ADIME is an acronym representing the standardized documentation structure used by Registered Dietitians (RDs) and other nutrition professionals within the healthcare setting. This systematic approach provides a framework for delivering high-quality, patient-centered nutritional care. The structure is the definitive method for documenting each step of the Nutrition Care Process (NCP), ensuring a consistent, logical flow of clinical reasoning. Employing this framework allows practitioners to clearly communicate their findings, decisions, and outcomes to other members of a patient’s healthcare team.
The Nutrition Care Process and ADIME
The acronym ADIME stands for Assessment, Diagnosis, Intervention, and Monitoring and Evaluation, representing the four core steps of the Nutrition Care Process (NCP). The Academy of Nutrition and Dietetics formally adopted this process in 2003 to provide a consistent methodology for patient care. ADIME functions as the specific charting format that translates the conceptual steps of the NCP into a standardized note within a patient’s medical record. This standardization ensures consistent, high-quality care across different practitioners and healthcare settings. The common language helps communicate the unique role and impact of nutrition services to other health disciplines.
Assessment: Gathering Comprehensive Data
The Assessment phase, the “A” in ADIME, is a continuous process of collecting and analyzing data related to the patient’s nutritional status. This comprehensive data gathering serves as the foundational evidence for all subsequent steps in the care cycle. Practitioners collect information across several domains, ensuring the problem identified later is rooted in verifiable evidence.
Assessment Data Domains
The assessment data includes:
- Food and nutrition-related history, covering current intake, knowledge, beliefs, and physical activity patterns.
- Anthropometric data, such as height, current weight, weight history, and body mass index (BMI).
- Biochemical data, including relevant lab values like blood glucose, hemoglobin A1c, or electrolyte panels.
- Nutrition-focused physical findings, recorded through direct observation of areas like muscle loss, oral health, and signs of nutrient deficiencies.
- Client history, encompassing personal, social, family, and medical factors.
Diagnosis: Formulating the PES Statement
Following the assessment, the practitioner moves to the Diagnosis phase, identifying a specific nutrition problem that a Registered Dietitian can independently treat or manage. This is distinct from a medical diagnosis, which describes a disease state. The diagnosis is formulated into a structured statement known as the P-E-S statement, which stands for Problem, Etiology, and Signs/Symptoms. This format links the assessment data directly to the identified issue and its root cause.
The Problem is a standardized term describing the nutrition-related issue, such as “Inadequate protein intake.” The Etiology is the primary cause, connected to the problem with the phrase “related to,” which the intervention will target. The Signs and Symptoms are the objective data from the assessment that provide proof of the problem, linked by the phrase “as evidenced by.” For example, a complete statement might read: “Excessive sodium intake related to reliance on convenience and fast foods as evidenced by an average intake of 4343 mg sodium daily and elevated blood pressure readings.”
Intervention: Planning and Implementing Care
The Intervention phase, the “I” in ADIME, translates the nutritional diagnosis into a plan of action designed to resolve or improve the identified problem. This step includes planning specific goals and implementing chosen strategies. The strategies must target the Etiology (E) identified in the P-E-S statement, as addressing the root cause is the most effective way to effect lasting change.
Interventions fall into four categories: Food and/or Nutrient Delivery (modifying diet or providing nutrition support); Nutrition Education (imparting knowledge); Nutrition Counseling (using behavior change theories); and Coordination of Care (collaborating with other providers). For instance, if the etiology was a lack of cooking skills, the intervention might be nutrition education focused on meal preparation techniques. The plan must be measurable and time-bound, setting the stage for the final step of the process.
Monitoring and Evaluation: Tracking Progress and Outcomes
The final steps, Monitoring and Evaluation, represent the cyclical completion of the care process. Monitoring involves the systematic tracking of the patient’s progress toward established goals and checking that the intervention is being implemented as planned. This includes reviewing data such as food intake records, patient-reported symptoms, and adherence to the care plan.
Evaluation is the process of comparing current findings against the initial assessment data and predetermined goals to determine the effectiveness of the nutrition care. The practitioner re-collects relevant assessment data, such as changes in anthropometric measurements or lab values, and compares them to the initial baseline. The outcomes of this final step are used to decide whether to continue the existing plan, modify the intervention, or initiate a new Assessment.