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Oct 15 2013
Dietitians Critical Role in Leading Nutrition Intervention in the Hospital
Ainsley Malone, M.S., R.D., C.N.S.C., L.D.

The value of proper nutrition in the hospital setting has never been higher. With a spotlight on improving quality of care and reducing readmissions rates, now is the time for hospitals to focus on preventable conditions such as malnutrition.

Comprehensive Recommendations for Dietitians

The Alliance to Advance Patient Nutrition has published a nutrition care model, to help guide clinicians in improving nutrition protocols within their hospitals. The model includes tips specifically for dietitians, who can lead the charge towards better nutrition practices.

In my current role as a nutrition support dietitian at Mount Carmel West Hospital in Columbus, I am involved everyday in the management of patients’ nutritional needs. I see the impact early and automatic nutrition intervention can have on patients’ outcomes and I always look for ways to share this knowledge with my colleagues.

As the President of A.S.P.E.N., and as a representative to the Academy of Nutrition and Dietetics Malnutrition Workgroup, I have been able to take my experiences in the hospital and open a dialogue about the importance of improving patient nutrition. I understand how vital dietitians’ role is in getting this conversation going. I also know that clinician collaboration among the care team is the way to get results in the hospital. The Alliance to Advance Patient Nutrition has brought together clinicians across the continuum of care for that reason. The below nutrition care recommendations are a great way for hospitals to improve their nutrition intervention and take a step towards improving their patients’ outcomes.

Principle 1: Create an institutional culture where all stakeholders value nutrition
Dietitians should embrace their role as the primary authority on all things nutrition, and serve as a resource to fellow clinicians. I encourage all dietitians to share their knowledge and expertise on the importance of nutrition in all aspects of patient care. We are armed with the knowledge to educate key hospital stakeholders, including administrators, on the impact improved nutrition care can have not only improving patient outcomes, but also on reducing hospital costs.

Principle 2: Redefine clinicians’ role to include nutrition care
In my experience with A.S.P.E.N., I have seen how successful programs can be when all clinicians work together. Take Alliance resources and use them to communicate the importance of nutrition to your fellow clinicians. Engage other team members by sharing data on progress made with nutrition care efforts. If your hospital offers interdisciplinary teams or meetings, make an effort to be a regular participant. Nutrition should be part of every clinicians care plan, not just the dietitians.

Principle 3: Recognize and diagnose all malnourished patients and those at risk
Assessing and diagnosing malnutrition should not be an option. Mt. Carmel Health System, where I work, implemented a validated nutrition screening tool during its transition to electronic health records (EHR) in 2012. By including the MST, a simple three-question tool which calculates the patient’s weight lost and evaluates appetite, the system ensures that every patient is screened as part of their admission health assessment. The electronic MST automatically sends referrals to the dietitian, improving efficiency and allowing patients to be treated faster.

Additionally, all dietitians in the Mt. Carmel Health System have been trained on the standardized set of diagnostic characteristics recommended by the Academy of Nutrition and Dietetics and A.S.P.E.N. , which was developed to better identify and document adult malnutrition in routine clinical practice. We must ensure that all malnourished patients are diagnosed as part of standard hospital procedures.

Principle 4: Rapidly implement comprehensive nutrition intervention and continued monitoring
Patients identified as “at risk” during nutrition screenings should automatically receive nutrition intervention within 24 hours. All clinicians need to be aware of what their hospitals’ protocols are and what exactly to do when patient is identified as malnourished. One option is to provide enteral nutrition formulary and micronutrient therapy options in written form as a pocket-size document and make it readily available to all staff to ensure fast intervention.

It’s important that nurses understand how to maximize food / oral nutritional supplements (ONS) consumption and monitor nutritional intake and needs. Dietitians should work with nurses, who spend the most time at the patients’ sides, to make sure they know the simple ways to improve patient nutrition.

Principle 5: Communicate nutrition care plans
When a patient is identified as malnourished in the hospital, it’s important that this is documented and communicated to the patient, caregivers and all healthcare providers involved. Collaboration with the patient’s physician is essential to not only determine nutrition intervention strategies but also for malnutrition documentation in the medical record. This is a critical step in the malnutrition coding process.

Dietitians can play an administrative role by ensuring that standardized policies, procedures and EHR-automated triggers relevant to nutrition are established and maintained in their hospitals.

Principle 6: Develop a comprehensive discharge, nutrition care, and education plan
This last principle is extremely important for the patients and the hospital. When a patient is sent home, it is the patient and the provider’s hope that patients remain healthy and out of the hospital. We must provide patients, family members and caregivers with nutrition education and a comprehensive post-hospitalization nutrition care plan. We know there is a lot to worry about when a patient leaves the hospital. It’s vital that patients and caregivers understand the value of nutrition in their recovery process.

As the experts on nutrition in the hospital setting, dietitians have the opportunity to lead the way in implementing these six steps. We can work with nurses and physicians to address the issue of malnutrition, which will enhance the quality of care and improve clinical outcomes for our patients.