Title: IMPLEMENTATION OF THE NUTRITION CARE PROCESSIN THE AFFINITY PATIENT CHARTING SYSTEM

Author(s): L. E. Trombley1, L. M. Rodrigues2; 1Martin Luther King,Jr. - Multi-Service Ambulatory Care Center, Morrison ManagementSpecialists, Inc., Los Angeles, CA, 2Morrison ManagementSpecialists, Inc., Los Angeles, CA

Learning Outcome: To demonstrate maintenance of productivity,competency, and regulatory compliance with implementation of theNutrition Care Process.

Text: The Nutrition Care Process (NCP) provides a standardized yetindividualized approach to nutritional care of patients. When thedecision was made to implement the NCP into the electronicdocumentation system at Harbor-UCLA Medical Center, dietitians(RDs) raised two primary concerns: would the briefer method ofdocumentation meet regulatory requirements and would formation ofthe Nutrition Diagnosis (ND) statement take significantly longer todevelop during the initial transition, resulting in decreasedproductivity? RDs were trained in the NCP over a six month periodand the Clinical Nutrition Manager (CNM) worked with InformationSystems (IS) to ensure all ND and Nutrition Interventionterminology was included in the Affinity Patient Charting system.The NCP was formally implemented in October, 2007. RDproductivity pre-NCP ranged from 1.39 - 1.81 (average 1.63) in-patients seen per hour. Since implementation of the NCP,productivity has averaged 1.58 (range 1.53 - 1.67). A minimum of 5chart reviews are conducted on each RD quarterly to ensurecompliance with regulatory requirements as well as assesscompetency. Chart audit scores prior to NCP implementation rangedfrom 90.98% to 97.54%. Post-implementation, initial chart auditscores were 95%, increasing to 98.32% the following quarter. Insummary, use of the NCP has not resulted in a decreasedproductivity level, even during the initial learning phase, and chartaudit scores have improved to an annual high during the recentquarter. As the staff become more accustomed to the NCP, data willcontinued to be tracked for further improvement in productivity,competency, and regulatory compliance.

Funding Disclosure: None

Title: NUTRITION CARE PROCESS IN THE ELECTRONICMEDICAL RECORD

Author(s): M. Weis; Nutrition Services, Abbott NorthwesternHospital, Minneapolis, MN

Learning Outcome: Understand the benefits of utilizing theNutrition Care Process in an Electronic Medical Record.

Text: Abstract: The Electronic Medical Record (EMR) isemerging as the standard for hospital charting. Our hospitalsystem is in the process of transitioning completely to anelectronic medical record. There are eleven hospitals and forty-eight clinics in our system, and we have the most extensive EMRin the country at this time. The EMR system our hospital useshas the SOAP note format as the default for all of the dietitian’snotes. The Clinical Nutrition Managers from the hospitals acrossthe system made the decision to create a note template using theNutrition Care Process, as this was endorsed by the AmericanDietetic Association. The nutrition diagnoses and interventionsare available from a reselectable pick list on the pre-formatteddietitian notes. This way the dietitians do not have to memorizeor carry around pocket guides for nutrition diagnosis andintervention. The dietitians are now using the same language intheir diagnoses and interventions which allows us to compareoutcomes based on a diagnosis or intervention. We are in theprocess of creating a program that will allow us to look atoutcomes based on nutrition diagnosis. This would allow us toconduct studies on the benefit of having a registered dietitianinvolved in hospitalized patient’s care and report the data. Wewould also be able review and report the benefits of our nutritioninterventions.

Funding Disclosure: None

Title: EFFECTIVENESS OF NUTRITION INTERVENTION INMEETING OUTCOME GOALS IN CLIENTS WITH HIV/AIDS

Author(s): L. E. Trombley1, E. Driscoll1, L. M. Rodrigues2; 1MartinLuther King, Jr. - Multi-Service Ambulatory Care Center, MorrisonManagement Specialists, Inc., Los Angeles, CA, 2MorrisonManagement Specialists, Inc., Los Angeles, CA

Learning Outcome: To demonstrate the effectiveness of nutritionintervention by an RD in meeting outcome goals in clients with HIV/AIDS.

Text: The Nutrition Care Process (NCP) was implemented in 2007 atthe Oasis Clinic in Los Angeles, CA, an outpatient clinic servinguninsured members of the community diagnosed with HIV/AIDS. TheRDs follow this standardized process, including gathering assessmentdata, developing a nutrition diagnosis, setting specific outcome goals,implementing nutrition interventions, and monitoring results. Theprimary outcome goal for Oasis Clinic clients is related to weight(gain, maintenance, or loss). At the initial visit, a goal body weight(GBW) is established and interventions to accomplish the goal aredeveloped collaboratively with the client. At follow-up, weight changeis evaluated. The client successfully meets his/her outcome goal ifweight moves at least 5% toward the established GBW. Weights wereassessed pre- and post-RD intervention on a randomized sample ofclients (n�37). Clients had one of three primary goals, weight loss(n�14), weight gain (n�12), or weight maintenance (n�11). Of thesample, 78% demonstrated weight change of at least 5% towardGBW. Clients with a goal of weight gain experienced a higher successrate (92%) than those with goals for weight maintenance (82%success rate) or weight reduction (64% success rate). Implementationof the NCP with specific goal-setting and outcome measurement hasallowed the RD to easily identify success as compared to pre-established goals and has enabled the RD to demonstrate benefitfrom nutrition intervention to the medical care team as well assurveyors who review client records for quality of care.

Funding Disclosure: None

Title: INDEPENDENT NUTRITION ORDER WRITING BYREGISTERED DIETITIANS REDUCES COMPLICATIONSASSOCIATED WITH NUTRITION SUPPORT

Author(s): J. K. Duffy, R. L. Gray, S. Roberts, S. R. Glanzer,S. L. Longoria, E. K. Tiffany; Baylor University Medical Center,Dallas, TX

Learning Outcome: To demonstrate the correlation betweenindependent order writing by Registered Dietitians and improvedpatient care.

Text: Background: Delays in nutrition therapy (NT) implementation cancontribute to poor nutritional status and patient outcomes. A pilot studyat our institution demonstrated safe, timely, improved patient care wasprovided with RD nutrition order writing privileges (NOWP). Objective:To demonstrate ongoing improved outcomes through RD NOWP.Methods: A RD NOWP protocol was implemented in a large acute carehospital. Patients prescribed a physician-ordered protocol were managedby RDs meeting specific competency/credentialing requirements. Data(nutritional status, nutrition-related laboratory values, complications)was prospectively collected on patients receiving parenteral(PN) and/orenteral nutrition(EN):[control group (CG) (n�64) � physician managedorders, study group (SG) (n�105) � RD-managed orders]. Results: TheSG had a higher incidence of initial severe nutrition risk than the CG(62% vs 13%). Patients receiving PN (38% vs 95%), EN (31% vs 42%), orPN � EN (30% vs 100%) had fewer days of elevated glucose (�150 mg/dl) in the SG than CG, respectively. Less electrolyte abnormalitiesoccurred in PN and PN � EN (potassium: 14% vs 35%, 16% vs 63%),(phosphorus: 12% vs 45%, 23% vs 68%), (calcium: 4% vs 10%, 7% vs11%) patients in the SG vs CG, respectively. Fewer SG patients, despitemore severe initial risk, experienced a decline in nutritional statuscompared to CG patients (9% vs 13%). Conclusion: RD nutrition ordermanagement improves NT tolerance and reduces complications due toclose monitoring and management of NT by the RD. This studydemonstrates independent RD order writing improves patient outcomesby providing safe, efficient and effective care.

Funding Disclosure: None

SUNDAY, OCTOBER 26

ORIGINAL CONTRIBUTIONS: IMPLEMENTATION OF NUTRITION CARE PROCESS AND HEALTH OUTCOME MEASURES

Journal of the AMERICAN DIETETIC ASSOCIATION / A-9