Feasibility of using the mnutric nutritional risk screening tool to identify nutritionally at-risk patients in an Australian ICU

Abstract

Introduction: The modified NUTrition Risk In the Critically ill (mNUTRIC) score has been demonstrated to accurately quantify the risk of negative patient outcomes and discriminate which patients will benefit the most from nutrition intervention in the context of critical illness. However, the mNUTRIC is not widely used and questions have been raised about whether this is feasible in the context of routine clinical practice. Objectives/Aims: The purpose of this study was to assess the feasibility of nutrition risk screening using the mNUTRIC tool. Methods: A retrospective observational study of critically-ill patients admitted to the ICU was conducted. All patients admitted to ICU for ≥72h during the 5-month period from 1 January-30 May 2017 were included. Feasibility was determined by time taken to calculate the mNUTRIC score where resources suggested feasibility would be supported if this could be done in <5 minutes. Data availability was also a feasibility outcome with all data to be available for >90% of patients. Results: For the 260 eligible patients, calculation of a mNUTRIC score took a median of 4 minutes and 54 seconds (IQR 4.3-5.6 mins) with 96% of scores calculated in <10 minutes. Data were available to calculate mNUTRIC scores for 93% (241/260) of patients. One-third of the patients (n=81, 31%) were at high nutrition-risk with a mNUTRIC score of 6. Of these, 44% (36/81) had not been reviewed by a dietitian. The feasibility of using the mNUTRIC score in clinical practice was contested given dietitian availability in this clinical setting (0.6FTE). Conclusion: Available staffing resources can impact the feasibility of manually calculating mNUTRIC scores. An approach which adopts a shared responsibility for nutrition screening or automating the calculation may be possible solutions to increase feasibility of using the mNUTRIC score in clinical practice.