Implementation of Nutrition Screening within 24 Hours of Admission for Early Identification of Malnourished Patients

Abstract

LEARNING OUTCOME: To identify a methodology for a nutritional screen performed by nonnutrition staff within 24 hours of admission. Current Joint Commission on Accreditation of Healthcare Organizations standards require a nutritional screening of patients within 24 hours of admission. Staffing of dietitians and technicians is generally not available to perform this task within 24 hours. The clinical nutrition staff developed five screening criteria which were included on the “Interdisciplinary Admission/Screening for Special Needs” form which is completed by the registered nurse admitting the patient. The criteria, 1) Patient had involuntary weight loss of 10 pounds or greater over past 6 months, 2) Patient admitted with symptoms of nausea/vomiting or diarrhea, 3) Patient does not appear alert enough to eat or appears to have chewing/swallowing/appetite problems that affect food intake, 4) Patient has draining wound or pressure sore, and 5) Patient is emaciated or malnourished by appearance, were chosen because these questions can be answered on admission and do not require the nurse to review other information or wait for lab data. If any one of the questions is answered yes, a consult is sent via computer to the dietitian who does the nutritional evaluation. This process was implemented using plan, do, check, act, Continuous Quality Improvement principles. Initial data indicated a 15 percent referral rate of patients who were actually moderately or severely malnourished by dietitian assessment. Most recent data show this referral rate to have increased to 56 percent of those patients who should be referred for possible malnutrition actually being referred from the initial 24-hour screen. Two major areas of improvement identified were to provide increased education to nursing staff on proper completion of the form and sending a dietitian consult for one question answered yes instead of two yes answers. When an adequate number of patients are referred via this process, dietitians will no longer perform nutritional screening on all patients, but would operate by referral only. This provides for early intervention and allows more time for medical nutrition therapy for malnourished patients.