Nutrition Intervention Directed by Prealbumin Screening and Repeat Testing Improves Nutrition Monitoring and Directs Patient Care Planning

Abstract

LEARNING OUTCOME: To explain how PreAlbumin values can be used to identify patients at nutritional risk, direct registered dietitian interventions, and to measure patient outcomes. Registered Dietitians (RD) have limited objective criteria for measuring the effect of clinical interventions on patient outcomes. This study examines the nutrition care process utilizing PreAlbumin (PAB) as an objective tool. The nutrition care process included: 1) screening, 2) assessment, 3) intervention/care plan development, 4) recommendations to physicians, 5) repeat PAB testing, 6) reassessment/intervention, 7) discharge planning. The addition of PAB to the admission nutritional screen has identified 35% more patients at risk than the previous system. PAB was a more accurate indicator of nutritional risk and more readily available than albumin/weight status. Admission PAB allowed for 90% of patients to be screened within 24 hours of admission meeting accreditation standards and 98% of high risk patients to be assessed within 48 hours of admission. As a result of this process, 78% of RD recommendations were implemented. A sample of 37 patients were randomly selected to examine the effectiveness of utilizing repeat PAB's for reassessments/care planning. Of the 37 patients, 11 (30%) were discharged prior to repeat values. In 17 (65%) of the remaining 26 cases repeat PAB's were utilized in reassessment and directing RD interventions. Repeat PAB's drawn 3–4 days post RD intervention indicated increases of .9 mg/dL up to 11.0 mg/dL. Thirty-five percent of repeat PAB's that were decreased were attributed to poor intake, weight loss, stress reactions, severe dysphagia with refusal of enteral feedings. The nutrition care process concluded with documentation of PAB <14 mg/dL on the discharge summary for continuity of care with all providers at discharge. The nutrition care process utilizing PAB has proven to be an effective method of directing RD workflow and providing quantifiable results to physicians.