# FHIR Resources for Nutrition Intervention

## Nutrition Intervention Data and Associated FHIR Resources

Nutrition Intervention involves planning and implementing actions to address the nutrition diagnosis.

Several FHIR resources can be used to document these interventions:

* **NutritionOrder Resource** : Documents detailed nutrition care plans and orders.
* **NutritionProduct Resource:** Documents foods, fluids and oral nutrition supplements provided to the patient.
* **Procedure Resource** : Records specific nutrition-related procedures and interventions.
* **CarePlan Resource** : Provides a comprehensive plan of care that includes nutrition interventions.

| Types of Data Collected          | Purpose                                                                                                                                    | Example                                      | FHIR Resource                    |
| -------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------ | -------------------------------------------- | -------------------------------- |
| **Food and Nutrient Delivery**   | Document specific details of diets, oral supplements, or enteral/parenteral nutrition plans, including prescribed nutrition interventions. | High-protein diet, Tube feeding with formula | NutritionOrder, NutritionProduct |
| **Timing and Frequency**         | Specify schedules for meals, oral supplements (e.g., protein shakes), or other forms of nutrition support.                                 | TPN daily at night, Supplements twice daily  | NutritionOrder                   |
| **Nutrition Counseling**         | Capture details of counseling sessions and educational interventions to improve nutrition knowledge or behavior.                           | Nutrition education session on diabetic diet | Procedure                        |
| **Feeding Tube Placement**       | Record details of procedures related to the placement of feeding tubes for enteral nutrition support.                                      | Placement of nasogastric feeding tube        | Procedure                        |
| **Goals and Objectives**         | Outline specific, measurable nutrition-related goals that guide the overall care plan.                                                     | Increase weight by 2 kg in 1 month           | CarePlan                         |
| **Activities and Interventions** | Coordinate actions such as administering supplements, monitoring tube feeding, or adjusting dietary plans as needed.                       | Administer supplements, Monitor tube feeding | CarePlan                         |

## Examples

### Nutrition Order

This example demonstrates how the **NutritionOrder** resource can be used to document and manage dietary requirements, restrictions, and preferences for a patient. It illustrates a comprehensive cardiac diet order for an inpatient, including specific instructions, nutrient modifications, and food exclusions.

**Key features highlighted in this example:**

* **Diet Type:** Includes a low sodium diet and fluid-restricted diet to address cardiac health needs.
* **Nutrient Specifications:** Details on limiting sodium intake to 2 grams per day and fluids to 1500 milliliters per day.
* **Allergies and Exclusions:** Accounts for patient-specific allergies (e.g., cashew nuts) and excludes related food items.
* **Personalization:** Modifiers for food preferences, such as dairy-free options, to cater to the patient’s dietary needs and preferences.
* **Instructions:** Provides specific guidance on meal preparation and fluid allowances.

This example is based on the official [FHIR documentation](https://build.fhir.org/nutritionorder.html) and showcases how NutritionOrder supports structured, interoperable dietary management in healthcare.

For more examples and detailed use cases, refer to the [FHIR NutritionOrder documentation](https://build.fhir.org/nutritionorder.html) and [FHIR NutritionOrder examples](https://build.fhir.org/nutritionorder-examples.html).

{% code title="Nutrition Order" %}

```json
{
"resourceType" : "NutritionOrder",
"id" : "cardiacdiet",
"identifier" : [{
"system" : "http://goodhealthhospital.org/nutrition-requests",
"value" : "123"
}],
"status" : "active",
"intent" : "order",
"subject" : {
"reference" : "Patient/example",
"display" : "Peter Chalmers"
},
"encounter" : {
"reference" : "Encounter/example",
"display" : "Inpatient"
},
"dateTime" : "2014-09-17",
"orderer" : {
"reference" : "Practitioner/example",
"display" : "Dr Adam Careful"
},
"allergyIntolerance" : [{
"reference" : "AllergyIntolerance/example",
"display" : "Cashew Nuts"
}],
"foodPreferenceModifier" : [{
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/diet",
"code" : "dairy-free"
}]
}],
"excludeFoodModifier" : [{
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "227493005",
"display" : "Cashew Nut"
}]
}],
"oralDiet" : {
"type" : [{
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "386619000",
"display" : "Low sodium diet"
},
{
"system" : "http://goodhealthhospital.org/diet-type-codes",
"code" : "1040",
"display" : "Low Sodium Diet"
}],
"text" : "Low sodium diet"
},
{
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "226208002",
"display" : "Fluid restricted diet"
},
{
"system" : "http://goodhealthhospital.org/diet-type-codes",
"code" : "1040",
"display" : "Fluid restricted diet"
}],
"text" : "Fluid restricted diet"
}],
"nutrient" : [{
"modifier" : {
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "39972003",
"display" : "Sodium"
}]
},
"amount" : {
"value" : 2,
"unit" : "grams",
"system" : "http://unitsofmeasure.org",
"code" : "g"
}
},
{
"modifier" : {
"coding" : [{
"system" : "http://snomed.info/sct",
"code" : "33463005",
"display" : "Fluid"
}]
},
"amount" : {
"value" : 1500,
"unit" : "milliliter",
"system" : "http://unitsofmeasure.org",
"code" : "mL"
}
}],
"instruction" : "Starting on 2/10 breakfast, maximum 400 ml fluids per meal"
}
}
```

{% endcode %}

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