Malnutrition, Study notes of Nutrition

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Interdisciplinary Call

to Address Hospital

Malnutrition

Kathryn Tucker MS RD CSG LD

Department for Aging and

Independent Living

OBJECTIVES

• Define malnutrition
• Describe how malnutrition can impact recovery during a hospital admission.
• Identify 2 characteristics to support a malnutrition diagnosis
• Identify ICD10 Codes for coding malnutrition

Malnutrition- Why the FUSS? We screen for cancer and if a patient is at risk for Cancer we take action! We screen for nutritional risk and when a patient is at risk, how serious are you taking it? Nutritional Risk must be taken Seriously!

Why the Concern?

• Malnutrition is common in hospitals but often overlooked
• Malnutrition can adversely affect clinical outcomes
• Malnutrition can affect hospital reimbursement and increase costs

Collaboration is the KEY Nursing performs the initial nutrition screen and reassesses regularly CNA aware of intake, meal tolerance, and WEIGHTS Dietitians complete the nutritional assessment with interventions Pharmacists evaluation drug/nutrient interactions Rehab identify weakness and strength needs Physicians over sees the overall care plan and documentation to support reimbursement for services and patient care.

Keys for Advancing Patient Nutrition (EHR) http://pen.sagepub.com/content/early/2013/05/31/0148607113484066.full.pdf+html?ijkey=.IBeLilr4VDwE&keyt ype=ref&siteid=sppen

Clinical complication continued

• Malnourished surgical patients are 2-3 times more likely to develop a surgical site infection or postoperative pneumonia
• Malnourished patients are twice as likely to develop a pressure ulcer
• 45% of patients who fall in the hospital are malnourished
• Malnourished pt.'s spent an average of 12.6 days in the hospital compared to 4.4 days for others pt.'s
• Malnourished have increased mortality http:// malnutrition.com/progressreport https://www.ncoa.org/wp-content/uploads/Malnutrition-Fact-Sheet.pdf

What happens when we Treat Malnutrition?

• 25% reduction in the incidence of pressure ulcers
• 14% fewer overall complications
• 2 day reduction in length of stay
• 28% drop in avoidable readmissions
• Decreased mortality
• Improved quality of life

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084475/

http://malnutrition.com/getinspired/factsheet

Nutritional Screens These screens are reliable and validated Malnutrition Screening Tool (MST) Mini Nutritional Assessment (MNA-SF) Malnutrition Universal Screening Tool (MUST) Nutrition Risk Screening (NRS-2002)

https://www.health.qld.gov.au/nutrition/resources/hphe_scrn_tools.pdf

Malnutrition Screening Tool (MST)

MST of 0 or 1 = no risk for

malnutrition

MST of 2 or more = at risk for

malnutrition

Nutrition Screen Comparison Guide

A study conducted in 2011 reveals that the criterion validity of the two

comprehensive malnutrition screening tools (MUST and NRS-2002) and the two

quick-and-easy malnutrition screening tools (MST and SNAQ) seems to be

adequate for malnutrition risk screening of adult hospital inpatients. However,

MUST was found to be less applicable due to the high rate of missing values in the

questionnaire. Due to its poor specificity, the MNA-SF should not be applied to

older hospital inpatients. Our advice is to introduce screening all hospital

inpatients on malnutrition with either MST, MUST, NRS-2002 or SNAQ instead

of discussing which tool is best to use and at the same time doing nothing.

Neelemaat, F., Meijers, J., Kruizenga, H., van Ballegooijen, H. and van Bokhorst-de van der Schueren, M. (2011), Comparison of five malnutrition screening tools in one hospital inpatient sample. Journal of Clinical Nursing, 20: 2144–2152. doi:10.1111/j.1365-2702.2010.03667.x

A Comparison Chart is also available at the link below.

https://www.health.qld.gov.au/nutrition/resources/hphe_scrn_tools.pdf

Acute Illness or Injury Chronic Illness Social or Environmental Non-Severe Malnutrition Severe Malnutrition Non-Severe Malnutrition Severe Malnutrition Non-Severe Malnutrition Severe Malnutrition Energy Intake <75% of EEE

7days <50% of EEE 5days < 75% of EEE 1 month <75% of EEE 1 month <75% of EEE 3 months <50% of EEE 1 month **Weight

Loss** 1 - 2 % 1 week 5% 1 month 7.5% 3 months

2% 1 week 5% 1 month 7.5% 3 months 5% 1 month 7.5% 3 months 10% 6 months 20% 1 year 5% 1 month 7.5% 3months 10% 6 months 20% 1 year 5% 1 month 7.5% 3months 10% 6 months 20% 1 year 5% 1 month 7.5% 3months 10% 6 months 20% 1 year Body Fat Mild Moderate Mild Severe Mild Severe Muscle Mass Mild Moderate Mild Severe Mild Severe Fluid Mild Moderate to Severe Mild Moderate to Severe Mild Moderate to Severe Grip Strength

N/A Measurably Reduced N/A Measurable Reduced N/A Measureable Reduced

Characteristics to Support a Diagnosis of Malnutrition

Academy of Nutrition and Dietetics / American Society of Parenteral and Enteral Nutritional

Clinical Characteristics to support diagnosis of malnutrition. Supported by the CMS and RAC.

What do the Characteristics look like?

More Characteristics