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HE ACADEMY OF NUTRITION
and Dietetics (Academy) supports nutrition screening as
the rst step to identify patients at nutritional risk who would
benet from seeing a registered dietitian nutritionist (RDN).1 Nutrition
screening is a supportive task that triggers the entry of a patient into the
Academys Nutrition Care Process
(NCP), a standardized process to identify nutrition-related problems and
provide appropriate intervention.
However, nutrition screening and
nutrition assessment are terms often
used interchangeably in the literature
and in practice despite their differences. This could lead to confusion.1
The different functions of nutrition
screening and assessment in the
context of malnutrition are the focus
of this narrative.
In 1995, The Joint Commission
mandated that all patients be screened
for nutrition risk to determine whether a
patient would benet from a full nutrition assessment.2 Screening must be
done within 24 hours of admission to an
acute care facility. The Academy supports
this approach3 as do the American Society for Parenteral and Enteral Nutrition
(A.S.P.E.N.) and the European Society for
Parenteral and Enteral Nutrition.4-6
However, The Joint Commission does
not mandate the tool or criteria to be
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CLINICAL DOCUMENTATION IN
PRACTICE: ACADEMY
NUTRITION CARE PROCESS
In 2003 the Academy adopted the
Nutrition Care Process and Model
(NCP), a standardized process for
nutrition and dietetics practitioners to
use critical thinking and decisionmaking skills to address nutritionrelated problems and provide quality
care.1 The NCP, updated in 2008,18
consists of four steps to be done in
sequence: (a) Nutrition Assessment,
(b) Nutrition Diagnosis, (c) Nutrition
Intervention, and (d) Nutrition Monitoring and Evaluation. These four steps
have corresponding standardized terminology, called the NCP Terminology
(NCPT), that supports consistent use of
language in documentation of nutrition
care. Nutrition screening is a supportive task that triggers the entry of a
patient into the NCP.
Nutrition Screening
Nutrition screening identies patients
who need to be seen by an RDN.
Screening is most often completed by
someone other than a nutrition and
dietetics practitioner (eg, nurse), and
2015 by the Academy of Nutrition and Dietetics.
Nutrition Assessment
The Academy denes nutrition assessment as the process to obtain, verify,
and interpret data needed to identify
nutrition-related problems, their causes, and signicance.20 A nutrition
assessment provides the foundation for
the other three steps of the NCP by
providing information for determining
the nutrition diagnosis and also for
understanding the cause of the diagnosis (ie, the etiology), and should be
done by a trained nutrition professional.
An understanding of the etiology helps
the RDN determine the most feasible
and effective intervention to implement
for resolution of the diagnosis.
Assessment information/data are
organized into ve categories: (a) food/
nutrition-related history; (b) anthropometric measurements; (c) biochemical data, medical tests, and
procedures;
(d)
nutrition-focused
physical ndings; and (e) client/patient history.20 Single nutrition assessment ndings alone do not warrant a
nutrition diagnosis; rather, they are
collectively used in the documentation
of a nutrition diagnosis and etiology
and help to direct nutrition intervention and identify outcomes to monitor.
The clinician identies signs and
symptoms (assessments) to support
each diagnostic term dened in the
NCPT. Groups of assessments that are
commonly used together and are validated may be referred to as diagnostic
tools. Examples of diagnostic tools for
malnutrition are the Subjective Global
Assessment21 (SGA) and the Malnutrition Clinical Characteristics (MCC).22
Term
Denition
Example
Sensitivity
Specicity
Positive predictive
value (PPV)
Negative predictive
value (NPV)
Figure 1. Common measurements used when testing the validity of a nutrition screening or assessment tool as compared to a gold
standard.
May 2015 Volume 115 Number 5
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Screening
Result
Positive
Screening
Result
Negative
Sensitivity
1,568 (True Positive)/1,568 (True
Positive)124 (False Negative)93%
Specicity
7,720 (True Negative)/7,720)(True
Negative)588 (False Positive)93%
Figure 2. 22 illustration of sensitivity and specicity based on the Malnutrition Screening Tool for 10,000 patients when compared
with a gold standard assessment tool. The bullets describe the hypothetical clinical scenario of patients with each combination of
screening and assessment results.
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References
1.
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23.
24.
25.
26.
27.
Steiber A, Leon JB, Secker D, et al. Multicenter study of the validity and reliability
of subjective global assessment in the
hemodialysis population. J Renal Nutr.
2007;17(5):336-342.
28.
29.
30.
2.
12.
3.
13.
4.
14.
5.
6.
7.
8.
9.
10.
11.
15.
16.
17.
18.
19.
20.
21.
AUTHOR INFORMATION
STATEMENT OF POTENTIAL CONFLICT OF INTEREST
Full salary support for L. B. Field is through an educational grant from Abbott Nutrition to the Academy of Nutrition and Dietetics; however,
Abbott Nutrition had no control over the content or publication of this article. R. K. Hand has no conict of interest to report.
FUNDING/SUPPORT
There was no funding for this article.
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