The alliance, which is made possible with support from Abbott’s nutrition business, recommends that physicians implement a three-step plan to improve patient outcomes. The approach begins with an evaluation of a patient’s nutritional status on admission using a simple, validated screening tool, such as the Malnutrition Screening Tool. When an at-risk status is determined, a more in-depth screening is performed. “When patients at risk for malnutrition can be identified faster, appropriate interventions can be put into place sooner,” Quatrara says.
The second step is nutrition intervention with a personalized nutritional care plan that takes into account the individual’s health conditions, caloric needs, physical limitations, tastes, and preferences. An interdisciplinary team approach can transform hospital nutrition, bringing together hospitalists, nurses, nursing assistants, registered dietitians, and the dietary staff to collaboratively develop a nutrition care plan that will be central to patient’s overall treatment, Dr. Tappenden says.
“There is a science behind nutrition and metabolic care,” Dr. Tappenden says. “Just like any other aspect of patient care, we can’t just throw out a blanket solution.”
But nutritional care cannot stop with developing this plan at the outset. Patients must be rescreened throughout their time at the hospital to measure any changes in nutritional status due to disease progression or treatment success.
For optimal impact, all members of the nutritional care team—nurses, nursing assistants, dietary support staff, and family members—should take responsibility for an essential component of the patient’s care: tracking and reporting consumption to the physician to open a dialogue about balancing an individual’s needs with tastes and preferences.
The hospitalist’s final step is developing a discharge plan that includes nutrition care and education so that patients, families, and caregivers can implement better nutrition at home.
“Nutrition makes sense,” Dr. Tappenden says. “Everything we are working toward in healthcare reform can be achieved by taking more care to make nutrition part of the solution.”
Maybelle Cowan-Lincoln is a freelance writer in New Jersey.
- Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. J Hosp Med. 2013;8:52-58.
- Alliance for Patient Nutrition. Malnutrition Backgrounder.
- Banks M, Bauer J, Graves N, Ash S. Malnutrition and pressure ulcer risk in adults in Australian health care facilities. Clin Nutr. 2010;26:896-901.
- Fry DE, Pine M, Jones BL, Meimban RJ. Patient characteristics and the occurrence of never events. Arch Surg. 2010;145:148-151.
- Gariballa S, Forster S, Walters S, Powers H. A randomized, double-blind, placebo-controlled trial of nutritional supplementation during acute illness. Am J Med. 2006;119:693-699.
- Neelemaat F, Lips P, Bosmans J, Thijs A, Seidell JC, van Bokhorst-de van der Schuerer MA. Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished older adults. J Am Geriatr Soc. 2012;60:691-699.
- Brugler L, DiPrinzio MJ, Bernstein L. The five-year evolution of a malnutrition treatment program in a community hospital. J Qual Improv. 1999;25:191-206.
- Stratton PJ, et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev. 2005;4:422-450.
- Lawson RM, Doshi MK, Barton JR, Cobden I. The effect of unselected post-operative nutritional supplementation on nutritional status and clinical outcomes of elderly orthopaedic patients. Clin Nutr. 2003;22:39-46.