What is ADIME? The nutrition care process documentation format

What it means

ADIME is a way of writing a nutrition note so that it follows the steps of care. The letters stand for Assessment, Diagnosis, Intervention, and Monitoring and Evaluation. They match the four steps of the Nutrition Care Process (NCP), the framework the Academy of Nutrition and Dietetics (then the American Dietetic Association) adopted in 2003 to give dietitians a consistent method for critical thinking and decision-making.

The Academy publishes a standard vocabulary for each step, the Nutrition Care Process Terminology (NCPT), and intends it to be used with the ADIME format, which mirrors the NCP step for step. ADIME is not the only way to chart, though. The Academy has noted that the NCP can be worked into any documentation system, including SOAP and narrative notes, recognizing that in many settings dietitians cannot change the format their hospital uses.

The four parts of an ADIME note

Illustrative example only, not clinical guidance:

Part	What the dietitian records	Illustrative entry
Assessment	Food and nutrition history, anthropometric measurements, biochemical data and medical tests, nutrition-focused physical findings and client history	Eating less than half of most meals for five days; pain when chewing with loose dentures; attendee confirms poor appetite
Diagnosis	The nutrition problem, written as a PES statement	Inadequate oral intake related to poorly fitting dentures, as evidenced by less than half of most meals eaten for five days
Intervention	The plan, aimed at the cause of the problem	Easy-to-chew meals agreed with the treating doctor; dental review requested; preferred foods added to the menu
Monitoring and evaluation	What will be tracked, and how progress will be judged	Meal intake at each slot and weight at the next review

The PES statement

The diagnosis step is what sets ADIME apart. A nutrition diagnosis is not a medical diagnosis: it names a nutrition problem that nutrition care can resolve or improve. It is written as a PES statement: the Problem, related to its Etiology, as evidenced by Signs and symptoms. The intervention is aimed at the etiology, and monitoring tracks the signs and symptoms, so a well-written PES statement ties the whole note together. The Academy’s tutorials also ask for signs and symptoms to be as objective as possible, so follow-up can show whether the problem is improving.

Where ADIME fits in an Indian hospital

ADIME grew out of US dietetics practice, but the structure is useful anywhere a dietitian’s note has to be read by others. NABH standards for small healthcare organizations, for example, expect admitted patients to be screened for nutritional risk, with an assessment for those found at risk, and therapeutic diets to be planned collaboratively. An ADIME note in the case file or HIMS records that work in an order the treating doctor, the next dietitian on duty and an auditor can all follow.

Common mistakes

• Writing a medical diagnosis, such as diabetes, in the diagnosis section instead of a nutrition problem.
• An etiology that is really a sign, such as a lab value, which leaves the intervention nothing to act on.
• Signs and symptoms that are vague rather than measurable.
• A monitoring plan with no indicator or timeframe, so progress cannot be judged.
• An intervention that never reaches the kitchen: the note says easy-to-chew meals, but the tray that arrives is the regular one.

How MedMeals handles it

MedMeals does not replace the dietitian’s ADIME note, which lives in the case file or HIMS. It makes the food side of the plan enforceable. When an intervention changes a patient’s diet, texture or allergy list, the dietitian updates the patient’s record and the menu on every ordering channel follows, with unsafe items hidden. For monitoring, each patient keeps a full meal history, and meal reports cover consumption and diet compliance by ward, diet or period. See patient nutrition management, MedMeals for dietitians or book a demo.