You’ve had a great interaction with a nutrition client and now, the time has come: you have to complete your chart…complete with the PES statement. Yikes!
PES statements can feel confusing for RDs and RD2Bes alike. But take heart: this post will provide you with tricks and tools to help you feel more confident as you write your next PES statement. Plus, we have examples of PES Statements from different niches.
If you’ve been looking for help with PES Statements before, you may have noticed how many articles are very high-level…where are the actual PES statement examples? And you probably don’t want to be lugging a book with you as you move from patient to patient to support your charting.
In this blog post, you’re invited to refresh your memory about what PES statements are, their intention to provide for better patient outcomes as well as several examples for you to actually see PES statement examples in action. You’re probably going to want to bookmark this post for later!
Let’s dive in!
What is a PES Statement?
What is a PES Statement exactly? A PES statement is one part of the formal charting process that dietitians can use in a hospital setting, in a long-term care facility, or in their private practice.
The purpose of the PES statement is to clearly state what the RD will be doing to improve the health and wellness of the patient, with changes or optimizations to the patient’s nutrition intake, education, or access to safe food.
Dietitians have been encouraged to use the ADIME format for charting since its inception in 2003 (1). The formal charting note captures the patient or client’s medical and health history, medical diagnosis, as well as their nutrition status and plans for improving any nutrition issues.
ADIME is an acronym for:
The ADIME note includes the PES statement in the diagnosis section. If you will be creating your own charting template for your own private practice, you’ll want to check out the ADIME Nutrition Assessment Charting Form Template on WellResourced. No need to waste time or energy crafting something that has already been made well by an RD colleague!
You’ll also want to bookmark this blog post: Charting Tips for Dietitians: Your No Hassle Guide.
Meanwhile, let’s dive a little deeper into each section of the PES statement – what does each component mean?
Quick reminder: the nutrition diagnosis, or problem, part of the PES statement is the nutrition diagnosis, not the medical diagnosis. The P section of the PES statement is what problem or issue the RD will be tackling in their work with the patient.
There are three main categories of nutrition diagnosis:
- Intake – is the patient consuming too much or too little of a food or nutrient?
- Clinical – a nutrition issue related to their medical diagnosis
- Behavioral or environmental – refers to a patient needing education, access to different or safer food, or needing to adjust a belief.
A dietitian cannot change a diagnosis of cancer, but a dietitian can teach a cancer patient how to better manage nausea that is causing weight loss or provide information about safer use of herbal supplements in conjunction with the prescription medications that the patient is taking.
Etiology
The Etiology is the dietitian’s assessment of why this nutrition diagnosis happened to begin with. Ask yourself what is the root cause of the nutrition problem?
As dietitians, the etiology section of the PES statement is aimed to address the nutritional problem that you are solving with your work.
You may find it helpful to start at the etiology section and work backward from there. This strategy can help prevent you from feeling stuck if you aren’t quite sure where to start with the PES statement.
Signs/Symptoms
This part of the PES statement is where the RD provides the evidence to support why they diagnosed the nutrition problem, to begin with. What is the objective (such as a lab or anthropometric value) and subjective (such as a food recall) data to support the claim?
The PES statement, within the ADMIE note, is part of the larger process of providing nutrition care as a whole. This is known at the NCP: let’s explore that now.
PES Statements and the Nutrition Care Process
PES Statements are one piece of the formal documentation – the ADIME note – that is part of the whole standardized methods that dietitians are taught to move through as they provide patient care.
The purpose of the Nutrition Care Process (abbreviated NCP) is to have a standardized method for providing nutrition interventions as well as a standard language used throughout the process.
The intention is that with a standardized process and language, the NCP enables patients to receive more consistent and predictable care. But more than that: the NCP allows dietitians to deliver high-quality care and outcomes for their patients. A nutrition diagnosis statement should be one that we as dietitians take accountability to address and resolve.
PES Format
PES statements follow a standardized format.
The format of the PES statement is — Problem (the nutrition diagnosis) related to Etiology (the root cause of the nutrition diagnosis) as evidenced by Signs and Symptoms (findings from the nutrition assessment that determine the nutrition diagnosis).
A visual way to look at the standard PES statement format is:
(Problem) _____________ related to (Etiology) _____________ as evidenced by (Signs and symptoms) __________________.
PES Statement Examples
Now that we’ve explored what PES statements are, how they fit into the context of charting ADIME notes as well as within the NCP at large, you’re probably ready to see some examples.
Here we will cover PES statement examples in many different niches. Seeing different examples is a great way to feel more comfortable with new skills.
Reminder: the PES statement refers to the nutrition diagnosis, not the patient’s medical diagnosis.
PES Statement for Diabetes
In this example, the PES statement might apply to a patient who is newly diagnosed with diabetes or a patient who has not yet had any nutrition education about their condition.
P: Food/nutrition-related knowledge deficit related to…
E: no prior diabetes nutrition-related education as evidenced by…
S: questions raised regarding carbohydrates and being unaware of the need to moderate them.
PES Statement for Malnutrition
In this PES example, the patient is losing weight and unable to eat adequately because of their chronic disease as well as a recent additional acute diagnosis of pneumonia.
P: Malnutrition as related to…
E: Chronic disease (hx of emphysema and recent dx of pneumonia) as evidenced by…
S: Patient’s unintentional weight loss of 7.9% of his usual body weight in the past six weeks, mild loss of muscle mass, and severe loss of fat mass, as well as inflammatory markers: elevated CRP (12mg/L) and WBC (12.4) and decreased albumin (2.8g/dL).
PES Statement for Inadequate Intake
In this example, the PES statement might be a good example appropriate for a patient who has a compromised nutrient status because of drinking alcohol in excess and not being able to eat a generally healthy diet.
P: Malnutrition and inadequate intake as related to….
E: Alcohol addiction as evidenced by…
S: Loss of appetite and limited ability to prepare and consume adequate energy and reported intake of >8 drinks per day, loss of 15% of body weight in the past 3 months, food intake of less than 50% of normal in the past month and moderate to severe signs of muscle wasting
PES Statement for Obesity
In this example, the PES statement is about a WIC patient who had gained weight quickly in her pregnancy.
P: Excessive energy intake related to…
E: High-calorie fast-food meals and sweetened drinks as evidenced by…
S: Rapid weight gain of 8 pounds per month and dietary recall
PES Statement for Cirrhosis
In this example, the patient has lost their appetite as a result of their medical diagnosis, cirrhosis.
P: Inadequate intake related to…
E: loss of appetite secondary to cirrhosis as evidenced by…
S: 10% weight loss in last 5 months.
PES Statement for Hypertension
For this PES statement example, the patient is not yet able to eat well for their diagnosis of HTN and has been eating too much sodium.
P: Excessive intake of sodium related to…
E: High intake of fast food and convenience foods as evidenced by…
P: Fluid retention and elevated blood pressure of 150/95.
FAQs about PES Statements
You may have a few questions about PES statements. Here are a few of the common questions we have come across for PES statements.
What is the difference between PES and ADIME?
PES statements are one piece of the larger ADIME charting note format. The ADIME note is the entire documentation of the patient visit while the PES statement is one section of the ADIME note.
Where do you find PES statement terminology?
You have two options for finding the PES statement terminology.
On the website of the Academy of Nutrition and Dietetics, you can purchase a hard copy of the Abridged Nutrition Care Process Terminology (NCPT) Reference Manual: Standardized Terminology for the Nutrition Care Process. There is a discount for Academy members.
The other option is to purchase a subscription to the electronic Nutrition Care Process Terminology (eNCPT). When you purchase the hard copy of the NCPT manual, you receive a complimentary one-year membership to the eNCPT.
What is the eNCPT?
What is the eNCPT? eNCPT is short for electronic Nutrition Care Process Terminology. This is an online hub of information related to using ADIME charting.
eNCPT is not free, but they do offer a discount for AND members as well as for students. Pricing for eNCPT can be found here.
What are the benefits of using PES statements?
The benefit of using PES statements is that you’re following the recommended formatting crafted by the Academy of Nutrition and Dietetics. In addition, you have a predictable and repeatable format to document with and you’re flexible as you change roles or employers; your documentation methods are transferable from one role to another!
What trainings are available that cover the NCP?
If you’re ready to learn more about the NCP and get an hour of CPE, you’ll want to check out the free training offered via the AND here.
What is documentation in the nutrition care process?
The Nutrition Care Process (abbreviated NCP) is the standard framework for dietitians to use as they get to know their clients’ histories, medical diagnoses, and nutritional needs.
The formal charting framework is known as ADIME and is covered in-depth earlier in this article.
Do I have to use PES Statements?
This answer will vary based on where you work or if you’re in private practice. If your hospital or long-term care facility requires PES statements, then yes, you have to use them.
If you’re in your own private practice, the decision is more in your hands. However, if you bill for insurance, it is worth checking to see if they have preferences for formatting that would be best for you to follow.
Key Takeaways: PES Statements
The PES statement is part of the Nutrition Care Process (NCP), a systematic approach to providing high-quality nutrition care. The PES Statement is one part of the ADIME note, the formal documentation of your entire encounter with your patient or client.
While any new system or terminology can take some practice to get used to, this article is a guide you can come back to as needed for a refresher as you get more familiar with using PES statements.
PES Statement How-To Guide
Put down your nutrition textbook and turn to the only PES-writing resource that you need. This 3-page guide is packed with simple visuals, examples for quick reference and a checklist. Get the Dietitian’s Guide to Writing PES Statements today.
