PES Statement Overview
PES statements are structured sentences used by dietitians to communicate the nutrition diagnosis of a patient. They follow a specific structure that uses standardized terminology.
What Does PES Stand For?
The acronym in PES stands for the following:
- P – problem
- E – etiology
- S – signs/symptoms
How To Write a PES Statement
PES statements are written as follows:
[Problem/nutrition diagnosis] related to [Etiology], as evidenced by [Signs/symptoms].
Problem/Nutrition Diagnosis
First, the problem, or nutrition diagnosis must be identified. It is important to note that nutrition diagnoses are not medical diagnoses. Examples of potential nutrition diagnoses include:
- Excessive energy intake
- Inadequate enteral nutrition infusion
- Inadequate fluid intake
- Excessive alcohol intake
- Inadequate intake of calcium
- Obesity Class III
- Food and nutrition related knowledge deficit
The nutrition diagnosis should be a problem that the dietitian ideally can treat independently and can be resolved, or at least improved, through nutrition intervention.
Nutrition diagnoses are from a specific list found at the eNCPT website. Previous to this electronic version being available, the lists were found in the International Dietetics and Nutrition Terminology texts. These texts are no longer updated, so the eNCPT website must be used.
A subscription is required to access this information – the cost is $35/year for students, $50/year for Academy of Nutrition and Dietetics (AND) members and $100/year for non-members. There are also student, organization, educator and developer subscriptions with various pricing available.
Etiology
Next, the etiology of the nutrition problem is documented. This is the “root cause” of the problem and is what the nutrition intervention will be targeting. Ideally, the etiology is something that can be resolved through dietary intervention.
The etiology could be a wide range of conditions or circumstances related to the patient’s cultural values, beliefs, medical conditions, physical or cognitive function, medical or surgical treatment, or social history.
Some examples of etiologies include:
- Altered body image
- Limited value for behavior change
- Limited physical ability
- Loss of appetite awareness
- Change in living situation
Signs and Symptoms
Finally, the signs/symptoms of the nutrition diagnosis are listed. These are the defining characteristics collected in the assessment step used to determine the nutrition diagnosis.
The signs and symptoms could be from a variety of sources such as the medical record, your interview of the patient or from a Nutrition Focused Physical Exam.
You may list several signs and symptoms. They should be specific enough that they can be monitored to see if the problem has been resolved or improved.
Some potential examples of signs and symptoms include:
- <25% of meals consumed
- Reported weight loss of 10 lbs in the last three months
- Feeling loss of control around food
- Poor skin turgor
- Estimated protein intake of 20 g per day
- Daily consumption of refined grains
- Elevated blood pressure readings
- Average of 2000 steps per day
- Patient stating he does not have enough time to eat healthy
- Meal skipping
PES Statement Example
Inadequate energy intake related to difficulty swallowing as evidenced by <25% of meals consumed and reported weight loss of 10 lbs in the last three months.
See 20 PES Statement Examples for more.
What if a Patient Has No Nutritional Problems?
If a patient has no immediate nutrition-related issues, “no nutritional diagnosis at this time,” can be documented.
Tips for Writing PES Statements
- Use information gathered in the assessment to determine the nutrition problem
- Use critical thinking to make inferences
- The nutrition diagnosis can ideally be resolved, or at least improved, through a nutrition intervention provided by the dietitian
- Choose nutrition diagnoses from the intake domain, over other domains, as these are the most likely to be resolved by the dietitian through a nutrition intervention
- PES statements should be clear and concise
- Keep PES statements to three or less for a patient
- Feel free to not write complete sentences by leaving out words such as “and” and “the”
PES Statements Background and History
PES statements are part of a larger framework known as the Nutrition Care Process (NCP). The NCP was adopted by AND, known as the American Dietetic Association at that time, in 2003 to provide dietitians with a framework to provide nutrition care using a systematic approach.
PES statements are just one step of the NCP which includes:
- Nutrition assessment
- Nutrition diagnosis (PES statement)
- Nutrition intervention
- Monitoring and evaluation
Are PES Statements Required?
Some institutions may have policies or procedures that require dietitians to write PES statements. The Academy strongly recommends using the NCP, including PES statements, but it is not required.
To my knowledge, there are no health insurance companies that require PES statements for Medical Nutrition Therapy claims to be reimbursed. PES statements are not included on claim forms, therefore an audit or specific request of documentation would have to be done for the insurance company to access this information.
I personally do not write PES statements but rather have a “clinical assessment” section where I write a collection of nutrition problems, etiologies, signs, symptoms and other statements based on my synthesis of the information. I have been asked for medical records from multiple insurance companies and no one has ever questioned my documentation.
Note that the 2023 edition of the Nutrition Care Process Terminology (eNCP) is used, which is the most current version at the time of this article being published.
References:
Electronic Nutrition Care Process Terminology (eNCPT)
Nutrition Care Process Terminology NCPT) Overview and Resources