Abstract
Initial nutrition screening can be a labor intensive activity that is a key to the entire nutrition care process. A flow chart of a nutrition screening protocol for a tertiary care hospital revealed a need for improved timeliness and efficiency. The original screening protocol relied on medical record review and patient interviews to obtain screen data. Patient interviews were frequently delayed or unavailable due to surgery schedules or patient condition. A revised protocol identified weight loss ≥ 10% in 3 months, albumin of ≤ 3.0mg/dl, or the presence of a pressure ulcer as criteria for adult “at risk” status. The hospital's Pathology Department developed a automated list of albumin levels. The Information Systems Department added weight loss as an option when ordering diets via the patient care computer system. Weight and weight loss were then entered as part of a diet order, when available, by the nursing staff. A dietetic technician used this data to complete a standardized screen entry in the physician progress notes section of the medical record. Patient interviews were conducted only if data was unavailable from other sources. The standardized note identified patient risk status and alerted the medical team that a nutrition assessment was to follow within 24 hours for “at risk” patients. Positive results of the modified screening protocol included: 1) enhanced awareness of the nutrition screening & assessment protocol and patient status by other disciplines, 2) reduced interruptions to patients, 3) improved work flow for dietitian assessments 4) an opportunity to benchmark with institutions using the same screening criteria. There has been an increase of 15% in the number of patients screened since the modified protocol was implemented without a staffing change.
Published Version
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