ADIME Notes: What UK Dietitians Actually Use Instead

ADIME is the documentation format of the American Nutrition Care Process. UK dietitians work to the British Dietetic Association's Model and Process for Nutrition and Dietetic Practice, which has six steps rather than four and uses PASS statements rather than PES.

If you have searched for ADIME and found only American material, that is not an accident of search ranking. It is because the format is American, and because the UK model deliberately stopped telling you how to structure your notes.

What is ADIME?

ADIME stands for Assessment, Diagnosis, Intervention, Monitoring and Evaluation. It is the documentation structure attached to the Nutrition Care Process developed by the Academy of Nutrition and Dietetics in the United States.

It is a perfectly sensible structure and it is widely taught. It is simply not the UK framework, and its diagnosis component uses a different statement format from ours.

What do UK dietitians use?

The BDA Model and Process for Nutrition and Dietetic Practice, current version 2021, which superseded the 2020 and 2016 editions.

It has six steps rather than ADIME's four:

Step	What happens
1. Assessment	Gather and interpret the data
2. Nutrition and dietetic diagnosis	Identify the problem you are treating
3. Plan	Agree goals and the intervention
4. Implement	Deliver it
5. Monitor and review	Track against the goals
6. Evaluate	Judge whether it worked

The visible difference from ADIME is that monitoring and evaluation are separated into two distinct steps, and planning is separated from implementation. That is not cosmetic. It reflects a model where agreeing the plan with the patient is its own act.

PASS, not PES

This is the difference most likely to trip up someone trained on American material.

The American process uses a PES statement: Problem, Etiology, Signs and symptoms.

The BDA model uses a PASS statement: Problem, Aetiology, Signs, Symptoms.

The distinction is that PASS separates signs from symptoms rather than treating them as one component. Signs are what you observe and measure. Symptoms are what the patient reports. In practice a PASS statement reads as: the problem, related to its cause, as evidenced by what you found and what they told you.

If your notes currently use PES, they are not wrong in any clinical sense, but they are not the UK model and they will look unfamiliar to a UK reviewer.

Why does everyone still search for ADIME?

Here is the part that explains the confusion, and it is a genuine gap rather than a failure of understanding.

In its most recent revision the BDA removed the recording and documentation element that used to sit alongside each stage of the older Nutrition and Dietetic Care Process.

So the current model tells you what the process is. It does not tell you how to write it down. Faced with a framework that describes six steps but no note structure, dietitians go looking for one, and ADIME is what the internet offers.

That is a reasonable response to a real vacuum. It just means you are importing a documentation format from a different system, and it is worth knowing that is what you are doing.

So how should you structure a note?

Since the BDA does not prescribe a format, you need one that satisfies your professional obligations rather than one that satisfies a mnemonic. HCPC record-keeping standards require records that are full, clear and accurate, and that another practitioner could follow.

A workable structure maps onto the six steps without pretending to be a standard:

Assessment: anthropometric, biochemical, clinical, dietary and social data, with dates and sources
Diagnosis: the PASS statement, written as a statement rather than a list
Plan: goals agreed with the patient, in their words where possible, and the intervention chosen
Implementation: what you actually did and provided
Monitoring and review: what you will measure, when, and against what target
Evaluation: at review, whether the goal was met and what changes

The two things worth being disciplined about are the diagnosis statement, because it is what distinguishes a dietetic record from a general note, and the measurable goal, because without it the monitoring step has nothing to monitor.

On measurement specifically, NICE NG246 changed what you should be recording for adiposity assessment, and our guide to tracking weight and measurements covers what the guideline now expects.

What about SNOMED CT?

Worth knowing if you work in or alongside the NHS, or if you ever want your data to be interoperable.

The BDA maps the international nutrition and dietetics terminology into SNOMED CT, the clinical terminology used across the NHS, and publishes recommended term sets for both paper and electronic records.

For a private practice this is mostly forward-looking. It matters if you send structured information to NHS services, or if you want coded rather than free-text data you can analyse later.

What this means when choosing software

A practical warning, and we should be straight about our own position here.

Most practice management systems ship note shells built around SOAP, DAP and BIRP, which were designed for musculoskeletal and therapy work. Atlacare also has an ADIME shell for dietitians and nutritionists, with weight, height and waist captured in the assessment section, BMI calculated automatically, and a weight and BMI trend on the patient record.

It is labelled ADIME because that is the structure most dietitians recognise, and it does not mirror the six BDA steps one for one: plan and implementation share the intervention section, and monitoring and evaluation share the last one. Nothing stops you writing a PASS statement in the diagnosis section, and if you work to the BDA model you should.

Whichever system you use, the test is whether a dietitian can record a structured diagnosis and a measurable series without fighting a template designed for someone else. Ask to see a completed dietetic note before you commit. It is a reasonable question and the answer is usually revealing.

The short version

ADIME is American. The UK uses the BDA's six-step model with PASS statements. The reason UK dietitians keep finding ADIME is that the BDA stopped telling anyone how to write the note down, and something had to fill the gap.

Use the six steps as your structure, write a proper PASS diagnosis, make your goals measurable, and do not worry that your notes do not spell a familiar acronym.

This is general information about documentation frameworks, not clinical advice. The BDA model is revised periodically; check the current version before changing your documentation. Atlacare feature descriptions are accurate at the review date above.

Sources: BDA, Model and Process for Nutrition and Dietetic Practice · HCPC standards of proficiency, dietitians