Simplifying the ADIME Format for Nutrition Notes

Simplifying the ADIME Format for Nutrition Notes (FREE PDF)

Using the ADIME format when writing your nutrition note does not have to be complicated or confusing. In fact, a better understanding of the ADIME process can help you organize the flow of your appointments using the nutrition care process.

Read on to see how ADIME can work for you and your clients.

What is the ADIME format?

ADIME stands for:

  • Assessment
  • Diagnosis
  • Intervention
  • Monitoring and Evaluation.

What are the steps of ADIME?

Each part of the ADIME process is key to assisting your patients in achieving their health and nutrition goals.

Nutrition Assessment - image of a person taking an assessment

A = Assessment

The nutrition assessment is the first step of the ADIME format. It includes information gathered from your patient’s medical records, verbal info shared by your patient, and observations by you, the registered dietitian nutritionist (RDN).

According to the Academy of Nutrition and Dietetics and EatRight.org, there are 8 Domains that can be included in the assessment portion your note:

1. Food/Nutrition Related HistoryYour patient’s past and current eating patterns, knowledge, beliefs, etc.
2. Anthropometric MeasurementsMeasurements of the body including height, weight, body mass index (BMI), growth charts, etc.
3. Biochemical Data, Medical Test, and ProceduresLabs, test results, recent medical procedures.
4. Nutrition Focused Physical FindingsDetecting nutrient deficiencies through physical observations.
5. Client Personal HistoryVerbal reports shared by your patient about medical, family, and social history.
6. Assessment, Monitoring, and Evaluation ToolsThe RDN toolkit.
7. Etiology CategoryHelps to communicate the nutrition diagnosis etiology.
8. Progress EvaluationTracks progress towards goals and resolving the nutrition diagnosis.
Image of a check-list of Medical Chart Review points

Medical Chart Review

Several data points of these domains can be gathered through medical chart review. If you do not have access to your patient’s medical health information, consider collecting this info via a patient intake form or questionnaire.

  • Age
  • Gender
  • Past Medical History
  • Anthropometrics
    • Height
    • Weight history (if needed) including weight changes
    • BMI (if appropriate)
      • Usual Body Weight (UBW) – calculated by the RDN
      • Ideal Body Weight (IBW) – calculated by the RDN
  • Labs
  • Medical tests
  • Medications (those significant to nutrition, including oral nutrition supplements)
Image of a checklist of social and diet history points to discuss with a patient

Subjective Data

During the assessment portion of the nutrition appointment, the following info can be collected from your patient or their family members:

  • Appetite changes
  • Ability to chew/swallow
  • Nausea/vomiting
  • Constipation/diarrhea
  • Other GI concerns
  • Food allergies
  • Social history
  • Diet history
  • Food preferences
  • Diet followed at home
  • Food recall
  • Food security and budgeting
  • Screening for eating disorders (if deemed appropriate)
  • Physical activity history and limitations
  • Priorities for the nutrition appointment

Dietitian Observations

You, as the RDN, can complete a full or partial Nutrition Focused Physical Exam to assess changes in muscle or fat associated with weight loss.  These observations can include:

  • Nutrition Focused Physical Exam
    • Bilateral Muscle Wasting:
      • Temples
      • Clavicle
      • Deltoid
      • Interosseous Muscle
      • Thigh
      • Knee
      • Calves
    • Subcutaneous Fat Loss:
      • Eyes
      • Triceps
    • Fluid Assessment:
      • Edema
    • Hand Grip Strength:
      • Grip dynamometer
  • Skin tugor (or elasticity).

Estimated Nutrition Requirements

There are several equations that help dietitians determine a patient’s estimated nutrition requirements. Dietitians should use their clinical judgement when deciding which equation would be best suited for their patient.

Examples of nutrition predictive equations include:

  • Mifflin-St. Jeor (MSJ)
  • Harris Benedict
  • Ireton Jones.

Typically, the assessment portion of the ADIME format will be longest during your initial patient appointment. Follow-up notes can be shortened to only include changes in the assessment data points.

Image of a person writing notes on a clipboard.

D = Diagnosis

Using the info collected during the assessment, you can develop a Nutrition Diagnosis for your patient.

This diagnosis will help you to decide which nutrition interventions to consider for your patient to help them achieve their desired outcomes.

The Nutrition Diagnosis is not a medical diagnosis.  Rather, a nutrition diagnosis describes issues/variances in your patient’s nutrition. 

There are three parts to a nutrition diagnosis, the:

  1. Problem = (P)
  2. Etiology or cause = (E)
  3. Signs and/or symptoms = (S).

PES statements typically appear something like:

  • Nutrition Diagnosis (Problem) ____________________
  • Related to (Etiology) ____________________________
  • As Evidenced by (Signs and symptoms) _____________.

Below is an example of a PES statement:

Food- and Nutrition-Related knowledge deficit related to a Lack of or limited prior nutrition-related education as evidenced by Verbalizes inaccurate or incomplete information.

Dietitians typically narrow things down to one specific PES statement for each appointment.  In some cases, there might be 2 PES statements.  The goal is to address each PES statement with an intervention that will improve or resolve the nutrition diagnosis.

Image of the PES statement discussed above.

Evaluating your PES Statement

Here are a few questions to help you evaluate the quality and strength of your PES statement:

  1. Within your PES statement, can you identify the Nutrition Diagnosis? The Etiology? The Signs & Symptoms?
  2. Can you, as the dietitian, help to improve or resolve the nutrition diagnosis with an intervention?
  3. Does the data gathered in the nutrition assessment support the Nutrition Diagnosis, Etiology, and Signs & Symptoms?
  4. If you measured the Signs & Symptoms at follow-up, could you tell if the problem was improving or resolved?
  5. Did you get specific enough with the Signs & Symptoms so they can be easily measured?
  6. Will you be able to evaluate any changes that may occur between now and the next nutrition appointment?

These questions may help you to further refine your PES statements.

What if your patient does not have a nutrition diagnosis?

If your patient does not have a nutrition diagnosis, you can indicate this in the note with a statement like “No Nutrition Diagnosis.”

Image of a hand stopping dominos from falling.

I = Intervention

As stated above, the nutrition intervention should address the nutrition diagnosis. During this portion of the appointment, you and your patient will work together on ways to improve or resolve their problem while achieving their health-related goals.

There are six domains for nutrition interventions:

  1. Nutrition Prescription (NP),
  2. Food and/or Nutrient Delivery (ND),
  3. Education (E),
  4. Counseling (C),
  5. Coordination of Nutrition Care (RC), and
  6. Population Based Nutrition Action (P). 

In the outpatient setting, RDNs typically use the four below:

Food and/or Nutrient Delivery (ND)

Food and/or Nutrient Delivery interventions could include supplementation in the outpatient setting.  In the inpatient setting, this could include a change in diet, nutrition support, or the inclusion of vitamin/mineral supplements.

Education (E)

Nutrition education is meant to teach a skill, improve a skillset, and increase a patient’s confidence and knowledge on a specific topic. Nutrition education is the sharing of information where a lack of nutrition knowledge has been identified. 

Education topics can include specific nutrition guidelines, physical activity guidelines, or health behaviors that are linked with certain health outcomes.

Counseling (C)

Nutrition Counseling is a collaborative process between a dietitian and their patients.  A dietitian will guide/coach a patient towards their identified health priorities.

Coordination of nutrition care (RC)

This can include coordinating patient care with other healthcare providers, professionals, or institutions. 

During the intervention portion of your appointment, you will work with your patient on creating SMART goals. For more information on SMART goal setting, check out this article – 13 Examples of SMART Goals for Dietitians.

Image of a page turning with header Nutrition Monitoring and Evaluation on the pages.

M = Monitoring and E = Evaluation

Monitoring outcomes (signs and symptoms) helps to see if the nutrition intervention(s) improved or resolved the problem(s).

Measuring the impact of an intervention can include tracking physical activity, food, symptoms, labs, blood pressure, or observed changes in intake (ex. eating and tolerating more solid foods vs. liquids).

Because you are evaluating the impact of the nutrition interventions, you will most likely collect data on the same points collected during the assessment portion of your previous appointments:

  1. Food/Nutrition Related History
  2. Anthropometric Measurements
  3. Biochemical Data, Medical Test, and Procedures
  4. Nutrition Focused Physical Findings
  5. Assessment, Monitoring, and Evaluation Tools
  6. Etiology Category
  7. Progress Evaluation

Note, the Client Personal History domain is not included in follow-up appointments because this data was collected in the initial appointment.

Follow-up

Part of the Monitoring and Evaluation process can include setting up follow-up care. You can work with your patient to decide if a follow-up appointment is needed.

Printable ADIME Note Template Example

Interested in a free note template? Click here.

Final Thoughts on the ADIME Format

The ADIME format is an excellent tool to help organize the flow of your nutrition appointments and document your process.

The ADIME format helps to ensure similar processes are followed by each RDN. This is done to allow better continuity of care. So, if another RDN needs to cover your nutrition appointment, they will have a clear understanding of the process you and your patient were following.

Likewise, you will have a more enjoyable experience if you are to see a patient after a fellow RDN if they are using the ADIME format.

For more information about The Dietitian Resource, sign-up for our newsletter, visit our site, or check out the blog.  Thanks for visiting!

References:

https://www.ncpro.org/nutrition-assessment-snapshot

https://www.ncpro.org/nutrition-care-process

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More About Rochelle

Rochelle Inwood MS, RDN, ACSM EP-C

Hello there! I’m Rochelle Inwood, a Registered Dietitian Nutritionist (RDN) and Exercise Physiologist (ACSM EP-C). With over 14 years of experience, I have sharpened my expertise through diverse roles, including weight management program co-coordinator, patient/employee gym supervisor, outpatient dietitian, program manager, dietetic internship preceptor, and more. I am passionate about learning, creating, teaching, and supporting personal growth and development.