The BDA’s Model and Process for Nutrition and Dietetic Practice is an ideal framework for the measurement of dietetic outcomes.
The Model and Process requires “standardised language” to enable outcome data to be collected in a systematic and straight forward way. The NHS has an agreed clinical vocabulary of standardised language terms known as SNOMED CT.
In early 2022, specialist groups were invited to comment on the BDA’s lists of standardised language terms and to suggest new and updated terms. In the summer of 2022, these updated terms were piloted across a range of dietetic teams to evaluate their usefulness and effectiveness in providing sufficient and relevant outcome data.
An Outcome Tool in excel was created for the Pilot. This was based on the Renal Nutrition Group’s Outcome Tool, who agreed that we could modify it for use across all dietetic settings This tool incorporated the key parts of the Model and Process to enable the collection of the outcomes of dietetic intervention using lists of the standardised language terms.
The lists of standardised language terms had the following headings:
- Nutrition Related Problem
- Aetiology
- Proposed Outcome
- Outcome Indicators
- Interventions
- Barriers
At the end of the pilot, all dietetic teams were asked to evaluate both the usefulness and effectiveness of the standardised language terms and the outcome tool.
They were asked for their suggestions for any new or amended standardised language terms that they would like to add to the tool for future use as well as any terms to delete. In total 14 teams completed the evaluation, representing 47 dietitians from most geographical regions within England and Scotland based in acute and community settings.
Learn more about the project and the results in our Dietetics Today article.
Summary of findings
Dietitians found it hard to suggest standardised language terms for deletion, yet many commented that there were too many terms available for use. Lack of familiarity with the terms meant that dietitians often found it difficult to choose the most appropriate term from a long list. Confidence grew as dietitians became more accustomed to the lists of SL terms over the 3-month pilot.
Despite many suitable standardised language terms on SNOMED, there are still significant gaps. As the Model and Process is not yet used by all dietitians in all clinical areas, there is a lack of knowledge and confidence on how to write a PASS statement and how to use standardised language terms, meaning that the updated standardised language terms will need further refinement over time.
It was recognised that only a small number of Dietitians were recruited to take part and therefore may not have reflected the true opinion of dietitians throughout the UK; to counter this, opinion from specialist groups was sought to review and refine lists further.
The updated list of requested new and reworded standardised language terms was sent to NHS Digital in April 2023, and if approved, these terms will be added to SNOMED and this information will be added to our outcomes webpage.
In the meantime, we have shared the full list of standardised language terms, including those that have been suggested as new terms, suggested reworded terms and those that we have decided to delete based on general consensus.
Those that are currently on SNOMED are highlighted in blue and those that have been sent to NHS Digital and are awaiting approval are highlighted in green.
The Outcome Tool was felt to be a useful, and an effective way to demonstrate dietetic outcomes by around half of the participants, however the main difficulty being the length of time needed to choose the most appropriate standardised language terms and having to enter the data on an external spreadsheet. It was felt that having a standard digital template to complete for documentation, that would include outcomes would be of greater benefit.
Next steps – Creating a Digital Dietetic Record
A new BDA project has now commenced to look into the feasibility of creating a unified dietetic digital record. The aim will be to develop a core dietetic record template embedding the recently updated standardised language terms on SNOMED. This would mean that the recording and evaluation of problems, interventions and outcomes could be undertaken seamlessly.
To undertake this work, it is vital to link in with individual dietitians, dietetic managers, first contact practitioners as well as those who consider themselves to be digital champions, so that we can assess the feasibility and the practicalities required to devise a suitable dietetic template.
The benefits to the dietetic workforce would be that both the Model and Process and the digital record are aligned and that embedded standardised language terms will facilitate the clarity of dietetic records and straightforward collection of outcomes, helping us to demonstrate our impact.