Resource type: nutritionorder

Description

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

Elements

PathShortDefinitionComments
Diet, formula or nutritional supplement requestA request to supply a diet, formula feeding (enteral) or oral nutritional supplement to a patient/resident.Referenced by an Order Request (workflow).
identifierIdentifiers assigned to this orderIdentifiers assigned to this order by the order sender or by the order receiver.The Identifier.type element can be to indicate filler vs. placer if needed. This is explained in further detail [here](servicerequest.html#notes).
instantiatesCanonicalInstantiates FHIR protocol or definitionThe URL pointing to a FHIR-defined protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder.Note: This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
instantiatesUriInstantiates external protocol or definitionThe URL pointing to an externally maintained protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder.This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
instantiatesInstantiates protocol or definitionThe URL pointing to a protocol, guideline, orderset or other definition that is adhered to in whole or in part by this NutritionOrder.
statusproposed | draft | planned | requested | active | on-hold | completed | cancelled | entered-in-errorThe workflow status of the nutrition order/request.Typically the system placing the order sets the status to "requested". Thereafter, the order is maintained by the receiver that updates the status as the request is handled. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
intentproposal | plan | orderIndicates the level of authority/intentionality associated with the NutrionOrder and where the request fits into the workflow chain.When resources map to this element, they are free to define as many codes as necessary to cover their space and will map to "proposal, plan or order". Can have multiple codes that map to one of these. E.g. "original order", "encoded order", "reflex order" would all map to "order". Expectation is that the set of codes is mutually exclusive or a strict all-encompassing hierarchy.
patientThe person who requires the diet, formula or nutritional supplementThe person (patient) who needs the nutrition order for an oral diet, nutritional supplement and/or enteral or formula feeding.
encounterThe encounter associated with this nutrition orderAn encounter that provides additional information about the healthcare context in which this request is made.
dateTimeDate and time the nutrition order was requestedThe date and time that this nutrition order was requested.
ordererWho ordered the diet, formula or nutritional supplementThe practitioner that holds legal responsibility for ordering the diet, nutritional supplement, or formula feedings.
allergyIntoleranceList of the patient's food and nutrition-related allergies and intolerancesA link to a record of allergies or intolerances which should be included in the nutrition order.Information on a patient's food allergies and intolerances to inform healthcare personnel about the type of foods that the patient shouldn't receive or consume.
foodPreferenceModifierOrder-specific modifier about the type of food that should be givenThis 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 feedings.Information on a patient's food preferences that inform healthcare personnel about the food that the patient should receive or consume.
excludeFoodModifierOrder-specific modifier about the type of food that should not be givenThis modifier is used to convey Order-specific modifier about the type of oral food or oral fluids 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 feedings.Information on a patient's food allergies, intolerances and preferences to inform healthcare personnel about the type of foods that the patient shouldn't receive or consume.
oralDietOral diet componentsDiet given orally in contrast to enteral (tube) feeding.
oralDiet.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
oralDiet.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.typeType of oral diet or diet restrictions that describe what can be consumed orallyThe kind of diet or dietary restriction such as fiber restricted diet or diabetic diet.
oralDiet.scheduleScheduled frequency of dietThe time period and frequency at which the diet should be given. The diet should be given for the combination of all schedules if more than one schedule is present.
oralDiet.nutrientRequired nutrient modificationsClass that defines the quantity and type of nutrient modifications (for example carbohydrate, fiber or sodium) required for the oral diet.
oralDiet.nutrient.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
oralDiet.nutrient.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.nutrient.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.nutrient.modifierType of nutrient that is being modifiedThe nutrient that is being modified such as carbohydrate or sodium.
oralDiet.nutrient.amountQuantity of the specified nutrientThe quantity of the specified nutrient to include in diet.
oralDiet.textureRequired texture modificationsClass that describes any texture modifications required for the patient to safely consume various types of solid foods.
oralDiet.texture.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
oralDiet.texture.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.texture.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
oralDiet.texture.modifierCode to indicate how to alter the texture of the foods, e.g. pureedAny texture modifications (for solid foods) that should be made, e.g. easy to chew, chopped, ground, and pureed.Coupled with the foodType (Meat).
oralDiet.texture.foodTypeConcepts that are used to identify an entity that is ingested for nutritional purposesThe food type(s) (e.g. meats, all foods) that the texture modification applies to. This could be all foods types.Coupled with the `texture.modifier`; could be (All Foods).
oralDiet.fluidConsistencyTypeThe required consistency of fluids and liquids provided to the patientThe required consistency (e.g. honey-thick, nectar-thick, thin, thickened.) of liquids or fluids served to the patient.
oralDiet.instructionInstructions or additional information about the oral dietFree text or additional instructions or information pertaining to the oral diet.Free text dosage instructions can be used for cases where the instructions are too complex to code.
supplementSupplement componentsOral nutritional products given in order to add further nutritional value to the patient's diet.
supplement.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
supplement.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplement.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
supplement.typeType of supplement product requestedThe kind of nutritional supplement product required such as a high protein or pediatric clear liquid supplement.
supplement.productNameProduct or brand name of the nutritional supplementThe product or brand name of the nutritional supplement such as "Acme Protein Shake".
supplement.scheduleScheduled frequency of supplementThe time period and frequency at which the supplement(s) should be given. The supplement should be given for the combination of all schedules if more than one schedule is present.
supplement.quantityAmount of the nutritional supplementThe amount of the nutritional supplement to be given.
supplement.instructionInstructions or additional information about the oral supplementFree text or additional instructions or information pertaining to the oral supplement.Free text dosage instructions can be used for cases where the instructions are too complex to code.
enteralFormulaEnteral formula componentsFeeding provided through the gastrointestinal tract via a tube, catheter, or stoma that delivers nutrition distal to the oral cavity.
enteralFormula.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
enteralFormula.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
enteralFormula.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
enteralFormula.baseFormulaTypeType of enteral or infant formulaThe type of enteral or infant formula such as an adult standard formula with fiber or a soy-based infant formula.
enteralFormula.baseFormulaProductNameProduct or brand name of the enteral or infant formulaThe product or brand name of the enteral or infant formula product such as "ACME Adult Standard Formula".
enteralFormula.additiveTypeType of modular component to add to the feedingIndicates the type of modular component such as protein, carbohydrate, fat or fiber to be provided in addition to or mixed with the base formula.
enteralFormula.additiveProductNameProduct or brand name of the modular additiveThe product or brand name of the type of modular component to be added to the formula.
enteralFormula.caloricDensityAmount of energy per specified volume that is requiredThe 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/mL.
enteralFormula.routeofAdministrationHow the formula should enter the patient's gastrointestinal tractThe route or physiological path of administration into the patient's gastrointestinal tract for purposes of providing the formula feeding, e.g. nasogastric tube.
enteralFormula.administrationFormula feeding instruction as structured dataFormula 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 hours.See implementation notes below for further discussion on how to order continuous vs bolus enteral feeding using this resource.
enteralFormula.administration.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
enteralFormula.administration.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
enteralFormula.administration.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
enteralFormula.administration.scheduleScheduled frequency of enteral feedingThe time period and frequency at which the enteral formula should be delivered to the patient.
enteralFormula.administration.quantityThe volume of formula to provideThe volume of formula to provide to the patient per the specified administration schedule.
enteralFormula.administration.rate[x]Speed with which the formula is provided per period of timeThe rate of administration of formula via a feeding pump, e.g. 60 mL per hour, according to the specified schedule.Ratio is used when the quantity value in the denominator is not "1", otherwise use Quantity. For example, the Ratio datatype is used for "200 mL/4 hrs" versus the Quantity datatype for "50 mL/hr".
enteralFormula.maxVolumeToDeliverUpper limit on formula volume per unit of timeThe maximum total quantity of formula that may be administered to a subject over the period of time, e.g. 1440 mL over 24 hours.
enteralFormula.administrationInstructionFormula feeding instructions expressed as textFree text formula administration, feeding instructions or additional instructions or information.Free text dosage instructions can be used for cases where the instructions are too complex to code.
noteCommentsComments made about the {{title}} by the requester, performer, subject or other participants.This element SHALL NOT be used to supply free text instructions for the diet which are represented in the `.oralDiet.instruction`, `supplement.instruction`, or `enteralFormula.administrationInstruction` elements.

Scope and Usage

This resource is a request resource from a FHIR workflow perspective - see Workflow. It is the intent of the Orders and Observation Workgroup to align this resource with the workflow pattern for request resources.

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.

Boundaries and Relationships

The NutritionOrder resource is used for requesting oral diets, oral nutrition supplements and enteral feedings in an in-patient setting. The MedicationRequest 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 Task resource and its associated workflow with the Nutrition Order referenced from Task.basedOn, or by using the Nutrition Task resource in the context of a messaging or service workflow where the request is explicit or implicit.

Notes:

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.administration.rate and enteralFormula.maxVolumeToDeliver elements. On the other hand, the intermittent feeding typically specifies the amount and frequency of administration using the enteralFormula.administration.quantity and enteralFormula.schedule elements. In both cases, to vary the rate or quantity over time the enteralFormula.administration element can be repeated.

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.

Search Parameters

additiveType of module component to add to the feedingNutritionOrder.enteralFormula.additiveType
datetimeReturn nutrition orders requested on this dateNutritionOrder.dateTime
formulaType of enteral or infant formulaNutritionOrder.enteralFormula.baseFormulaType
instantiates-canonicalInstantiates FHIR protocol or definitionNutritionOrder.instantiatesCanonical
instantiates-uriInstantiates external protocol or definitionNutritionOrder.instantiatesUri
oraldietType of diet that can be consumed orally (i.e., take via the mouth).NutritionOrder.oralDiet.type
providerThe identity of the provider who placed the nutrition orderNutritionOrder.orderer
statusStatus of the nutrition order.NutritionOrder.status
supplementType of supplement product requestedNutritionOrder.supplement.type

Extension Definitions

These are extension definitions for this resource defined by the spec