The Case for Implementing Validated Nutrition Screening Tools in Wound Care

By Mary Ellen Posthauer RDN, CD, LD, FAND

Since undernutrition is considered a reversible risk factor for pressure ulcer development, then early detection and management of undernutrition is essential.

The 2009 NPUAP/EPUAP pressure ulcer guidelines recommended using a validated, reliable, practical tool for nutrition screening that is quick, easy to use, cost-effective and accepted by both the individual and the clinician.

Your healthcare organization may currently be using a nutrition-screening tool but it is a validated tool? Has your tool been validated based on the best available relevant evidence? Is it supported by research to measure under-nutrition or risk of malnutrition for the population you serve?

Validated tools assist clinicians to help correctly identify individuals who require early nutrition intervention when the potential for recovery is greater. Organizations are less likely to waste resources on individuals who don’t require nutrition interventions when they use a validated tool. The screening tool should consider both current weight status, as well as historical weight, since both may be linked to appetite /food intake and disease severity.

The Malnutrition Screening Tool (MST) and the Short Nutritional Assessment Questionnaire (SNAQ) were developed to assist nurses quickly screen nutritional status in acute care settings. The MST tool has three parameters including: body mass index (BMI) with alternative measures noted if BMI is not appropriate, weight loss, and the acute disease effect score. The total of the three scores identifies low, medium or high risk nutritional status and includes appropriate interventions linked to each level of risk.

The SNAQ tool noted the most predictive questions related to malnutrition are unintended weight loss of 6 kilograms in six months or 3 kilograms in one month, capacity to eat and drink with help, and decreased appetite during past six months combined with BMI ≤ 20. The SNAQ was validated in nursing homes, residential communities and hospitals.

The Mini-Nutritional Assessment-Short Form (MNA-SF®) was revised from the original MNA to six questions. A table is provided with the form so the clinician can determine BMI without performing any calculations. The MNA-SF® is validated in both the community and healthcare setting specifically for adults over 65. The questions on the MNA-SF® address appetite, weight loss in the past three months, mobility, psychological stress or acute disease, neuropsychological problems, and BMI. If the score is 8-11 points, the individual is at risk for malnutrition and malnourished if the score if 0-7 points. A score of 12-14 indicates normal nutritional status. Weight loss, low BMI, and appetite, which are predictors for the risk of malnutrition are common characteristics of these validated tools.

Validated nutrition screening tools are more widely used in Europe than in the United States. However, with the increased focus on both controlling cost and using evidence-based guidelines to achieve positive outcomes, organizations should strongly consider implementing validated nutrition screening tools. Every healthcare organization should have a policy on nutrition screening that addresses the frequency of screening and the procedure for communicating the results of the screening to the appropriate clinician, preferably the registered dietitian when nutritional risk is identified.

About The Author
Mary Ellen Posthauer RDN, CD, LD, FAND is an award winning dietitian, consultant for MEP Healthcare Dietary Services, published author, and member of the Purdue University Hall of Fame, Department of Foods and Nutrition, having held positions on numerous boards and panels including the National Pressure Ulcer Panel and the American Dietetic Association’s Unintentional Weight Loss work group.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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