Practicalities of Using the Nutrition Care Process in Research.

E THANK MS. McCarthy for her comments 1 in response to our recently published article 2 and would like to express strong agreement that adherence to the standardized language and systematic processes of the Nutrition Care Process and Terminology (NCPT) is a vital for the comparabilityof research findings and advancement of nutrition outcomes research. We disagree that the inclusion of screening in our algorithmic process constitutes the addition of a step to the NCP. The eNCPT Nutrition Terminology Reference Manual (eNCPT) states that ‘‘patients/clients enter nutrition assessment, the first step of the NCP, through screening, surveillance systems data, and/or referral, all of which are outside of the NCP.’’ 3 We noted that the screening portion of the algorithm was not a part of the NCP in the final row of our flowchart description of the algorithm (Figure 1 in the original article 2 ), yet the patients in the study must have a point of entry into the NCP. In practice, screening may or may not be conducted by a nutrition professional, but in research study staffmust verifyeligibilityand gain informed consent,andthisoftennecessitatestheuseofregistereddietitian nutritionists (RDNs) for the screening in addition to the nutrition care. We also disagree that highlighting the components of a Nutrition Diagnosis constitutes the addition of a step to the NCP. As described by the eNCPT, ‘‘The nutrition diagnosis or nutrition problem is summarized into a structured sentence called the nutrition diagnosis statement or PES statement, and is composed of three distinct components: the problem (P), the etiology (E), and the signs and symptoms (S).’’ 4 This complex construction of clinical judgment simply cannot be represented algorithmically by a single clinician input. Our algorithm separated the selection of the problem statement from the identification of the etiology to collect structured data about both components, and we further divided the etiology, which is defined in eNCPT as ‘‘those factors contributing to the existence or maintenance of. problems,’’ 4 to prompt RDNs to consider factors related to both existence (etiologies) and maintenance (barriers) of problems while collecting structured data about each. When constructing NCP chains, we maintained the separation of the Nutrition Diagnosis step into two components according to the precedent set by Hakel-Smith et al. 5 This separation is necessary to support appropriate targeting of Nutrition Interventions as described in the eNCPT: ‘‘Whenever possible, food and nutrition professionals direct the nutrition intervention at the etiology of the problem.’’ 6 We regret that opportunities were missed to use standardized language in some instances in our algorithm. The Nutrition Diagnosis Terminology, the oldest and most widely adopted of the eNCPT terminology categories, was used faithfully in the algorithm, but the options for Assessment and Monitoring and Evaluation were not created withstandardizedtermsdespitethe factthat it would have been possible. It is important to note that the documentation of etiology is described in the eNCPTas, ‘‘Usually free text,’’ 4 meaning that descriptions outside of the standardized language are permitted. The options used for intervention were also not in-line with the standardized language. This was due, in part, to the need for data more granular than what was availablein the NCPTatthe time, but,in retrospect, there was potential for closer alignment with and organization according to the standardized terminology.