Nutrition Diagnoses (IDNT): Can they Benefit Hospital Foodservice?
The International Dietetics and Nutrition Terminology (IDNT) reference manual was implemented to provide standardized language for nutrition diagnoses. It was designed to support the development of nutrition templates within electronic medical records and to provide consistency of documentation and communication both within the profession and between professions. IDNT is now being implemented in various hospitals across Canada and allows Registered Dietitians to make appropriate diagnoses for their patients, while providing consistent documentation and language within the health record.
Diagnoses are classified within four different domains: Intake, Clinical, Behavioural-Environmental, and Other. Within these domains are various diagnoses. For example, under the Intake domain, the clinician will find diagnoses such as “excessive carbohydrate intake” or “inadequate intake of protein and energy”. These diagnoses are then related to an etiology and evidenced by the signs and symptoms the patient is experiencing. The following is an example of a nutrition diagnosis statement:
Inadequate protein-energy intake related to decreased ability to consume sufficient protein and energy (secondary to pharyngeal cancer) as evidenced by weight loss > 5% in 1 month and estimated energy intake less than calculated.
While most of these diagnoses are clinical in nature, relating diagnoses to various disease states and/or the consequences of the disease, they also have an application within the foodservice industry.
One such area where these diagnostic terms seem appropriate is patient intake. Patients have limited or inadequate oral intake in the hospital setting for a multitude of reasons, including side effects from medications, disease states, or level of consciousness. But patients can also experience inadequate intake due to food quality and food service. For example, patients who find hospital food unpalatable, unappetizing, and unappealing will likely experience reduced intakes, which can impair the patient’s nutritional status. Reduced intake can be described with diagnostic terms such as “inadequate intake of protein and energy”, “inadequate energy intake”, or “inadequate oral intake”. Typically, clinicians will relate these diagnoses to clinical states, such as a catabolic illness increasing nutrient needs or a decreased ability to consume adequate energy. However, the cause for this diagnosis can be as simple as the patient finding the food or meal service unappealing and unappetizing. That is not to say that all hospital food has to be that way! Using the appropriate equipment, recipes, and delivery methods can all help to improve patient satisfaction and therefore increase the patient’s intake.
Another diagnosis, found under the Behavioural-Enviromental domain, is “intake of unsafe food”. This diagnosis is defined as “intake of food and/or fluids intentionally or unintentionally contaminated with toxins, poisonous products, infectious agents, microbial agents, allergens, additives, and/or agents of bioterrorism”. While this definition may seem quite complicated, at its root is the cornerstone of all foodservice practices: food safety. While I would suspect that our hospital food is not being contaminated intentionally, the operation of unsafe food handling and storing practices can lead to “intake of unsafe food”.
But IDNT has further applications to hospital foodservice than simply determining the quality of a patient’s meal and service. The diagnostic statements can also be used to determine if the menu or specific diet provided to the patient is appropriate. For example, diagnostic statements such as “excessive fat intake”, “inadequate fiber intake”, or “inadequate energy intake” can all be markers to indicate that a particular meal or menu is providing too little or too much of a nutrient(s) for a patient’s particular condition. Certainly most, if not all, hospitals would have considered these factors prior to implementing a new diet, but with the nutrition world ever changing, these diagnostic statements can assist hospital foodservice operations to remain in the loop with current nutrition research.
IDNT is still in its infancy. As practitioners become more familiar with the terminology, they will likely be able to easily relate a nutrition diagnosis to the delivery and quality of the patient’s meal. While some nutrition diagnoses are related solely to a patient’s disease state, many can be related to the patient’s acceptance of the meal they are provided. In addition, the diagnostic statements can be used to assess if the hospital’s therapeutic diets and cycle menus are up to date with the latest nutrition research. The diagnostic terms are even coded to allow for evaluation of dietetic practice and for research purposes. With this coding, IDNT provides yet another platform to evaluate patient satisfaction and appropriateness of menus and therefore improve food quality and foodservice within the hospital setting.