Prior to the creation of the Nutrition Care Process (NCP), there was no single standardized method for documenting nutrition care services and establishing the benefit provided by those services. This lack of standardization made it diffi- cult to extract data about the results of the care provided by each nutrition and dietetics practitioner. Medical nutrition therapy (MNT) was evaluated as a possible way to stan- dardize care. However, MNT is a method for using nutri- tion care to treat a medical diagnosis that lacks definitions for care processes and outcomes. For that reason, MNT is an element of NCP but is not the total process. Therefore, a standardized method needed to be developed. A brief history follows:

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1998: The American Dietetic Association (ADA; now the Academy of Nutrition and Dietetics) Health Services Task Force (now the Council on Research) considered MNT as a method for docu- mentation, but this method was found to be too limited, and MNT was rejected in this capacity by the committee.

2001: A focus group was established to identify the value of nutrition services.

2002: The Nutrition Diagnosis and Nutrition Care Process Task Force made recommendations to ADA leadership.

2003: The Nutrition Care Process Standardized Language Committee began developing a stan- dardized language for the dietetics profession.

2003: The Nutrition Care Process and Model (NCPM) was published in the Journal of the American Dietetic Association.

2005: The first standardized nutrition diagnosis language for dietetics was published in the Nutrition Diagnosis Manual.

2007: The International Dietetics and Nutrition Terminology (IDNT) Reference Manual was first

CHAPTER Nutrition Care Process

published, with further editions published biannu- ally between 2009 and 2013. These publications expanded standardized terminology to include nutrition assessment, nutrition intervention, and nutrition monitoring and evaluation as well as nutrition diagnosis.

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2014: The electronic Nutrition Care Process Terminology (eNCPT) was released.

NUTRITION CARE PROCESS OVERVIEW

As noted by Lacey and Pritchett in the original article about the NCP, “providing high-quality nutrition care means doing the right thing at the right time, in the right way, for the right person, and achieving the best possi- ble results” (1). The purpose of the NCP is to support the critical-thinking process of dietetics practitioners and give them a standardized terminology for docu- menting in a consistent manner the individualized nutri- tion care provided to each resident/client or group. By establishing a standardized process for providing care, the NCP helps improve data collection and analysis about the outcomes of that care. Thus, dietetics practi- tioners can measure the evidence about care, rather than relying on experience and other subjective, nonstandard measures. The use of evidence-based care makes the registered dietitian nutritionist (RDN) and the nutrition and dietetics technician, registered (NDTR) the expert nutrition services providers (2). The NCP has four distinct steps along with two supporting systems (see Box 5.1 and Figure 5.1) (3):

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Step 1: Nutrition assessment Step 2: Nutrition diagnosis Step 3: Nutrition intervention

Step 4: Nutrition monitoring and evaluation