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Becky GradlAcademy of Nutrition and Dietetics
Sue Kent
Ben Atkinson
James Allain
Yanyan HuThe Joint Commission
Clare HicksCBORD

Yanyan walked us through the use case for breastmilk related to a hospital setting

  • Exclusive Breastmilk feeding is a quality measure for Joint Commission
  • Mom is discharged and baby is still in hospital
  • Mom expresses the breastmilk at home but brings it in to the hospital
  • Breastmilk has to be verified to ensure it is going to the right baby; mom is given scanable milk labels
  • Question on donor's milk: the process is the same and the bottle will be scanned as well
  • There needs to be another link that the milk needs to be identified as a product so if it goes into a distribution system, it can be identified; does it need to be part of CBORD or any other food service product system? The resource used for this needs to cover both the nutrition aspect and the supply chain idea
  • There is a whole product area for a nursery in a separate computer system (does not go into the CBORD system)
  • There needs to be a link back to supply for this use case due to the scanable labels
  • We need to capture donor milk separately from mother's milk to identify the two
  • We also need to capture if it was formula as well
  • What about PN? It is on the same form as I/O, but as a separate category than EN
  • Does NutritionIntake need to be more generic to be able to capture I/O and not specific to nutrition?

Ben walked us through his use case on Nutrition Prescription

  • RD recommends the nutrition prescription for the patient
  • This happens in the EHR, e.g. the RD would document a low sodium diet; this would go in their clinical notes, but does this need to go somewhere else? Some RDs do have order writing privileges. Does this need to go through an Order WF? In a perfect world, it would be nice to enter in the nutrition care process flow and it flows to the order area.
  • In some hospitals, the RD puts it in their note and enters it in the order system; in other hospitals, the RD puts it in their note and notifies the MD to enter the order (this is the instance where the RD does not have order writing privileges). If you placed the diet order into a flow sheet, it will automatically populate a note (this is from an Epic point of view as Sue doesn't know Cerner). 
  • We would want to capture the actual nutrition prescription as part of NutritionIntake (this is different from the I/Os). Need to investigate if the nutrition prescription is captured as NutritionOrder and linked to NutritionIntake or captured as NutritionIntake.

Reviewed and updated the Nutrition Landscape

  • Added in CarePlan
  • Combined foodbank, pantries, SNAP, School Lunch with Food Insecurity because they are a form of Food Insecurity; added School Lunch
  • Added a question on if we can determine if a patient is participating in a food insecurity intervention
  • Discussed the need for an additional use case on how would a school get NutritionIntake related to their students (call this: how we get the status of people's enrollment in different nutrition programs (i.e. SNAP, meals on wheels, etc.))–Ben to document

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