In 2002, the Academy of Nutrition and Dietetics (formally American Dietetic Association), created the Nutrition Care Process (NCP) as a way to improve consistency and quality of individualized care for residents and the predictability of resident outcome.   The goal of NCP is to standardize a process for providing nutrition care.   There are four steps involved in the NCP to form a framework for the RD to create an individualized nutrition plan.

Step 1: Nutrition Assessment.

The first step in the NCP begins when a referral is made to the dietitian professional.  The key components the dietitian look at are grouped into five categories: food/nutrition-related history; anthropometric measures; labs, medical tests and procedures; nutrition-focused physical findings and client history.   Many dietitians begin by talking with the resident and/or family to assess weight history, usual dietary patterns, any food allergies/intolerances, any difficulties chewing or swallowing and any nutritional concerns.  A resident’s clinical record and nursing, dietary and therapy staff also serve as good resources when assessing nutritional status.

Step 2: Nutrition Diagnosis.

The second step in the NCP links nutrition assessment and intervention.  The RD identifies and labels a specific nutrition diagnosis that the RD is responsible for treating.  Standardized language for the NCP has been developed to be used in identifying a nutrition diagnosis.  A nutrition diagnosis may currently exist or the resident is at risk of occurring.  It is important to note that the nutrition diagnosis is not a medical diagnosis .   The nutrition diagnosis statement should be clear, concise, related to one problem and based on reliable, accurate assessment data.

Step 3: Nutrition Intervention.

The third step includes planning and implementing a plan focused on the nutrition problem identified in the nutrition diagnosis.  This step includes discussing with the resident and other members of the interdisciplinary team realistic goals and creating a plan to reach that goal.  Often in the long-term care setting, interventions may include speech therapy referral, altered diet texture or consistency, diet liberalization and providing nutrient dense supplements.

Step 4: Nutrition Monitoring and Evaluation.

The final step is monitoring the progress that has been made by the resident.  This final step links back to the first step as the RD assesses the progress made in weight status, meal intake, labs, and nutrition-focused physical findings.  In the long term care sector, the RD monitors residents’ progress on an annual basis if the resident is nutritionally stable.  More frequent nutrition monitoring is completed if the resident is at a higher nutritional risk such as decreased meal intakes, weight changes, skin alterations or receiving nutrition through tube feeding or TPN.

To learn more about the NCP, visit the Academy of Nutrition and Dietetics website