An Overview of PES Statements – Plus Four Ways to Write Them Better. 

While there are many ways to document client and patient interactions, it is important to write clearly and consistently. PES statements are a standardized format for you as the registered dietitian to focus on the care of your patients or clients. 

Since 2003, registered dietitians have had the opportunity to document and chart patient interactions following a specific format called ADIME, which stands for:

• Assessment
• Diagnosis
• Intervention
• Monitoring
• Evaluation

This charting system has a specific structure to support why the RDN is recommending what he or she is recommending, based on the client or patient history, goals and root causes (1, 2). 

The PES statement is the diagnosis piece of an ADIME note. The nutrition diagnosis gets to the meat of the matter. What are you as the dietitian working to solve, first? Let’s explore!

Photo by Van Tay Media on Unsplash

What are PES Statements?

The PES statement is the diagnosis of the most pressing nutrition issue. A nutrition diagnosis may not be the same as the patient’s medical diagnosis (3). 

PES statements can be used for charting in the clinical setting or in private practice. Melissa Mitri, MS, RDN owner of Melissa Mitri Nutrition LLC  gets us started understanding what a PES statement is:

“A PES Statement is a structured sentence that pinpoints the main nutrition problem your patient or client has that you are helping them to resolve. 

The goal of incorporating PES statements into your notes is to hone in on the main nutrition problem and provide consistent documentation for follow up.  It is a standard, universal way of documenting as part of the total nutrition care progress guidelines. 

PES stands for Problem, Etiology, Symptoms.”

Do all RDs use PES statements?

PES statements can be used in a clinical or private practice setting. Not every RD finds PES statements to be essential nor does every institution require them.  

Megan Boitano, MS, RD and founder of the RD2RD marketplace feels that PES statements are a must. 

“Charting requires both speed and accuracy. Writing a PES statement is how I get focused and achieve both. Once I have this identified, it’s easy to work backward to assessment data to include appropriate interventions and monitoring criteria. 

No need to worry about leaving out information or spending more time on superfluous details. Using an ADIME charting template is a must!” 

One big benefit of being your own business owner is that you get to make decisions about what works best for you and your practice. If PES statements are not working to make your business more effective and efficient – skip them! 

Leslie Edmunds MPH, RDN, CDE, CLT owner of Clem&Thyme Nutrition did not see the ADIME charting method taking her business to the next level. 

 “In my experience, insurance companies don’t know anything about PES statements and have reps that have no education in nutrition evaluating our medical notes. For our practice, the PES statements don’t offer us a benefit so we don’t use them.”

How can I be more efficient while charting?

Lisa Andrews, MEd, RD, LD, Owner, Sound Bites Nutrition, LLC uses PES statements when she sends a progress note to an MD after a nutrition consult.

“I made a progress note template that includes the most commonly used statements to include in my note. I keep the AIDME reference book handy in case I have an “oddball” diagnosis.”

 

 

 

 

 

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Four ways to write better PES statements

1 Don’t write too many

Just like our patients and clients, RDs can run into trouble if they are trying to solve every problem in one sitting. Don’t overwhelm your client (or yourself) by focusing on too many PES statements – drill it down to one or two. 

Remember that you splitting focus into too many directions makes it difficult to make progress on any one of them. 

2. Get to the root cause

The first part of your PES statement is what you’re going to address with your nutrient recommendations. This is the root cause, not the symptoms. 

When I was in school to become a dietitian (go Bobcats!) I remember being a bit confused about where to plug the different pieces into the sentence. Sometimes it can feel like the chicken or the egg conundrum, but the exercise here is that we are distinguishing between the root cause and what is contributing to it. 

3. Back up your nutrition diagnosis

Where is the evidence? We are a field that makes recommendations because there is research to support it. During your client charting, you’re putting that research and your critical thinking to work.

4. Use a template

Save time by not reinventing the wheel! Use a template of the PES statements that apply to your clientele the most often. 

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An effective business owner is effective with her time, whether it is writing PES statements, blogs for your website that speak directly to your ideal clients or compelling captions for your social media outreach. 

Are you a registered dietitian in private practice looking to level up? Look for ways to delegate!

If you don’t love writing or aren’t seeing the return on the investment of your time spent writing, I’d love to meet, learn about your amazing business and see how I can contribute to you achieving your next goals.