Harnessing the Benefits of the Nutrition Care Process Quality Evaluation and Standardization Tool: A National Auditing Initiative to Improve Quality of Documentation

The Nutrition Care Process Quality Standardization and Evaluation Tool (NCP QUEST) is a validated audit instrument assessing the quality of NCP documentation by registered dietitian nutritionists. The present quality improvement project describes change in documentation quality as measured by NCP QUEST and word count of notes after a monthly national digital training provided to Veterans Affairs registered dietitian nutritionists. The training and adoption of NCP QUEST was voluntary. Facilities were recruited among those that had participated during the design and validation study of NCP QUEST. The NCP QUEST score was calculated and the word count was determined for 52 documentation notes (28 from NCP QUEST nonuser facilities and 24 from NCP QUEST user facilities) before and after training. The mean pretraining NCP QUEST score for notes from NCP QUEST nonuser facilities was 13.71 and 13.88 for NCP QUEST user facilities. The mean posttraining total NCP QUEST score for nonuser facilities was 14.00 and 17.65 for user facilities, with no improvement for the nonuser facilities (P = 0.69). A significant improvement was identified for the NCP QUEST user facilities (P ≤ 0.001). All facilities experienced a significant reduction in the word count of assessment notes (P = 0.04). Use of the electronic NCP Terminology website increased 123-fold and was sustained after the training. NCP QUEST users reported that the audit tool is useful. The NCP QUEST should be at the center of registered dietitian nutritionists’ training and more strategic effort is needed to engage practitioners in the optimal application of the NCP.