How Identifying Malnutrition Can Help You Provide High Quality, Affordable Care
by Mary Ellen Posthauer RDN, CD, LD, FAND
In September, the Journal of the Academy of Nutrition and Dietetics, Journal of Parenteral and Enteral Nutrition, and the MEDSURG Nursing Journal simultaneously published the article "Critical role of nutrition in improving quality of care: an interdisciplinary call to action, to address adult hospital malnutrition." The Alliance to Advance Patient Nutrition (Alliance) includes representatives from the Academy of Nutrition and Dietetics, the Academy of Medical-Surgical Nurses, the Society of Hospital Medicine, the American Society of Parenteral and Enteral Nutrition and Abbott Nutrition.
The Alliance reported that malnutrition is associated with adverse outcomes but is frequently not identified or treated in many acute care patients. The article highlights the significant role of nutrition intervention in clinical care and proposes practical methods to quickly diagnose and treat both malnourished patients and those at risk for malnutrition. An interdisciplinary approach is an essential component of addressing malnutrition in both the hospital and post hospital phase.
The Alliance Nutrition Care Recommendations include six principles:
- Create an Institutional Culture: All stakeholders' value nutrition, including clinicians and administrators
- Redefine Clinicians' Roles to Include Nutrition: Empower dietitians, secure nurse and physician leadership
- Recognize and Diagnose All Patients at Risk: Use valid screening tools and criteria to assess/diagnose nutrition
- Rapidly Implement Interventions and Continued Monitoring: Establish a policy to feed patients within 24 hour of "at risk" screen, monitor food and supplement consumption
- Communicate Nutrition Care Plans: Leverage EHR to standardize nutrition documentation and ensure care discussions include nutrition
- Develop Discharge Nutrition Care and Education Plan: Incorporate nutrition care plan into the discharge plan, educate patients and families and communicate with the patient's health care providers
As members of the wound care team, how can we assist to implement these principles in our organizations? Is every hospitalized patient screened for malnutrition, using a validated tool, as part of standard procedure? Are the results of the screen communicated to the dietitian through the EHR? Is there a procedure to ensure those identified "at risk" receive a nutrition intervention within 24 hours while awaiting a complete assessment, diagnosis and plan of care? Does the administration in your organization recognize the value of nutrition and provide support for developing a process of effective nutrition care? Is the nutrition care plan a part of discharge planning? Are patients and their families aware of nutrition problems and educated on the significance of nutrition and wound healing?
I pose these questions hoping that we can begin a dialog on the issue of malnutrition and how collectively we can improve the quality of care for the clients we are treating. Please, weigh in and express your opinion. I look forward to hearing from you and to reporting your reply in November.
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.