User Interface Name

Field Identifier

Definition

Data Value Format (code or other value)

Value Sets

Date of Assessment

Assessment_Date

This is the date the actual risk assessment (or review) was carried out with the patient

8 digit numeric, CCYYMMDD
6 digit numeric: hh:mm:ss

Measured,Reported, Estimated or Unable to weigh

Weight_Est_Act

This is to indicate whether the patients weight is measured, reported, estimated or unable to weigh

n1

1 - Patients weight measured
2 - Patients weight reported
3 - Patients weight estimated
4 - Unable to weigh patient

Measured,Reported, Estimated or Unable to weigh

Height_measured_reported

This is to indicate whether the patients height is measured, reported, estimated or unable to weigh

n1

1 - Patients height measured
2 - Patients height reported
3 - Patients height estimated
4 - Unable to measure patient

Weight

Weight_Loss

This is to allow the assessor to describe the patients weight loss within the last 6 months.

n1

1 - Unitentional Weight loss of 6 kg or more (1 stone) within last 6 months, extremely thin or cachexic,  BMI < 18.5 kg/m2  = 7
2 - Unintentional weight loss 3kg (7lb) within last 6 months = 2
3 - No weight loss = 0

Appetite (current)

Appetite

This is to allow the assessor to describe the patients current appetite outlining their food and fluid intake.

n1

1 - Little or no appetite or refuses meals and drinks = 4
2 - Poor – eating less than a quarter (1/4) of meals and drinks = 3
3 - Reduced – eating half of meals = 1
4 - Good – eats 3 meals/day or is fully established on tube feed = 0

Ability to eat (current)

Eating_Ability

This is to allow the assessor to describe the patients current ability to eat.

n1

1 - NBM for more than 5 days = 7
2 - Unable to tolerate food via gastrointestinal tract due to nausea or vomiting, constipation or diarrhoea, difficulty chewing/swallowing due to dysphagia or mucositis = 4
3 - Requires prompting, encouragement or assistance to eat and drink = 1
4 - No difficulties- able to eat and drink normally and independently = 0

Stress Factor
(for CURRENT condition. If clinical condition is not listed, choose a similar condition)

Stress_Factor

This is to allow the assessor to describe other conditions that can impact on the patients nutrition.

n1

1 - Upper GI cancer - pre/post surgery, extensive bowel resection/high output stoma / fistula. Head & neck cancer/surgery, both kidney & pancreatic or bone marrow transplants, mixed depth burns (>20%)  = 7
2 - Moderate surgery e.g. cardiothoracic, kidney transplant, vascular Malignant disease with complication e.g. infection. Recent multiple injuries e.g. spinal injury/trauma, head injury, GBS,  bowel surgery (uncomplicated),  liver disease (decompensated). Kidney e.g. Acute kidney injury, renal replacement therapy (HD/PD). Severe infection e.g. sepsis, endocarditis, pneumonia, peritonitis. Pancreatitis (Acute and chronic), HIV, Burns (15-20% mixed depth) = 4
3 - Progressive disorders e.g. MND, MS, Parkinson’s, dementia, heart failure, COPD, Stroke, Fractured neck of femur, inflammatory bowel disease. Uncomplicated/stable malignant disease, 10-15% mixed depth burn = 2
4 - Uncomplicated condition with no interruption in food intake e.g. MI = 0

Pressure Ulcer / Wound (if ungradable, choose higher grade/score)

Pressure_Ulcer_Wound

This is to allow the assessor to identify the condition of the patients skin or wounds.

n1

1 - Cat 4 pressure ulcer or open abdomen = 7
2 - Cat 3 pressure ulcer or dehisced/infected/moderate exudate wound = 4
3 - Cat 1-2 pressure ulcer or non-healing/low level exudate wound = 2
4 -Pressure areas intact, healing or healthy wound = 0