement

Medical and Nutrition Diagnosis

Medical diagnosis: gouty arthritis

Nutrition diagnosis: Excessive intake of internal organ and meat

related to poor knowledge on purine rich foods as evidenced by elevated uric acid level in the blood.

Medical and Nutrition diagnosis

Medical diagnosis: NIDDM

Nutrition diagnosis: Excessive intake of high fat and energy foods

related to frequent eating in fast food establishment as evidenced by an elevated HbA1c.

Medical and Nutrition diagnosis

Medical diagnosis:hypertension

Nutrition diagnosis: Excessive intake of fats and cholesterol related

to the frequent eating of bopiz and bulalo as evidenced by an elevated blood pressure.

NUTRITION CARE PROCESS

3. Nutrition Intervention- attempt to modify dietary and lifestyle

practices or environmental conditions that interfere with nutrition status or health through nutrition education, diet plan and diet counseling

NUTRITION CARE PROCESS

4. Nutrition Monitoring and Evaluation- effectiveness of the nutrition care plan must

be evaluated periodically