This post is Part 1 of IDNT and the Nutrition Care Process.
It’s an adventure through the world of IDNT (International Dietetic and Nutrition Terminology) and the Nutrition Care Process. I said it is an adventure right? So I hope to make it fun experience for all. My aim to explain to you (in my own way) what the Nutrition Care Process is all about. I also plan to convert all you non believers to the ways of IDNT. Tough task I have set myself…but I will give it my best.
If there is questions or topics around IDNT and the Nutrition Care Process you want me to cover please let me know.
So here goes.
What is NCP and IDNT?
In a nutshell, the Nutrition Care Process (NCP) is a model for providing high quality nutrition care and International Dietetics and Nutrition terminology (IDNT) is the standardised language used to describe the NCP.
I have written about the benefits of NCP and IDNT a few times before, so I will not repeat myself here, but I will mention one of the uses for IDNT. IDNT is used for the documentation of clients’ (or patients’) nutrition care i.e. medical note documentation. And this is how we use IDNT in Kalix. The standardised documentation format for NCP is ADIME (A-Assessment, D-Diagnosis, I- Intervention, ME-Monitoring and Evaluation). And again this is the format we use in Kalix. In saying that, you can use IDNT to write notes in whatever format you like including SOAP, ABCD etc.
The first stage in the Nutrition Care Process is the Nutrition Assessment and hence, this is the first section in ADIME. Assessment contains the data you collect about a client/patient during the consultation, from medical records, food records, weight records, client observations, from discussions with other healthcare providers, carers or family members etc.
There is one important point I would like everyone to understand about Nutrition Assessment in NCP. But, before I explain it, I would like to ask, a very important question:
Why do Dietitians conduct nutritional assessments with clients?
Sure, there is not one answer to this, but many. Some of the reasons include:
• To confirm clients’ medical history
• Collect anthropometric measurements
• Gather information about their diet and food intake
• Learn clients’ personal preferences to assist with providing tailored advice
The list can go on… but now I ask you, why do Dietitians collect this information and what do we do with it?
Dietitians conduct nutritional assessments to obtain client data, which we verify (check that it is accurate) and interpret (compare it to relevant reference standards and look at the data in relation to the client as individual) to determine whether the dietary modifications are required or not i.e. that a nutrition related problem exists (this problem is the Nutrition Diagnosis). Dietitians then examine this client data to identify the cause/s of the nutrition-related problem (its etiology) and its significance (the effect the nutrition-related problem has on client’s health and wellbeing). All of this information then used to determine how to go about resolving (this is the Nutrition Intervention) the nutrition-related problem .
Makes sense…so what is my important point?
Nutrition Assessment, should not be just list of assessment information, it is should contain only relevant information that is used to demonstrate;
• Whether a nutrition-related problem exists
• The cause/s of the nutrition-related problem
• Its significance (the effect the nutrition-related problem has on client’s health and wellbeing).
As Dietitians, our time as is too precious to be wasted writing irrelevant information in the Nutrition Assessment. So I recommend to you to only enter relevant information in the Nutrition Assessment section.
Now we have that clear, it will talk a bit about what makes up the Nutrition Assessment section.
In the ADIME the Nutrition Assessment is ordered a little bit differently compared to other note writing formats, with Food/Nutrition-Related History listed first.
This section includes all information about your client’s oral intake, as well as nutritional support plus enteral and parental nutrition. Basically, any diet related information i.e. the client’s diet history (and your analysis of it), complementary/alternative medicine use, knowledge/beliefs about food and eating, access to adequate healthful food and nutrition quality of life. Physical activity history also lives here.
Ok, a common comment I hear about this section, is why isn’t Anthropometric first?
In ADIME, we list the most important stuff first. We know medical staff do not always read every part of a Dietitian’s notes, they may read the first part then skim the rest. Food/Nutrition-Related History is the most important part of a Dietitian’s documentation, right? A Dietitian’s ability accurate gather nutrition and diet-related information and interpret it, is what makes us unique as a profession. Other professionals measure weight and other anthropometric measurement (even doctors do it sometimes), all health professionals collect medical histories, most check the biochemical/lab data, but only dietitians assess dietary and nutrition related history. That’s why is section is first.
We all know what goes here, height, weight, body mass index (BMI), growth pattern indices/percentile, and weight history etc.
Something I would like to talk about (and it’s something that I have touched on previously) is Nutrition Care Indicators. Nutrition Care Indicators are client data gathered during the nutrition assessment that are used to identify a client’s Nutrition Diagnosis and its etiology and signs/symptoms. i.e. they are indicators that nutrition care is required. Any Nutrition Assessment data can be a Nutrition Care Indicator, including anthropometric measurements e.g. the client’s BMI. If a client’s BMI is in the obese category, for example, this is an indicator that nutrition care is warranted for weight management. In this case, the client’s BMI will be used as a sign and symptom for the Nutrition Diagnosis of Excessive Energy Intake (the reason for why it is a sign and symptom and not the Nutrition Diagnosis will be explained in the next blog).
Biochemical Data (Blood tests), Medical Tests and Procedures
Includes laboratory data, (e.g. electrolytes, blood glucose levels and lipid panel) and tests (e.g. gastric emptying time, resting metabolic rate).
The important thing to remember here, is the Nutrition Care Process supports evidenced based practice, it is not enough to say client A has an HbA1c of 10%, you need to show what this means (interpret it). It does not have to be a long description…all you have to do is compare your client results against some relevant standard. It can be a reference standards i.e. Australian Diabetes Society recommended HbA1c target or the client’s goal e.g. reduce HbA1c by 1%.
Client A’s HbA1c is 11% [The client’s result and the Nutrition Care Indicator], which is above [the comparison- it does not need to be long] the recommended range of < 7% [the reference range].
Nutrition-Focused Physical Findings
These are findings obtained from the evaluation of “body systems” including overall appearance, cardiovascular, digestive system, skin and vital signs. The results should be nutrition-related physical characteristics, such as nausea, loss of subcutaneous fat and temporal wasting, and they should be associated with pathophysiological states e.g. cancer cachexia, malnutrition. So again, I emphasis only including relevant information. Nutrition-focused physical findings can be derived from a nutrition-focused physical exam, medical records, direct observation, client reports etc.
This section includes current and past information related to personal, medical, family, and social history. Personal History includes general client information such as age, gender, race/ethnicity, language, education, and role in family. Medical history can be history of the client or the family history. Medical history should only contain conditions that may have a nutritional impact, so no irrelevant information. Social History includes items such as socioeconomic status, living situation, medical care and involvement in social groups.
Client information is often used as part of the etiology for a Nutrition Diagnosis e.g. economic constraints, cultural practices and depression (etiology), can be the cause of Inadequate Energy Intake (Nutrition Diagnosis).
So that is all for Nutrition Assessment, next blog I will talk about Nutrition Diagnosis and PES Statements. Below are some final tips.
P.S. I would love to hear what you think about this blog, please share your thoughts below.
1. Decide on what data is appropriate to collect (consider the client, your setting, the referral reason etc.)
2. Collect data using applicable validated assessment tools
3. Distinguishing relevant between relevant and irrelevant data (only include relevant data)
4. Validate your data by comparing it against relevant standards or client goals.