[go: up one dir, main page]
DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.17 Resource NutritionOrder - Content

Orders and Observations Work GroupMaturity Level: 1Compartments: Encounter, Patient, Practitioner

A request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident.

4.17.1 Scope and Usage

The NutritionOrder resource describes a request for oral diets (including general diets such as General Healthy diet, or therapeutic diets such as Consistent Carbohydrate, 2 gram Sodium, or Fluid Restricted), oral nutrition supplements (such as nutritionally complete pre-packed drinks), enteral nutrition (tube feedings) and infant formula which govern the distribution of food and nutritional products used to feed patients within an in-patient setting. It does not cover orders for parenteral (IV) nutrition which are typically filled by pharmacy. These nutrition orders are combined with information on a patient's food allergies and intolerances, and ethnic or cultural food preferences (e.g. Kosher or Vegetarian) to inform healthcare personnel about the type, texture, and/or quantity of foods that the patient should receive or consume.

Enteral orders are distinguished from supplements because they have some unique attributes and typically include administration information whereas oral nutritional supplements may simply be supplied (e.g. home health or outpatient settings). In a simple case, the requestor may designate type of product, product name and the route of administration along with free text instructions without a having to complete the additional structured details.

This resource is intended to be used by providers from a variety of specialties such as physicians, dietitian/nutritionists, or speech therapists. One provider may simply order a base element oral diet such as General Healthful diet. Another provider, based on scope of practice, may use other elements to communicate additional therapeutic needs or patient preferences. The optionality included gives an ordering provider the capability to write a simple order for an oral diet, nutritional supplement or formula with minimal requirements beyond that of specifying the diet, supplement or formula product, but also supports the ability to provide more detailed information that may be further augmented by a dietitian or nutrition specialist. For example, a physician may order a 2 g sodium diet. A speech therapist, based on the results of a swallowing evaluation, then orders a mechanically altered texture with nectar thick liquids.

4.17.2 Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationOrder resource should be used for requesting parenteral (IV) nutrition and prescribing dietary supplements such as vitamin or mineral supplements.

The Nutrition Order is a record of the request for the supply of a diet, oral supplement or enteral formulas for a patient. However, to initiate the request requires the use of the Order resource and its associated workflow with the Nutrition Order referenced from the Order.details, or by using the Nutrition Order resource in the context of a messaging or service workflow where the request is explicit or implicit.

This resource is referenced by CarePlan, ClinicalImpression and Goal

4.17.3 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder IDomainResourceA request for a diet, formula or nutritional supplement
Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
... patient Σ1..1Reference(Patient)The person who requires the diet, formula or nutritional supplement
... orderer Σ0..1Reference(Practitioner)Who ordered the diet, formula or nutritional supplement
... identifier 0..*IdentifierIdentifiers assigned to this order
... encounter 0..1Reference(Encounter)The encounter associated with this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... status ?! Σ0..1codeproposed | draft | planned | requested | active | on-hold | completed | cancelled
NutritionOrderStatus (Required)
... allergyIntolerance 0..*Reference(AllergyIntolerance)List of the patient's food and nutrition-related allergies and intolerances
... foodPreferenceModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should be given
Diet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
Food Type Codes (Example)
... oralDiet I0..1BackboneElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
Diet Codes (Example)
.... schedule 0..*TimingScheduled frequency of diet
.... nutrient 0..*BackboneElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
Nutrient Modifier Codes (Example)
..... amount 0..1SimpleQuantityQuantity of the specified nutrient
.... texture 0..*BackboneElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g. pureed
Texture Modifier Codes (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
Texture Modified Food Type Codes (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
Fluid Consistency Type Codes (Example)
.... instruction Σ0..1stringInstructions or additional information about the oral diet
... supplement I0..*BackboneElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
Supplement Type Codes (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... schedule 0..*TimingScheduled frequency of supplement
.... quantity 0..1SimpleQuantityAmount of the nutritional supplement
.... instruction Σ0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1BackboneElementEnteral formula components
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
Enteral Formula Type Codes (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
Enteral Formula Additive Type Code (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1SimpleQuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
Enteral Route Codes (Extensible)
.... administration 0..*BackboneElementFormula feeding instruction as structured data
..... schedule 0..1TimingScheduled frequency of enteral feeding
..... quantity 0..1SimpleQuantityThe volume of formula to provide
..... rate[x] 0..1Speed with which the formula is provided per period of time
...... rateQuantitySimpleQuantity
...... rateRatioRatio
.... maxVolumeToDeliver 0..1SimpleQuantityUpper limit on formula volume per unit of time
.... administrationInstruction Σ0..1stringFormula feeding instructions expressed as text

doco Documentation for this format

UML Diagram

NutritionOrder (DomainResource)The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference [1..1] « Patient »The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference [0..1] « Practitioner »Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier [0..*]An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »The date and time that this nutrition order was requesteddateTime : dateTime [1..1]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [0..1] « Codes specifying the state of the request. Describes the lifecycle of the nutrition order. (Strength=Required)NutritionOrderStatus! »A link to a record of allergies or intolerances which should be included in the nutrition orderallergyIntolerance : Reference [0..*] « AllergyIntolerance »This modifier is used to convey order-specific modifiers about the type of food that should be given. These can be derived from patient allergies, intolerances, or preferences such as Halal, Vegan or Kosher. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedingsfoodPreferenceModifier : CodeableConcept [0..*] « Medical, cultural or ethical food preferences to help with catering requirements (Strength=Example)Diet?? »This modifier is used to convey order-specific modifiers about the type of food that should NOT be given. These can be derived from patient allergies, intolerances, or preferences such as No Red Meat, No Soy or No Wheat or Gluten-Free. While it should not be necessary to repeat allergy or intolerance information captured in the referenced allergyIntolerance resource in the excludeFoodModifier, this element may be used to convey additional specificity related to foods that should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedingsexcludeFoodModifier : CodeableConcept [0..*] « Codes used to indicate the type of food that should NOT be given to the patient. (Strength=Example)Food Type ?? »OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diabetic diettype : CodeableConcept [0..*] « Codes used to indicate the type of diet being ordered for a patient. (Strength=Example)Diet ?? »The time period and frequency at which the diet should be givenschedule : Timing [0..*]The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patientfluidConsistencyType : CodeableConcept [0..*] « Codes used to represent the consistency of fluids and liquids provided to the patient. (Strength=Example)Fluid Consistency Type ?? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « Codes for types of nutrient that is being modified such as carbohydrate or sodium. (Strength=Example)Nutrient Modifier ?? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureAny texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept [0..1] « Codes for food consistency types or texture modifications to apply to foods. (Strength=Example)Texture Modifier ?? »The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods typesfoodType : CodeableConcept [0..1] « Codes for types of foods that are texture modified. (Strength=Example)Texture Modified Food Type ?? »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableConcept [0..1] « Codes for nutritional supplements to be provided to the patient (Strength=Example)Supplement Type ?? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]The time period and frequency at which the supplement(s) should be givenschedule : Timing [0..*]The amount of the nutritional supplement to be givenquantity : Quantity(SimpleQuantity) [0..1]Free text or additional instructions or information pertaining to the oral supplementinstruction : string [0..1]EnteralFormulaThe type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formulabaseFormulaType : CodeableConcept [0..1] « Codes for type of enteral formula to be administered to patient. (Strength=Example)Enteral Formula Type ?? »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string [0..1]Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formulaadditiveType : CodeableConcept [0..1] « Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula. (Strength=Example)Enteral Formula Additive Type...?? »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string [0..1]The amount of energy (Calories) that the formula should provide per specified volume, typically per mL or fluid oz. For example, an infant may require a formula that provides 24 Calories per fluid ounce or an adult may require an enteral formula that provides 1.5 Calorie/mLcaloricDensity : Quantity(SimpleQuantity) [0..1]The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tuberouteofAdministration : CodeableConcept [0..1] « Codes specifying the route of administration of enteral formula. (Strength=Extensible)Enteral Route + »The maximum total quantity of formula that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hoursmaxVolumeToDeliver : Quantity(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : string [0..1]AdministrationThe time period and frequency at which the enteral formula should be delivered to the patientschedule : Timing [0..1]The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : Type [0..1] « Quantity(SimpleQuantity)|Ratio »Class that defines the quantity and type of nutrient modifications required for the oral dietnutrient[0..*]Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture[0..*]Diet given orally in contrast to enteral (tube) feedingoralDiet[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of this would be an instruction to increase the rate of continuous feeding every 2 hoursadministration[0..*]Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula[0..1]

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) The person who requires the diet, formula or nutritional supplement --></patient>
 <orderer><!-- 0..1 Reference(Practitioner) Who ordered the diet, formula or nutritional supplement --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <status value="[code]"/><!-- 0..1 proposed | draft | planned | requested | active | on-hold | completed | cancelled -->
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <oralDiet>  <!-- ?? 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <schedule><!-- 0..* Timing Scheduled frequency of diet --></schedule>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <supplement>  <!-- ?? 0..* Supplement components -->
  <type><!-- 0..1 CodeableConcept Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <schedule><!-- 0..* Timing Scheduled frequency of supplement --></schedule>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <enteralFormula>  <!-- ?? 0..1 Enteral formula components -->
  <baseFormulaType><!-- 0..1 CodeableConcept Type of enteral or infant formula --></baseFormulaType>
  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <additiveType><!-- 0..1 CodeableConcept Type of modular component to add to the feeding --></additiveType>
  <additiveProductName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume that is required --></caloricDensity>
  <routeofAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeofAdministration>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule><!-- 0..1 Timing Scheduled frequency of enteral feeding --></schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <administrationInstruction value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  The person who requires the diet, formula or nutritional supplement
  "orderer" : { Reference(Practitioner) }, // Who ordered the diet, formula or nutritional supplement
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "status" : "<code>", // proposed | draft | planned | requested | active | on-hold | completed | cancelled
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "oralDiet" : { // C? Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "schedule" : [{ Timing }], // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g. pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "supplement" : [{ // C? Supplement components
    "type" : { CodeableConcept }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "schedule" : [{ Timing }], // Scheduled frequency of supplement
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { Timing }, // Scheduled frequency of enteral feeding
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) }
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "administrationInstruction" : "<string>" // Formula feeding instructions expressed as text
  }
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. NutritionOrder IDomainResourceA request for a diet, formula or nutritional supplement
Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class
... patient Σ1..1Reference(Patient)The person who requires the diet, formula or nutritional supplement
... orderer Σ0..1Reference(Practitioner)Who ordered the diet, formula or nutritional supplement
... identifier 0..*IdentifierIdentifiers assigned to this order
... encounter 0..1Reference(Encounter)The encounter associated with this nutrition order
... dateTime Σ1..1dateTimeDate and time the nutrition order was requested
... status ?! Σ0..1codeproposed | draft | planned | requested | active | on-hold | completed | cancelled
NutritionOrderStatus (Required)
... allergyIntolerance 0..*Reference(AllergyIntolerance)List of the patient's food and nutrition-related allergies and intolerances
... foodPreferenceModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should be given
Diet (Example)
... excludeFoodModifier 0..*CodeableConceptOrder-specific modifier about the type of food that should not be given
Food Type Codes (Example)
... oralDiet I0..1BackboneElementOral diet components
.... type Σ0..*CodeableConceptType of oral diet or diet restrictions that describe what can be consumed orally
Diet Codes (Example)
.... schedule 0..*TimingScheduled frequency of diet
.... nutrient 0..*BackboneElementRequired nutrient modifications
..... modifier 0..1CodeableConceptType of nutrient that is being modified
Nutrient Modifier Codes (Example)
..... amount 0..1SimpleQuantityQuantity of the specified nutrient
.... texture 0..*BackboneElementRequired texture modifications
..... modifier 0..1CodeableConceptCode to indicate how to alter the texture of the foods, e.g. pureed
Texture Modifier Codes (Example)
..... foodType 0..1CodeableConceptConcepts that are used to identify an entity that is ingested for nutritional purposes
Texture Modified Food Type Codes (Example)
.... fluidConsistencyType 0..*CodeableConceptThe required consistency of fluids and liquids provided to the patient
Fluid Consistency Type Codes (Example)
.... instruction Σ0..1stringInstructions or additional information about the oral diet
... supplement I0..*BackboneElementSupplement components
.... type Σ0..1CodeableConceptType of supplement product requested
Supplement Type Codes (Example)
.... productName 0..1stringProduct or brand name of the nutritional supplement
.... schedule 0..*TimingScheduled frequency of supplement
.... quantity 0..1SimpleQuantityAmount of the nutritional supplement
.... instruction Σ0..1stringInstructions or additional information about the oral supplement
... enteralFormula I0..1BackboneElementEnteral formula components
.... baseFormulaType Σ0..1CodeableConceptType of enteral or infant formula
Enteral Formula Type Codes (Example)
.... baseFormulaProductName 0..1stringProduct or brand name of the enteral or infant formula
.... additiveType 0..1CodeableConceptType of modular component to add to the feeding
Enteral Formula Additive Type Code (Example)
.... additiveProductName 0..1stringProduct or brand name of the modular additive
.... caloricDensity 0..1SimpleQuantityAmount of energy per specified volume that is required
.... routeofAdministration 0..1CodeableConceptHow the formula should enter the patient's gastrointestinal tract
Enteral Route Codes (Extensible)
.... administration 0..*BackboneElementFormula feeding instruction as structured data
..... schedule 0..1TimingScheduled frequency of enteral feeding
..... quantity 0..1SimpleQuantityThe volume of formula to provide
..... rate[x] 0..1Speed with which the formula is provided per period of time
...... rateQuantitySimpleQuantity
...... rateRatioRatio
.... maxVolumeToDeliver 0..1SimpleQuantityUpper limit on formula volume per unit of time
.... administrationInstruction Σ0..1stringFormula feeding instructions expressed as text

doco Documentation for this format

UML Diagram

NutritionOrder (DomainResource)The person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feedingpatient : Reference [1..1] « Patient »The practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedingsorderer : Reference [0..1] « Practitioner »Identifiers assigned to this order by the order sender or by the order receiveridentifier : Identifier [0..*]An encounter that provides additional information about the healthcare context in which this request is madeencounter : Reference [0..1] « Encounter »The date and time that this nutrition order was requesteddateTime : dateTime [1..1]The workflow status of the nutrition order/request (this element modifies the meaning of other elements)status : code [0..1] « Codes specifying the state of the request. Describes the lifecycle of the nutrition order. (Strength=Required)NutritionOrderStatus! »A link to a record of allergies or intolerances which should be included in the nutrition orderallergyIntolerance : Reference [0..*] « AllergyIntolerance »This modifier is used to convey order-specific modifiers about the type of food that should be given. These can be derived from patient allergies, intolerances, or preferences such as Halal, Vegan or Kosher. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedingsfoodPreferenceModifier : CodeableConcept [0..*] « Medical, cultural or ethical food preferences to help with catering requirements (Strength=Example)Diet?? »This modifier is used to convey order-specific modifiers about the type of food that should NOT be given. These can be derived from patient allergies, intolerances, or preferences such as No Red Meat, No Soy or No Wheat or Gluten-Free. While it should not be necessary to repeat allergy or intolerance information captured in the referenced allergyIntolerance resource in the excludeFoodModifier, this element may be used to convey additional specificity related to foods that should be eliminated from the patient’s diet for any reason. This modifier applies to the entire nutrition order inclusive of the oral diet, nutritional supplements and enteral formula feedingsexcludeFoodModifier : CodeableConcept [0..*] « Codes used to indicate the type of food that should NOT be given to the patient. (Strength=Example)Food Type ?? »OralDietThe kind of diet or dietary restriction such as fiber restricted diet or diabetic diettype : CodeableConcept [0..*] « Codes used to indicate the type of diet being ordered for a patient. (Strength=Example)Diet ?? »The time period and frequency at which the diet should be givenschedule : Timing [0..*]The required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patientfluidConsistencyType : CodeableConcept [0..*] « Codes used to represent the consistency of fluids and liquids provided to the patient. (Strength=Example)Fluid Consistency Type ?? »Free text or additional instructions or information pertaining to the oral dietinstruction : string [0..1]NutrientThe nutrient that is being modified such as carbohydrate or sodiummodifier : CodeableConcept [0..1] « Codes for types of nutrient that is being modified such as carbohydrate or sodium. (Strength=Example)Nutrient Modifier ?? »The quantity of the specified nutrient to include in dietamount : Quantity(SimpleQuantity) [0..1]TextureAny texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureedmodifier : CodeableConcept [0..1] « Codes for food consistency types or texture modifications to apply to foods. (Strength=Example)Texture Modifier ?? »The food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods typesfoodType : CodeableConcept [0..1] « Codes for types of foods that are texture modified. (Strength=Example)Texture Modified Food Type ?? »SupplementThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplementtype : CodeableConcept [0..1] « Codes for nutritional supplements to be provided to the patient (Strength=Example)Supplement Type ?? »The product or brand name of the nutritional supplement such as "Acme Protein Shake"productName : string [0..1]The time period and frequency at which the supplement(s) should be givenschedule : Timing [0..*]The amount of the nutritional supplement to be givenquantity : Quantity(SimpleQuantity) [0..1]Free text or additional instructions or information pertaining to the oral supplementinstruction : string [0..1]EnteralFormulaThe type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formulabaseFormulaType : CodeableConcept [0..1] « Codes for type of enteral formula to be administered to patient. (Strength=Example)Enteral Formula Type ?? »The product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula"baseFormulaProductName : string [0..1]Indicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formulaadditiveType : CodeableConcept [0..1] « Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula. (Strength=Example)Enteral Formula Additive Type...?? »The product or brand name of the type of modular component to be added to the formulaadditiveProductName : string [0..1]The amount of energy (Calories) that the formula should provide per specified volume, typically per mL or fluid oz. For example, an infant may require a formula that provides 24 Calories per fluid ounce or an adult may require an enteral formula that provides 1.5 Calorie/mLcaloricDensity : Quantity(SimpleQuantity) [0..1]The route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tuberouteofAdministration : CodeableConcept [0..1] « Codes specifying the route of administration of enteral formula. (Strength=Extensible)Enteral Route + »The maximum total quantity of formula that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hoursmaxVolumeToDeliver : Quantity(SimpleQuantity) [0..1]Free text formula administration, feeding instructions or additional instructions or informationadministrationInstruction : string [0..1]AdministrationThe time period and frequency at which the enteral formula should be delivered to the patientschedule : Timing [0..1]The volume of formula to provide to the patient per the specified administration schedulequantity : Quantity(SimpleQuantity) [0..1]The rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedulerate[x] : Type [0..1] « Quantity(SimpleQuantity)|Ratio »Class that defines the quantity and type of nutrient modifications required for the oral dietnutrient[0..*]Class that describes any texture modifications required for the patient to safely consume various types of solid foodstexture[0..*]Diet given orally in contrast to enteral (tube) feedingoralDiet[0..1]Oral nutritional products given in order to add further nutritional value to the patient's dietsupplement[0..*]Formula administration instructions as structured data. This repeating structure allows for changing the administration rate or volume over time for both bolus and continuous feeding. An example of this would be an instruction to increase the rate of continuous feeding every 2 hoursadministration[0..*]Feeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavityenteralFormula[0..1]

XML Template

<NutritionOrder xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <patient><!-- 1..1 Reference(Patient) The person who requires the diet, formula or nutritional supplement --></patient>
 <orderer><!-- 0..1 Reference(Practitioner) Who ordered the diet, formula or nutritional supplement --></orderer>
 <identifier><!-- 0..* Identifier Identifiers assigned to this order --></identifier>
 <encounter><!-- 0..1 Reference(Encounter) The encounter associated with this nutrition order --></encounter>
 <dateTime value="[dateTime]"/><!-- 1..1 Date and time the nutrition order was requested -->
 <status value="[code]"/><!-- 0..1 proposed | draft | planned | requested | active | on-hold | completed | cancelled -->
 <allergyIntolerance><!-- 0..* Reference(AllergyIntolerance) List of the patient's food and nutrition-related allergies and intolerances --></allergyIntolerance>
 <foodPreferenceModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should be given --></foodPreferenceModifier>
 <excludeFoodModifier><!-- 0..* CodeableConcept Order-specific modifier about the type of food that should not be given --></excludeFoodModifier>
 <oralDiet>  <!-- ?? 0..1 Oral diet components -->
  <type><!-- 0..* CodeableConcept Type of oral diet or diet restrictions that describe what can be consumed orally --></type>
  <schedule><!-- 0..* Timing Scheduled frequency of diet --></schedule>
  <nutrient>  <!-- 0..* Required  nutrient modifications -->
   <modifier><!-- 0..1 CodeableConcept Type of nutrient that is being modified --></modifier>
   <amount><!-- 0..1 Quantity(SimpleQuantity) Quantity of the specified nutrient --></amount>
  </nutrient>
  <texture>  <!-- 0..* Required  texture modifications -->
   <modifier><!-- 0..1 CodeableConcept Code to indicate how to alter the texture of the foods, e.g. pureed --></modifier>
   <foodType><!-- 0..1 CodeableConcept Concepts that are used to identify an entity that is ingested for nutritional purposes --></foodType>
  </texture>
  <fluidConsistencyType><!-- 0..* CodeableConcept The required consistency of fluids and liquids provided to the patient --></fluidConsistencyType>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral diet -->
 </oralDiet>
 <supplement>  <!-- ?? 0..* Supplement components -->
  <type><!-- 0..1 CodeableConcept Type of supplement product requested --></type>
  <productName value="[string]"/><!-- 0..1 Product or brand name of the nutritional supplement -->
  <schedule><!-- 0..* Timing Scheduled frequency of supplement --></schedule>
  <quantity><!-- 0..1 Quantity(SimpleQuantity) Amount of the nutritional supplement --></quantity>
  <instruction value="[string]"/><!-- 0..1 Instructions or additional information about the oral supplement -->
 </supplement>
 <enteralFormula>  <!-- ?? 0..1 Enteral formula components -->
  <baseFormulaType><!-- 0..1 CodeableConcept Type of enteral or infant formula --></baseFormulaType>
  <baseFormulaProductName value="[string]"/><!-- 0..1 Product or brand name of the enteral or infant formula -->
  <additiveType><!-- 0..1 CodeableConcept Type of modular component to add to the feeding --></additiveType>
  <additiveProductName value="[string]"/><!-- 0..1 Product or brand name of the modular additive -->
  <caloricDensity><!-- 0..1 Quantity(SimpleQuantity) Amount of energy per specified volume that is required --></caloricDensity>
  <routeofAdministration><!-- 0..1 CodeableConcept How the formula should enter the patient's gastrointestinal tract --></routeofAdministration>
  <administration>  <!-- 0..* Formula feeding instruction as structured data -->
   <schedule><!-- 0..1 Timing Scheduled frequency of enteral feeding --></schedule>
   <quantity><!-- 0..1 Quantity(SimpleQuantity) The volume of formula to provide --></quantity>
   <rate[x]><!-- 0..1 Quantity(SimpleQuantity)|Ratio Speed with which the formula is provided per period of time --></rate[x]>
  </administration>
  <maxVolumeToDeliver><!-- 0..1 Quantity(SimpleQuantity) Upper limit on formula volume per unit of time --></maxVolumeToDeliver>
  <administrationInstruction value="[string]"/><!-- 0..1 Formula feeding instructions expressed as text -->
 </enteralFormula>
</NutritionOrder>

JSON Template

{doco
  "resourceType" : "NutritionOrder",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "patient" : { Reference(Patient) }, // R!  The person who requires the diet, formula or nutritional supplement
  "orderer" : { Reference(Practitioner) }, // Who ordered the diet, formula or nutritional supplement
  "identifier" : [{ Identifier }], // Identifiers assigned to this order
  "encounter" : { Reference(Encounter) }, // The encounter associated with this nutrition order
  "dateTime" : "<dateTime>", // R!  Date and time the nutrition order was requested
  "status" : "<code>", // proposed | draft | planned | requested | active | on-hold | completed | cancelled
  "allergyIntolerance" : [{ Reference(AllergyIntolerance) }], // List of the patient's food and nutrition-related allergies and intolerances
  "foodPreferenceModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should be given
  "excludeFoodModifier" : [{ CodeableConcept }], // Order-specific modifier about the type of food that should not be given
  "oralDiet" : { // C? Oral diet components
    "type" : [{ CodeableConcept }], // Type of oral diet or diet restrictions that describe what can be consumed orally
    "schedule" : [{ Timing }], // Scheduled frequency of diet
    "nutrient" : [{ // Required  nutrient modifications
      "modifier" : { CodeableConcept }, // Type of nutrient that is being modified
      "amount" : { Quantity(SimpleQuantity) } // Quantity of the specified nutrient
    }],
    "texture" : [{ // Required  texture modifications
      "modifier" : { CodeableConcept }, // Code to indicate how to alter the texture of the foods, e.g. pureed
      "foodType" : { CodeableConcept } // Concepts that are used to identify an entity that is ingested for nutritional purposes
    }],
    "fluidConsistencyType" : [{ CodeableConcept }], // The required consistency of fluids and liquids provided to the patient
    "instruction" : "<string>" // Instructions or additional information about the oral diet
  },
  "supplement" : [{ // C? Supplement components
    "type" : { CodeableConcept }, // Type of supplement product requested
    "productName" : "<string>", // Product or brand name of the nutritional supplement
    "schedule" : [{ Timing }], // Scheduled frequency of supplement
    "quantity" : { Quantity(SimpleQuantity) }, // Amount of the nutritional supplement
    "instruction" : "<string>" // Instructions or additional information about the oral supplement
  }],
  "enteralFormula" : { // C? Enteral formula components
    "baseFormulaType" : { CodeableConcept }, // Type of enteral or infant formula
    "baseFormulaProductName" : "<string>", // Product or brand name of the enteral or infant formula
    "additiveType" : { CodeableConcept }, // Type of modular component to add to the feeding
    "additiveProductName" : "<string>", // Product or brand name of the modular additive
    "caloricDensity" : { Quantity(SimpleQuantity) }, // Amount of energy per specified volume that is required
    "routeofAdministration" : { CodeableConcept }, // How the formula should enter the patient's gastrointestinal tract
    "administration" : [{ // Formula feeding instruction as structured data
      "schedule" : { Timing }, // Scheduled frequency of enteral feeding
      "quantity" : { Quantity(SimpleQuantity) }, // The volume of formula to provide
      // rate[x]: Speed with which the formula is provided per period of time. One of these 2:
      "rateQuantity" : { Quantity(SimpleQuantity) }
      "rateRatio" : { Ratio }
    }],
    "maxVolumeToDeliver" : { Quantity(SimpleQuantity) }, // Upper limit on formula volume per unit of time
    "administrationInstruction" : "<string>" // Formula feeding instructions expressed as text
  }
}

 

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.17.3.1 Terminology Bindings

PathDefinitionTypeReference
NutritionOrder.status Codes specifying the state of the request. Describes the lifecycle of the nutrition order.RequiredNutritionOrderStatus
NutritionOrder.foodPreferenceModifier Medical, cultural or ethical food preferences to help with catering requirementsExampleDiet
NutritionOrder.excludeFoodModifier Codes used to indicate the type of food that should NOT be given to the patient.ExampleFood Type Codes
NutritionOrder.oralDiet.type Codes used to indicate the type of diet being ordered for a patient.ExampleDiet Codes
NutritionOrder.oralDiet.nutrient.modifier Codes for types of nutrient that is being modified such as carbohydrate or sodium.ExampleNutrient Modifier Codes
NutritionOrder.oralDiet.texture.modifier Codes for food consistency types or texture modifications to apply to foods.ExampleTexture Modifier Codes
NutritionOrder.oralDiet.texture.foodType Codes for types of foods that are texture modified.ExampleTexture Modified Food Type Codes
NutritionOrder.oralDiet.fluidConsistencyType Codes used to represent the consistency of fluids and liquids provided to the patient.ExampleFluid Consistency Type Codes
NutritionOrder.supplement.type Codes for nutritional supplements to be provided to the patientExampleSupplement Type Codes
NutritionOrder.enteralFormula.baseFormulaType Codes for type of enteral formula to be administered to patient.ExampleEnteral Formula Type Codes
NutritionOrder.enteralFormula.additiveType Codes for the type of modular component such as protein, carbohydrate or fiber to be provided in addition to or mixed with the base formula.ExampleEnteral Formula Additive Type Code
NutritionOrder.enteralFormula.routeofAdministration Codes specifying the route of administration of enteral formula.ExtensibleEnteral Route Codes

4.17.3.2 Constraints

  • nor-1: Nutrition Order SHALL contain either Oral Diet , Supplement, or Enteral Formula class (xpath: exists(f:oralDiet) or exists(f:supplement) or exists(f:enteralFormula))

4.17.4 Notes:

4.17.4.1 Enteral continuous vs. intermittent tube feedings

Tube feedings can be administered via continuous drip using a pump or via intermittent feedings, using gravity drip or a pump. The examples Nutrition Order Enteral Bolus Feeding Example and Nutrition Order Enteral Continuous Feeding Example show how this resource can be used to order both kinds of enteral feeding using the structured data elements. The continuous feeding typically specifies rate of administration and a maximum volume of delivery using the enteralFormula.rate and enteralFormula.maxVolumeToDeliver elements. On the other hand, the intermittent feeding typically specifies the amount and frequency of administration using the enteralFormula.quantity and enteralFormula.schedule elements. In both cases, to vary the rate or quantity over time the enteralFormula.administration element can be repeated.

4.17.4.2 Note about the examples

The examples associated with this resource demonstrate the core elements and do not necessarily reflect real world implementations that may be constrained by future profiles for a given implementation or setting. For example, a renal diet is often comprised of pre-coordinated components including common nutrient modifications such as protein, potassium and phosphorus to assist with the speed of entry of complex diet orders.

4.17.5 Search Parameters

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionPaths
additivetokenType of module component to add to the feedingNutritionOrder.enteralFormula.additiveType
datetimedateReturn nutrition orders requested on this dateNutritionOrder.dateTime
encounterreferenceReturn nutrition orders with this encounter identifierNutritionOrder.encounter
(Encounter)
formulatokenType of enteral or infant formulaNutritionOrder.enteralFormula.baseFormulaType
identifiertokenReturn nutrition orders with this external identifierNutritionOrder.identifier
oraldiettokenType of diet that can be consumed orally (i.e., take via the mouth).NutritionOrder.oralDiet.type
patientreferenceThe identity of the person who requires the diet, formula or nutritional supplementNutritionOrder.patient
(Patient)
providerreferenceThe identify of the provider who placed the nutrition orderNutritionOrder.orderer
(Practitioner)
statustokenStatus of the nutrition order.NutritionOrder.status
supplementtokenType of supplement product requestedNutritionOrder.supplement.type