What is the ADIME Format?
The ADIME format used in charting for Dietitians working in medical nutrition therapy. It is a systematic approach to formatting and documenting to ensure the best care possible.
ADIME documentation is frequently used in healthcare settings as a way of charting that provides for consistency among the various disciplines.
ADIME is a way of organizing your nutrition assessment into a concise and organized manner. Personally, it is my favourite way to chart.
What does ADIME stand for?
ADIME is an acronym that stands for:
Assessment, Diagnosis, Intervention, Monitoring and Evaluation.
If you’ve been a Dietitian for longer than 5 seconds, you look at that and it looks familiar… That’s because it’s exactly like the Nutrition Care Process (NCP) that we’ve been taught since undergrad.
It is incredibly similar to the NCP, the only difference is that ADIME is a charting method, the NCP is a nutrition assessment method.
The easiest way to understand it though is that the NCP fits into each letter of an ADIME chart note.
What is the Difference Between ADIME and
the Nutrition Care Process?
In very simple terms, ADIME is a format for charting, the NCP is a step by step approach to provide expert nutrition care to people.
The NCP is how you gather the nutrition data. It is a sequence of steps that you take in order to uncover what the nutrition diagnosis is and how to solve it.
ADIME is the way that you will document your findings from the NCP. You will translate each step of the NCP into a finely tuned chart note in the format of ADIME.
Similar to the individualized nutrition care plan articles you can find here, the NCP is simply translated into a different format for understanding across other disciplines.
When a Doctor for example reads your chart note in ADIME format, they will know exactly what your nutrition diagnosis is, what nutrition interventions you’re implementing, and your monitoring plan.
Why Do Dietitian’s Need to Know ADIME?
Dietitians fall into the healthcare practitioner category, for obvious reasons that means that we have to follow specific charting standards.
ADIME is the most commonly used way to chart in most facilities, some teach SOAPE.
I recommend that all Dietitians become proficient in charting ADIME. By knowing how to do ADIME charting you can transfer your skills no matter where you work.
Assessment
The nutrition assessment is your comprehensive assessment that will lead to a nutrition diagnosis. The assessment includes (a ridiculous) amount of subjective and objective data that the Dietitian gathers.
Here are the exact categories of data that you should be gathering in the nutrition assessment:
| Category | Nutrition Assessment Data |
| Client History | Relevant medical history (diagnoses, surgeries), Family and Social history, Cultural and Religious affiliations affecting nutrition care, Cognitive function (Dementia, Impairments). Biochemical data, medical tests and procedures. |
| Anthropometric Measurements | Height (Actual, Estimated, Reported), Weight (History, Current, Actual, Measured), Comparative weight range (Based on BMI 23.0-29.9) |
| Food Nutrition Related History | Previous intake, current intake, percentages, if inadequate give a time period and any reasoning. |
| Weight Changes | Non-Significant or Significant. If significant, what percentage and time period. Stable or continuous. If actual numbers are not known, estimate mild, moderate, severe weight change. |
| Symptoms Affecting Oral Intake | Diarrhea, constipation, nausea, vomiting, dysphagia, anorexia, dental issues, early satiety, cognition, pain, other. |
| Functional Capacity | No dysfunction, wheelchair, walker, bed ridden. |
| Metabolic Requirements | Increased? If so, include what condition is causing this. |
| Nutrition-focused physical exam | Use the NFPE manual to find the nutrition focused-physical findings. If you do not have one, comment on fat and muscle wasting. Also discuss sarcopenia or cachexia if present. |
If you need a good nutrition assessment form with all of this built in, find an assessment tool here.
Diagnosis
After the nutrition assessment is done, you will develop a nutrition diagnosis from the data gathered.
As a side note before I dive into the nutrition diagnosis:
There is not always going to be a nutrition diagnosis. If your patient has optimal nutrition status, don’t try to invent a nutrition problem simply to have one.
You can simply write, ‘No nutrition diagnosis present at this time, will continue to monitor as needed.’
If you do find there is a nutrition diagnosis, you will use the standardized nutrition terminology to write out the nutrition diagnosis. Even after years of practice I still refer to my manual.
The nutrition diagnosis will fall into one of a few categories:
Intake, Clinical, Behavioural-Environmental.
In my experience working with the older adults, it will generally fall into Intake or Clinical. With compromised cognition in a significant amount of the population, I would rarely blame knowledge as the reason.
Some very common nutrition diagnosis examples used in the older adult population are:
Unintentional Weight Loss
Inadequate Energy Intake
Predicted Suboptimal Energy Intake
Increased Energy Expenditure
Underweight
Inadequate Oral Intake
Altered Nutrition-Related Laboratory
Inadequate Protein Intake
Swallowing/Chewing Difficulty
Biting/Chewing Difficulty
As you can see, most of the nutrition diagnosis used are from the clinical and intake categories.
If there are multiple nutrition diagnoses, then you can write out a couple. But as a reminder, for each nutrition diagnosis, you will need separate nutrition interventions.
You will also format your nutrition diagnosis in the form of a PES statement. If you need to brush up on your PES statement skills, this article will help.
PES Statements
PES statements always follow the same format using your nutrition diagnosis:
P = Problem. This is where you will put in the nutrition diagnosis.
E = Etiology. Write out what you think is causing the nutrition diagnosis, what you plan to resolve.
S/S = Signs and Symptoms. The evidence of the nutrition diagnosis. This can be subjective or objective data.
Intervention
Once you’ve selected your nutrition diagnosis, or multiple, you will move onto the nutrition intervention stage.
Don’t forget to set nutrition goals here. What do you want to see achieved through the nutrition interventions?
This should directly be related to the nutrition diagnosis.
Some Dietitians will teach you that you need to use the standardized nutrition intervention terminology. I don’t really see this being practiced in the real world.
This is largely due to the fact that a) Most Dietitians working in long term care are the only ones, and b) Nobody cares about you using standardized terminology.
In the standardized nutrition intervention terminology they fall into four categories:
- Food and/or Nutrient Delivery
Modifying textures, fluids, nutrients, feeding/dining environment.
- Nutrition Education
Educating the patient on different nutrition choices and/or diets.
- Nutrition Counseling
Providing nutrition counseling using education models to teach a patient or their loved ones.
- Coordination of Care
Referring patients to different healthcare team members to improve their health and nutrition.
Here are some questions to consider when developing your nutrition interventions:
- What is the food and/or supplement being offered to ‘cure’ the nutrition diagnosis?
- What is the method of delivery?
- How often is the nutrition intervention being offered?
All nutrition interventions should be developed in agreement with the patient and/or their loved ones.
It’s also very important if your nutrition interventions affect other team members such as oral nutrition supplements at MedPass that they are involved in the planning.
Monitoring
Next you need the nutrition monitoring plan.
All you need to do is ask yourself these questions (and then write it out!):
- How often will I be checking up on the effectiveness of the nutrition interventions?
If it’s a more high risk situation such as a Stage 4 Pressure Injury, that should be checked up on at least every 7 days. If it is weight loss, you may evaluate once per month depending on the severity.
Evaluation
Lastly, you want to come up with a nutrition evaluation plan.
Here you will develop how often you are going to check up on what you are monitoring. You can have all the nutrition interventions you want in place, but if you don’t evaluate them, how do you know if they are effective?
ADIME Note Example
(A) Patient has had 5% body weight loss in 30 days, resulting in BMI 21.5, indicating below desirable weight range (based on BMI 23.0-29.9). Current body weight is 60.5 kg, usual body weight is 64.0 kg. Patient reports decreased interest in food related to difficulty swallowing. RD performed meal time observation and noted increased coughing after eating, and clearing their throat frequently. No noted issues with liquids. RD suspects weight loss is related to decreased intake secondary to Dysphagia. See assessment section of the chart for RD’s full nutrition assessment and findings.
(D) Swallowing difficulty related to Dysphagia as evidenced by frequent throat clearing, coughing, and patient reports.
(I) RD has consulted the Speech-Language Pathologist (SLP) for a swallowing assessment to be completed within 2 days. RD has changed diet to minced texture after discussion with patient and SLP. Patient is agreeable to temporary change until SLP assessment.
RD will also introduce 2Cal TID 60 mL with Medpass.
(M) RD will perform a second meal observation to assess how minced texture diet is being accepted and tolerance. RD will also assess SLP’s assessment when completed.
RD will also monitor patient’s weight.
(E) RD will evaluate meal observation results and make changes as needed.
RD will follow-up after SLP assessment is complete.
RD will assess patient’s weight weekly for 4 weeks.
ADIME doesn’t have to be intimidating as a charting method. Just think of reformatting your NCP and putting in in each letter of ADIME.
Looking for more practical resources? The Long Term Care RD has a fantastic central resource area that you can find here. You can find step-by-step approaches to treating patients, learn everything the job of a Long Term Care Dietitian entails, and much more! Find it all here.
Dietitian Takeaway Points
- ADIME is an acronym for Assessment, Diagnosis, Intervention, Monitoring and Evaluation.
- ADIME is a charting format for Dietitians.
- The Nutrition Care Process is completed prior to ADIME charting.
- Each step in the Nutrition Care Process fits into ADIME.
- If you want to in-depth teaching about performing a nutrition assessment and interpreting the results, click here.
