Nutrition priority system: a model for patient care

The criterion for the level of nutrition monitoring used by many hospitals and residential care facilities has traditionally been the patient's diet order. Patients on "regular" diets may receive minimal monitoring (if any) with little discharge instruction, and patients on "modified diets" receive a full assessment with specified routine follow-up by nutrition-care team members and detailed discharge planning. The concentration on the diet rather than the patient gives cause for concern, but in residential care facilities such concerns are magnified. While it is appropriate to monitor a 60-year-old patient with adult-onset diabetes whose disease of 20 years' duration is stable, the present diet order system insists that that patient be monitored intensely but ignores his 80-year-old neighbor on a general diet, despite her poor appetite and 87-lb weight. The authors developed a priority system that sets three levels of patient care and materials for teaching the system to treatment team members. The system is based on the patient's needs, not the diet order. Although reduction in staff time would have been an additional welcome result, use of the system does permit the more efficient utilization of the dietitian's and dietetic technician's time. The greatest effect has been individualized, monitored nutrition care for residential psychiatric patients.