[CNM] Nutrition Care Process/PES Statements

Crant-Oksa, Aimee Aimee.Crant-Oksa at healthsouth.com
Tue May 9 09:53:48 PDT 2006


Have you had any physician feedback?

Aimee Crant-Oksa MS, RD
Clinical Dietitian
HealhSouth Specialty Hospital at Union
1000 Galloping Hill Road
Union, NJ
908-851-8354

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Kristin Heimes
Sent: Tuesday, May 09, 2006 12:48 PM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

This was a case study from our RD who is the most well-versed on writing
the statements:

Dx:  Acute MI
Hx: DM, HTN, L big toe amputation

Assessment:   Pt states never had been educated on ADA/Cardiac diet
before.  Pt stopped taking DM meds related to problems getting the
prescription filled.  Eats one big meal/day, snacks in-between meals.
Eats in restaurants frequently, doesn't cook, chooses grab and go foods.
116% Ideal body weight
Labs:  high glucose, HbA1C, Triglycerides.  Low HDL
Med ordered: oral hypoglycemic

PES statement:
(Problem aka nutrition diagnosis) Altered nutrition-related labs related
to (Etiology) inconsistent carbohydrate intakes secondary to food,
nutrition, and nutrition-related knowledge deficit as evidenced by
(Signs and Symptoms) HbA1C, Trig, glucose levels; non-compliance in
taking meds; no diet education.

Goals:
Education patient on diabetic/cardiac diet
Trend labs to normal


Kristin Heimes, RD, CDE 
Clinical Coordinator, Nutrition Services
Faith Regional Health Services
2700 West Norfolk Avenue
Norfolk, NE   68701
402-644-7513

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Crant-Oksa, Aimee
Sent: Tuesday, May 09, 2006 11:31 AM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

I mean examples of actual pt notes using this method.

Aimee Crant-Oksa MS, RD
Clinical Dietitian
HealhSouth Specialty Hospital at Union
1000 Galloping Hill Road
Union, NJ
908-851-8354

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Kristin Heimes
Sent: Tuesday, May 09, 2006 12:25 PM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

http://www.eatright.org/ada/files/NCPM.pdf
There's a few on this powerpoint.  If the link doesn't open up, you can
go to the website and download it.

Kristin Heimes, RD, CDE
Clinical Coordinator, Nutrition Services Faith Regional Health Services
2700 West Norfolk Avenue
Norfolk, NE   68701
402-644-7513

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Crant-Oksa, Aimee
Sent: Tuesday, May 09, 2006 11:19 AM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

Can someone please show specific examples of the statement?

Aimee Crant-Oksa MS, RD
Clinical Dietitian
HealhSouth Specialty Hospital at Union
1000 Galloping Hill Road
Union, NJ
908-851-8354

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Kristin Heimes
Sent: Tuesday, May 09, 2006 12:14 PM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

Joan,
If you go to the ADA website, click on "Advocacy and the Profession" at
the top of the page, and then click on "Quality Management" on the left
sidebar.  On that page, you'll find information on the Nutrition Care
Process and Model.  There are journal articles from JADA, Powerpoint
presentations that are very good, and a sample policy and procedure.   

This book can be purchased from ADA or downloaded from the website:  "
Nutrition Diagnosis: A Critical Step in the Nutrition Care Process ."
To find the downloadable version, I typed "nutrition diagnosis" in the
search box and a link came up.  

Two of our RDs were taught how to write the PES statements in their
internships, but this is new to those of us who are older RDs.  However,
our newest RD was not taught about PES statements at all - each
internship is so different.  I read somewhere that questions on the PES
statement will be on the 2007 RD exam.

We had our first meeting on this a couple of weeks ago.  We chose some
case studies of current patients and practiced writing the PES
statements for them, and we'll continue to practice until everyone feels
comfortable.  
 
Kristin Heimes, RD, CDE
Clinical Coordinator, Nutrition Services Faith Regional Health Services
2700 West Norfolk Avenue
Norfolk, NE   68701
402-644-7513

-----Original Message-----
From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]
On Behalf Of Joan Leboeuf
Sent: Monday, May 08, 2006 4:52 PM
To: cnm at lists.my180.net
Subject: RE: [CNM] Nutrition Care Process/PES Statements

What is this referring to?  Is there an article I need to read to update
myself on this process?  I feel like I've missed something!


Joan LeBoeuf, RD, CNSD
Clinical Nutrition Manager
University of New Mexico Hospital
2211 Lomas Blvd. NE
Albuquerque, NM 87106
JLeboeuf at salud.unm.edu
505-272-2967

>>> "Keating, Cynthia" <KEATINC at ccf.org> 5/8/2006 2:30 pm >>>
We have asked our staff to incorporate the PES statement as follows:
 
Assessment section: contains the assessment of the patient utilizing the
subjective and objective information that supports the nutrition problem
chosen.  It is difficult for many not to write age, sex, ht., wt., etc.
in each note and just list the pertinent data.
 
Beneath the assessment section, the PES statement would be written
followed by a measurable goal based on the nutrition problem chosen, and
one or more interventions to meet the goal.  The difficult thing for
some people is paying attention to the definition and ensuring
calculations or standards are listed to support the problem chosen.
 
We are just beginning to develop our follow-up notes that will include
the monitoring and evaluation pieces.  So far we plan on opening the f/u
note with:
Patient (fully met, partially met or didn't meet) the goal from (write
date of the initial assessment if this is the first f/u note); if
partially met or didn't meet, state why and create another PES
statement, measurable goal, and one or more interventions.
 
Please feel free to contact me directly if you have questions. 
Thanks.
 
Cynthia Keating, RD, LD
Coordinator, Quality Assurance
Nutrition Therapy, M17
Cleveland Clinic
Cleveland, Ohio 44195
216.445.3743

________________________________

From: cnm-bounces at lists.my180.net [mailto:cnm-bounces at lists.my180.net]

On Behalf Of Berard, Nancy
Sent: Monday, May 08, 2006 11:37 AM
To: cnm at lists.my180.net
Subject: [CNM] Nutrition Care Process/PES Statements



I was wondering what you've implemented/plan on implementing in terms of
the Nutrition Care Process. More specifically, how you've integrated PES
statements into your documentation. 

Samples I've received from other facilities and from various seminar
PowerPoints on the topic seem to run the gamut from keeping existing
templates the same and just adding PES statements into them to getting
rid of weight hx, labs, PMHx, etc and having the PES statement be your
entire note (i.e. ADI format).

Thanks
Nancy Berard, RD, LDN
Clinical Section Chief
Nutrition & Food Service
Hines VA Hospital 



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