The provision of adequate nutrition to people in hospital is an integral aspect of nutrition care and is associated with better patient outcomes.
The Nutrition standards for adult inpatients in NSW hospitals (2011) and the Nutrition standards for consumers of inpatient mental health services in NSW (2013) define the basic food and nutrition needs of adult inpatients and are used as the basis of menu design.
Separate detailed guidelines called diet specifications are needed to facilitate the development of menus for patients, especially those with higher or special nutritional needs. Diet specifications describe the foods allowed and not allowed to be offered to patients ordered a particular diet. Diet specifications give guidance about the type and quantities of suitable foods for adult inpatients needing a range of therapeutic diets.
A uniform state wide approach to diet specifications facilitates consistency, communication between health professionals and food service providers, and underpins recipe and menu development.
The ACI Diet Specifications for Adult Inpatients describe the foods allowed and not allowed in each diet and provide nutrient targets for each main meal component, for those diets requiring quantitative nutrient levels.
The Specifications aim to be:
- presented in an agreed standardised format
- consistent in wording and definitions
- easy to read and interpret by non-specialist staff (e.g. food service or nursing staff without access to a dietitian) in most cases. Note – some diets will require the input of a dietitian for interpretation.
- sufficiently detailed to reliably support safe and appropriate meal provision to patients on therapeutic diets
- based on the best available evidence.
Following principles developed by the NSW Health Nutrition and Dietetic Advisors Group, the diets are named according to the nutrients to be modified (e.g. low sodium, high fibre), rather than disease states (e.g. cardiac). This clearly describes the exact nature of the diet, and recognises the importance of planning diets to meet patients’ individual needs, rather than applying standard protocols. The exceptions to this (diabetic, renal and Parkinson diets), acknowledge the widespread use and understanding of these terms.
The ACI Diet Specifications: Adult and Paediatric Reference Group is responsible for the development and review of the diet specifications. This reference group (previously named the ACI Nutrition Standards and Diet Specifications Reference Group) was established by the Nutrition in Hospitals Committee in 2012. The Reference group developed the review framework, created an online feedback tool and engaged senior clinical specialists to act as consultants and provide expert advice.
Feedback about the documents is reviewed by the Reference group in collaboration with the clinical specialist groups where required. Current literature is accessed and considered before changes are finalised. Changes approved by the Reference Group are incorporated into the revised versions of the Diet Specifications. New diets are created to meet a clinical need. Diets will be rescinded (in consultation with expert clinicians) where there is no longer a clinical need for the diet. New and revised Diet Specifications are released individually or as a group and changes are communicated to all stakeholders.
Review of the specifications
Ongoing evaluation and revisions are managed by the Diet Specifications Adult and Paediatric Reference Group. Feedback received by email or via the feedback from is reviewed by this group on a monthly basis. Diet specifications will be reviewed every five years. The specifications last reviewed more than five years ago are programmed for review in the next twelve months.