Why I love the Nutrition Care Process

Claire smallerWow I just came across this post. I drafted it an entire year ago but never published it. I wrote the content below after speaking at an electronic health record showcase in Melbourne Australia. I spoke about a topic that is very close to my heart, Kalix’s electronic document feature, particularly it’s ability to track client outcomes and measure the effectiveness of professional practice. The basis of Kalix’s document feature is the Nutrition Care Process, hence the reason for the title of this post.

Reading my post again after an entire year, I still feel the topic is relevant now and reflective of my current thoughts so I thought it was time to put it out there. Why I didn’t publish it originally? I am not quite sure now…perhaps I felt it was a bit too much of a rant or maybe I couldn’t draw the post to a concise conclusion.  But isn’t the purpose of blog to give people a medium to rant on (at least from time to time)?

Ok so now onto the post!

Why I love the Nutrition Care Process

In my very first blog post I said I liked the Nutrition Care Process (NCP), that was 18 months ago. Between then and now I have been lucky to speak to many dietitians from around the world about NCP terminology.  And I have heard very many varying points of view about it. There are some who have well and truly adopted NCP. While there are many others who still unsure about its merits.

You might be waiting for me to say that I’ve had second thoughts about NCP,  but no. Eighteen months ago I said I liked NCP, now I say I love it!

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That’s me a year ago speaking at an electronic health  record showcase in Melbourne Australia. And the cardigan I am wearing is still one of my favorites! 

Back to the electronic health record showcase, so that is me, talking to a room of 80 or so, mostly middle-aged men, that do not know a lot about the world of dietetics and nothing about NCP or Kalix… but guess what, they all loved the idea! Ok, so I did include the big buzz words going around at the moment, ‘big data’, ‘outcomes analysis’ etc, but they were genuinely impressed and excited that dietitians are implementing standardized terminology and a standardized model of nutritional care.

Why standardized language is cool!

As a dietitian, I am very proud that we have our own standardized language. Standardized terminology is here to stay, we have ICD-9 (with ICD-10 coming… one day), SNOMED, HCPCS, the list could go on. But none of these ‘fit’ very well with what a dietitian does.

What are the advantages of using standardized terminology? Ok the most obvious one is having a shared common vocabulary. This allows different healthcare professions,  or dietitians across different sites,  healthcare systems, states and countries to exchange and apply health information in the same way.

It is estimated that 80% of serious medical errors involve miscommunication between healthcare professionals during patient transfer or handed-over. That’s scary!

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How does miscommunication occur? Well quite easily and for lots of reasons. All of us miscommunicate at times. Miscommunication occurs when what’s written or said is interpreted differently from its intended meaning. This can be due to the same word meaning different things, like ‘supplement’ can refer to a high protein high energy oral nutritional supplement or a vitamin mineral supplement. Different words can also mean the same thing, for example enteral nutrition therapy is often referred to as PEG feeding, tube feeding and even HEN.

And what about medical abbreviations?  Rx can mean Prescribe, Prescription , Prescription Only, Take, Therapy and Treatment. How about something more dietitan orientated, NBM can mean Nil by Mouth, No Bowel Movement , Normal Bowel Movement, Normal Bladder Mucosae and Normal Bone Marrow.

Using a standardize language limits miscommunication as there is only one possible interpretation of a given word or abbreviation. 

The changing shape of healthcare

The other major benefit of standardized terminology and NCP terminology (and this I what I find really exciting) is the ability to use it to measure the outcomes of client care and analyse our effectiveness.

Considering the completion in the health eating/wellness and weight management space, from weight loss programs, chefs, personal trainers, naturopaths, nutritionists, physicians, online weight loss gurus, the latest fad diet and many others. It isn’t enough for us dietitians to simply say that we know we make a difference to our clients’ health. To get clients and keep them, it’s up to us to demonstrate our effectiveness.

Yes collecting data and analyzing it takes time and we are all time poor these days. This is the reason I started Kalix. I wanted to provide dietitians with a quick and easy way to collect and analyse data so we can prove our effectiveness as a profession. 

Why do we need a standardized language to do this?

It’s said data is king. If this is true than big data (or data collated from many dietitians) is omnipotent.  As evidence based profession, we know about the different levels of evidence. Meta-analysis (results from lots of different sources) is the highest level of evidence. So it is better for us as a profession to work together to show our combined effectiveness, and not going it alone with each of us separately trying to do this. Power in numbers like the saying goes.

Levels of evidence

The problem is if we collect and record information using different methods and varying terminology, the ability to combine and collate data is greatly diminished.

That’s why we need a standardized language!

Got it?

The future

The adoption of a standardized language is difficult. Any big change is. As dietitians we know this from experience, trying to foster and achieve behavior change in our clients can be really hard!

But today, more than at anytime, we are able to take the plunge and make the change. With the technology available we can easily access any information we need in just a couple of clicks. We can also instantly connect and corroborate with others living on the other side of the world. Pretty amazing!

Technology  also allows us to automate data collection and analysis. At Kalix, we combine data collection and analysis with something dietitians have to do charting, therefore making the process automated. Electronic documentation can make charting a lot quicker. It can even limit the need to learn and memorize standardized terminology.

What do you think? Share your questions and comments in the box below.