Nutrition Care Process Implementation Research Articles

Implementation of nutrition care process in Indonesian athletes and its effect on nutritional status and aerobic capacity performance

Introduction: Despite the critical function of a nutritionist, only a few sports training centres for students in Indonesia have one. This study aimed to determine the effect of the nutrition care process (NCP) on athletes’ nutritional status and aerobic capacity performance. Methods: This cohort study was conducted in 2022 (May–August) in four training centres (TC) in Indonesia. Subjects were athletes who have been dwelling in TC for at least three months, excluding those absent for >14 days due to a competition or other commitments during the data collection period. NCP included the assistance of trained sports nutritionists. In total, 114 athletes participated in this study: 90 strength athletes and 24 endurance athletes. The participants were aged 14-19 years old with approximately (mean+SD) 6+2.5 years of experience in specific sports. Results: After three months of NCP, knowledge of nutrition (p=0.013), body fat composition (p<0.001), skinfold thickness scores (p<0.001), and performance (p<0.001) of athletes significantly improved. In spite of good intakes of protein and fat, none of the intakes showed significant changes (p>0.05). Furthermore, improved knowledge of sports nutrition and exercise science had a positive impact on dormitory meal choices. Conclusion: Overall, three months of NCP had a significant effect on athletes’ knowledge of nutrition, body fat composition, skinfold thickness, and also VO2Max.

Hospimeal: Website Based Nutrition Care Process Digitalization

The nutrition Care Process (NCP) is a systematic approach or standard to provide comprehensive nutritional care for patients or clients. NCP consists of 4 interrelated steps, namely nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring and nutrition evaluation. Implementation of NCP in many health services facilities face some barriers because of using manual NCP, such as human error, time-consuming, and incomplete documentation. Digitalization of NCP has proven to be beneficial in terms of efficiency of time and provision of electronic data to improve patient services. This study aimed to develop Hospimeal as a website-based Nutrition Care Process (NCP). The development of the web-based NCP application carried out in this study used the waterfall method. The stages of the waterfall method are need analysis, study of literature and data retrieval, system requirements, system planning, system implementation and testing, digitalization of NCP management in website. Digitalization of Standardized Nutrition Care Process (NCP) management can be developed in the form of a website called Hospimeal. This website provides nutritional care to patients/clients starting from nutrition assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring, and nutrition evaluation. The Hospimeal website can be operated by the relevant nutritionist/dietitian. At the beginning of the display there is a Login menu which can be used by nutrition-ists/dietitians to enter the website

Implementation of the Nutrition Care Process and the Nutrition Care Process Terminology among German- and French-Speaking Dietitians in Switzerland: A Secondary Analysis of the Swiss International Nutrition Care Process and Terminology Implementation Survey Data.

Successful implementation of the Nutrition Care Process (NCP) and the Nutrition Care Process Terminology (NCPT) depends on many factors, one of which is the spoken language of the users. Exploring implementation barriers and enablers in a multilingual country such as Switzerland, with a specific focus on dietitians speaking German and French, may provide valuable insights for successful implementation in other multilingual countries. The aim of this study was to compare the enablers and barriers encountered by Swiss German- and French-speaking dietitians in the implementation of NCP and NCPT in their daily work. The multinational observational INIS study was conducted between February-April 2017 using an online survey. Swiss data from the study were analyzed in a secondary analysis in August2021. In Switzerland, 237 registered dietitians participated in the INIS study. In this secondary analysis, a total of 228 (German-speaking n= 144, French-speaking n= 84) questionnaires were included. Nine participants were excluded because either they had incomplete surveys or had not completed dietetics training. Primary variables were barriers and enablers to the use of NCP and NCPT in their daily work. Furthermore, characteristics, familiarity with NCP and NCPT, and the extent of implementation of standardized nutrition diagnoses according to NCPT were analyzed. Descriptive statistics, including summary statistics with percentages, were used. Differences between the two groups were analyzed using the Fisher exact test. The most common barrier was lack of time; no significant differences were found between the two groups regarding implementation barriers. Some statistically significant differences were found in the frequency of mentioning enablers, such as "recommendation by the association to use NCP and NCPT" (German-speaking 89%, French-speaking 77%; P < 0.05), "requirement by the workplace" (German-speaking 75%, French-speaking 53%; P < 0.01), "allocated time to practice" (German-speaking 63%, French-speaking 43%; P < 0.05), and "electronic healthcare records" (German-speaking 81%, French-speaking 44%; P < 0.001). Some differences in enablers were found between German- and French-speaking dietitians, although the two groups were similar for all barriers and many enablers. In multilingual countries such as Switzerland, implementation strategies may need to be adapted to the language and the dietitians' specific experiences of using NCP and NCPT to ensure optimal use throughout the country.

Need Analysis for Digital Transformation of Nutrition Care Process

The Nutrition Care Process (NCP) is a systematic problem-solving method that nutrition professionals use to think critically and make decisions that address practice-related problems. Nutrition Care Process consists of 4 systematic steps, namely nutrition assessment, nutrition diagnosis, nutrition monitoring, and evaluation. Implementation of NCP in fact faces some barriers, such as much time needed and incomplete documentation. Digitalization of NCP is expected to be a solution to overcome the barriers. This study aimed at investigating the requirement of hospitals and clinics toward NCP digital. This was a qualitative study where the design was an exploration case study. The number of informants was 5 interviewees who work as dietitians and nutritionist in some hospitals and clinic. The data were collected by focus group discussion. The data were analyzed using thematic analysis. Five primary themes emerged as the main design needed in NCP digital. The themes are automatic calculation and categorization of nutrition assessment data, automatically selecting of nutrition diagnosis, integration with the diet leaflet for patients, and integration with medical record and other health care workers’ systems. In conclusion, the dietitians considered that NCP digital had some advantages to accelerate and improve their work. The dietitians had the intention to accept NCP digital and expected it to be a solution to making their work easily and faster. &#x0D;

Learning Outcomes From a Virtual Nutrition Care Process Workshop Delivered to Nutrition and Dietetics Professionals in Mexico

A virtual Nutrition Care Process (NCP) workshop was delivered to 11 nutrition professionals in Mexico. Knowledge was evaluated with an NCP pre-/posttest, focus groups were conducted to gain deeper understanding of the workshop experience, and patient notes (n = 79) were assessed for quality as a measure of NCP implementation. Mean knowledge scores increased after the workshop from 73.5% to 83.6% (P = .003). The focus group elucidated facilitators/barriers of NCP resources. Most patient notes were graded “low quality.” Although the online delivery was a viable method to provide NCP education to a global audience, application of knowledge was not demonstrated, indicating the need for follow-up support.

Ascertainment of Nutrition Care Process (NCP) Implementation and Use of NCP Terminologies (NCPT) among Hospital Dietitians in the Philippines.

The Nutrition Care Process (NCP) is a systematic method used by dietitians to provide high-quality nutrition care resulting in good patient outcomes. This study aimed to assess the NCP implementation and use of NCP Terminologies (NCPT) among hospital dietitians in the Philippines. Specifically, the study aimed at assessing the knowledge, perception, and practices on NCP and use of NCPT and correlate them with the dietitians' education, and professional and employment profile; and explain the barriers and facilitators of the practice of NCP and use of NCPT among hospital dietitians in the Philippines. The knowledge, perception, and practices (KPP) on NCP and NCPT of the dietitians employed in the Philippine Department of Health's licensed level 3 hospitals were determined using a validated questionnaire. Significant factors associated with the KPP were also determined. The barriers and facilitators of the practice of NCP and NCPT were determined using focus group discussion and key informant interviews of chief clinical dietitians and hospital administrators, respectively. The study revealed that majority of the participants had a high level of knowledge on NCP and NCPT, positively perceived its implementation, and more than half of them implement NCP and NCPT in the hospitals. The participants' knowledge on NCP and NCPT was significantly associated with research involvement and active membership in a professional organization. While the practice of NCP and NCPT was significantly associated with having NCP-related trainings, frequency of trainings, and active membership in a professional organization. The barriers to NCP implementation were insufficient resources; lack of orientation, trainings, and support; organizational and administrative constraints; pandemic constraints; insufficient time; and lack of confidence to conduct NCP. While the facilitators of implementation were collaboration, dedication, and commitment of the healthcare team; institutionalization of NCP laws and policies; budget allocation for NCP-related activities; monitoring and consistency of NCP implementation; and work schedule. The findings suggest that the implementation of NCP and NCPT in the Philippines needs further support from the institution, professional organizations, and policy makers by developing strategies to cope with the barriers, and strengthen the facilitators and factors associated with practice.

Persepsi ahli gizi di Indonesia terhadap penerapan nutritional care process (NCP) di rumah sakit

Dietitians’ perception of the implementation of the nutrition care process (NCP) in IndonesiaBackground: The nutrition care process (NCP) developed by The Academy of Nutrition and Dietetics was adopted and implemented in Indonesia. Some hospitals in Indonesia do not have a proper facility to support dietitians to implement NCP optimally.Objective: To evaluate dietitians’ perception of the NCP implementation in hospital settings in Indonesia.Methods: This study was a cross-sectional design with dietitians who have been working in a hospital as the study subject. Data were collected by questionnaire. Each subject answered questions on general data, nutrition screening practice, and 20 questions about the NCP implementation. The perception score is ranged from one(1) for ‘strongly disagree’ to five(5) for ‘strongly agree.’ The score was summarized and categorized into two groups ‘good’ and ‘less’ positive perception. Univariate and bivariate analysis was used to evaluate the data statistically. Results: More than half of the participants have a good/positive perception of NCP implementation (62.5%). There was a significant association between the level of education and nutrition screening training to other health workers' perceptions statistically. Conclusion: NCP has been implemented very well in a hospital setting in Indonesia. There are improvements needed in some key aspects to improve the quality of the nutrition care process in the hospital, especially for each dietitian to have a better and more standardized perception nationally on implementing NCP.

Sports nutritionists adopt the nutrition care process road map to develop individualized meal planning for athletes

Background: It is considered that the implementation of nutrition care process (NCP) leads to more efficient and effective care, as well as enhancing the roles of dietetics and nutrition professionals in the clinical setting. However, little is known about the NCP being implemented in the sports nutrition setting to deliver nutrition care, especially in meal planning. Therefore, this study aims to identify the process that sports nutritionists (SNs) practice in meal planning to plan meals for athletes and identify the application of NCP. Methods: In-depth interviews, using semi-structured interview questions, were conducted with SNs employed at the National Sports Institute of Malaysia. Five SNs who managed different types of sports were recruited. The interviews were audio-recorded and transcribed verbatim. Data were entered into ATLAS.ti 8 and analysed using thematic analysis. Results: The following processes were identified: (i) collecting pertinent data, (ii) analysing the collected data, (iii) determining nutrition prescriptions, (iv) formulating goals and determining actions, (v) implementing actions and recommendations and (vi) monitoring. Conclusions: This study identified six general processes practiced by SNs in meal planning that comprised the NCP's interrelated steps, except nutrition diagnosis statement from the nutrition diagnosis step of the NCP. A comprehensive process and workflow can help sports dietitians or nutritionists to develop individualised meal plans that can improve athletes' nutritional status, adherence, health and sports performance.

Enteral Nutrition Support in Management of a Pediatric Patient with Secondary Acute Malnutrition and SARS-CoV-2 Infection : A Case Report

Severe acute malnutrition (SAM) contributes to about one million deaths annually in children under the age of 5 years. Secondary acute malnutrition is common in children with underlying medical conditions. It may pose a great risk in developing severe illness during SARS-CoV-2 infection among children. Proper implementation of nutrition care process is critical in management of secondary acute malnutrition among children in clinical settings. Eight months old male admitted with meningoencephalitis; septic shock, anemia, rickets, osteomyelitis, severe malnutrition and severe SARS-CoV-2 pneumonia complications. On admission, body temperature was 370C, random blood sugars were 17.5mmol/L and with saturation of 98% on room air. He had a body weight of 5.5kg on admission with a z-score of -3sd. Nutrition focused physical examination revealed severe loss of muscle mass and adipose tissue. Nutrition prescription of high calorie high protein diet providing 846 calories and 22.3 g of protein per day was prescribed. The feed of choice was fortified blended flour (FBF) porridge which was administered via nasogastric feeding tube. After fourteen days of nutrition care in the unit, the patient had a weight gain of 100g. The average weight gain rate was 1.29g/kg/day. This case report documents challenges in nutrition management of secondary acute malnutrition with SARS-CoV-2 pneumonia in resource limited clinical settings. The review of existing guidelines and disease specific nutrition commodities in the management of secondary acute malnutrition in clinical settings is recommended. Keywords: Enteral nutrition, Nutrition care process, Secondary acute malnutrition, SARS CoV2 infection, Covid19

Predictors of nutrition care process knowledge and use among dietitians internationally.

The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.

PERBEDAAN TINGKAT ASUPAN ENERGI SERTA GLUKOSA DARAH SEBELUM DAN SESUDAH PROSES ASUHAN GIZI TERSTANDAR PADA PASIEN DIABETES MELITUS TIPE 2 &lt;br&gt;&lt;i&gt;Difference of Energy Intake and Blood Glucose Level Before and After Providing Standardized Nutrition Care Process in Type 2 Diabetes Mellitus Patients&lt;/br&gt;&lt;/i&gt;

The provision of nutrition care process (NCP) in diabetes mellitus (DM) patients is very important in determining the patient's diet to control blood glucose and to prevent complications. This study aimed to determine the diff erences in levels of intake and blood glucose levels before and after the implementation of NCP for type 2 DM (T2DM) inpatients of RSUD Dr. Saiful Anwar Malang. The design of this study was cross sectional, using secondary data sources from 32 patient medical records consisting of data on age, gender, nutritional status, complications of disease, nutritional diagnosis, nutritional intervention, energy intake, and blood glucose level. The analysis test used was the T-test dependent test on the normal data distribution and the Wilxocon test on the abnormal data distribution. The results of this study indicate a diff erence in the level of after and before intake (p = 0.020) with an increase in the average intake of 65.75 ± 18.23% to 75.50 ± 17.69% of the total energy needs. The analysis of blood glucose before and after showed p = 0.023, which means that there were diff erences in blood glucose before and after the NCP implementation. Blood glucose results showed an average decrease of 205 ± 93.85 mg/dl to 155.9 ± 50.53 mg/dl. The results of this study showed that there were diff erences in levels of energy intake and blood glucose levels before and after the provision of NCP by dietitians/nutritionists.

Status of nutrition care process implementation in hospitals in Jeddah, Saudi Arabia

The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently implemented by dietetics practitioners worldwide, with various advantages, including ensuring consistency and clarity of dietetics-related healthcare records and the possibility to collect and analyse patient outcomes; however, how Saudi dietitians experience the implementation process is poorly understood. The aim of this study was to explore the experiences of Saudi dietitians of NCP implementation in hospitals in Jeddah. In this quantitative, cross-sectional study, 56 dietitians were recruited from six principal hospitals in Jeddah. A questionnaire was used to collect data on the characteristics of the dietitians and hospital-related clinical nutrition care performance, the perception and opinions of dietitians towards the NCP, and the status of NCP implementation. Almost all dietitians (98%) were aware of the NCP; however, only 27% had received NCP training. Most dietitians (73%) reported that their department currently follows the NCP, while only 26% reported using the standardized NCP, including International Classification of Functioning, Disability & Health - Dietetics (ICF-D)-WHO and International Dietetic & Nutrition Terminology (IDNT) - USA, with 63% following the hospital's own NCP. Reported reasons for hospitals not following the NCP included insufficient dietitians, lack of experience, or conflict with the hospital's nutrition care system. A majority of dietitians reported no perceived barriers to applying the NCP; however, 23% reported NCP documentation as a challenge. The majority of dietitians are aware of the NCP and feel confident to practice; however, the NCP model is not currently implemented in Jeddah hospitals as standard. On-going education, a training program, and an implementation plan should be prioritised.

Barriers and enablers in the implementation of a standardised process for nutrition care: findings from a multinational survey of dietetic professionals in 10 countries.

To explore the barriers and enablers experienced by nutrition and dietetic professionals in the implementation of the standardised Nutrition Care Process (NCP) across 10 different countries. NCP related beliefs, motivations and values were investigated and compared. A validated online survey was disseminated to nutrition and dietetics professionals in 10 countries in the local language during 2017. Cross-sectional associations and differences between countries were explored for level of implementation, barriers/enablers and attitudes/motivation among the respondents. Higher NCP implementation was associated with greater occurrence of enabling aspects, as well as fewer occurrences of barriers. The most common enabler was 'recommendation by the national dietetic association' (69%) and the most common barrier was 'lack of time' (39%). A longer experience of NCP use was associated with a more positive attitude towards all NCP aspects. Differences between countries were identified, regarding both the occurrence of barriers/enablers and attitudes/motivations. Implementation efforts need to be tailored to country-specific contexts when implementing a new standard of care framework among nutrition and dietetic professionals. Additional research is needed to further assess the management and workplace strategies to support the development of nutrition and dietetics professionals in multidisciplinary healthcare organisations.

Nutrition Care Process Implementation: Experiences in Various Dietetics Environments in Sweden

BackgroundThe Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians’ experiences of the implementation process. ObjectiveThe aim of this qualitative study was to explore Swedish dietitians’ experiences of the NCP implementation process in different dietetics environments. MethodThirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework. ResultsMain categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation. ConclusionsThe diversity of dietetics settings and their different prerequisites should be considered in the development of NCP/NCPT implementation strategies. Tailored implementation strategies should be considered in relation to context, such as increased dietetics support and facilitation where management does not lead or support the implementation process.

Development of a Nutrition Care Process implementation package for hospital dietetic departments

AbstractAimThe Academy of Nutrition and Dietetics has led the development and dissemination of the Nutrition Care Process (NCP), incorporating the Nutrition Care Process Terminology as the standardised language. This research investigates and compares the views of Australian dietitians pre and post NCP implementation to inform development of an NCP implementation package.MethodsDietitians from two hospitals that had undergone informal NCP implementation (post‐implementers, n = 35) and three hospitals yet to implement NCP (pre‐implementers, n = 35) completed an online questionnaire (ASK NCP) surveying demographics and constructs relating to knowledge, familiarity, confidence, support, value, barriers, training and NCP education.ResultsPost‐implementers had higher knowledge scores (P &lt; 0.05), were more familiar with NCP (P &lt; 0.01), confident to implement (P &lt; 0.01) and supported to use NCP (P &lt; 0.01) than pre‐implementers. Lack of knowledge, support, training and resources was identified as a barrier by pre‐implementers. Busy workloads and work status were identified as barriers by post‐implementers. Pre‐implementers felt they had insufficient NCP training; however, if further training and support were to be provided, almost all reported they would be more confident to implement. Keys to successful implementation included allocated time to practice and regular tutorials; support and leadership from their management and NCP department leader; and professional growth through understanding how change could benefit practice.ConclusionsThe results of the study were used to inform the development of an NCP implementation package. Kotter's eight stages of change were identified as the most appropriate change management model with the framework incorporated into the package development.

Evaluation of a Nutrition Care Process implementation package in hospital dietetic departments

AbstractAimIncorporation of the Nutrition Care Process (NCP) and NCP Terminology (NCPt) into clinical dietetics practice is advocated in Australia; however, no evidence‐based implementation process exists, which may hinder uptake. Based on formative research findings from the Attitudes Skill Knowledge (ASK) NCP survey and using a change management framework, we developed an implementation package for Australian hospital dietitians. This paper aims to report on the outcome of the pilot evaluation and efficacy of the package.MethodsDietitians from three hospitals (two tests and one control) in Western Australia who had not undergone NCP implementation were recruited. Evaluation occurred through administering the ASK NCP survey pre and post implementation in all subjects and focus groups at test sites. The Mann–Whitney U‐test was applied to determine whether the changes in the test group were significantly different to the control group. The Wilcoxon signed rank test was used to determine whether there were significant changes within groups. Focus groups were audio‐recorded, transcribed and then analysed for themes by the authors.ResultsCompared to pre‐implementation, the dietitians from the test hospitals had significantly higher NCP knowledge (P = 0.006), were more familiar with NCP (P = 0.01) and NCPt (P = 0.025), and more confident to utilise NCP practice (P = 0.011). Compared to pre‐implementation, the control group displayed significantly higher familiarity with NCP and NCPt (P = 0.041); however, significant improvements in other constructs were not observed. No significant difference was observed between groups for all constructs.ConclusionsDietitians found the package useful and would recommend it to Australian hospital dietetic departments.

A Survey on the Status of Nutrition Care Process Implementation in Korean Hospitals

The Nutrition Care Process (NCP), developed by the American Dietetic Association, is a significant issue to dietetic professionals in many countries and there are rising needs for NCP implementation in Korea. We surveyed clinical nutrition managers of Korean general hospitals regarding the perception of NCP, the status of NCP implementation, and the opinions on NCP. The questionnaire was collected from 35 hospitals. Most clinical nutrition managers perceived NCP, but NCP implementation in hospital was at early stage. NCP was implemented in a fourth of the surveyed hospitals and many clinical nutrition managers responded that the lack of knowledge and the concern on increasing working time were major barriers to implementing NCP. To successfully implement NCP in Korean hospital, ongoing education and training programs should be developed to provide adequate knowledge and help dietitians to cope with the barriers.

Implementation of Nutrition Care Process in a Community Nutrition Education Setting

Implementation of Nutrition Care Process in a Community Nutrition Education Setting

The Development of Standardized Forms for the Implementation of Nutrition Care Process in a Pediatric Hospital

The Development of Standardized Forms for the Implementation of Nutrition Care Process in a Pediatric Hospital

Implementation of the Nutrition Care Process in the Affinity Patient Charting System

Text: The Nutrition Care Process (NCP) provides a standardized yet individualized approach to nutritional care of patients. When the decision was made to implement the NCP into the electronic documentation system at Harbor-UCLA Medical Center, dietitians (RDs) raised two primary concerns: would the briefer method of documentation meet regulatory requirements and would formation of the Nutrition Diagnosis (ND) statement take significantly longer to develop during the initial transition, resulting in decreased productivity? RDs were trained in the NCP over a six month period and the Clinical Nutrition Manager (CNM) worked with Information Systems (IS) to ensure all ND and Nutrition Intervention terminology was included in the Affinity Patient Charting system. The NCP was formally implemented in October, 2007. RD productivity pre-NCP ranged from 1.39 1.81 (average 1.63) inpatients seen per hour. Since implementation of the NCP, productivity has averaged 1.58 (range 1.53 1.67). A minimum of 5 chart reviews are conducted on each RD quarterly to ensure compliance with regulatory requirements as well as assess competency. Chart audit scores prior to NCP implementation ranged from 90.98% to 97.54%. Post-implementation, initial chart audit scores were 95%, increasing to 98.32% the following quarter. In summary, use of the NCP has not resulted in a decreased productivity level, even during the initial learning phase, and chart audit scores have improved to an annual high during the recent quarter. As the staff become more accustomed to the NCP, data will continued to be tracked for further improvement in productivity, competency, and regulatory compliance.