How to start a malnutrition program at your facility

The word is out! Malnutrition is a rampant problem in our healthcare facilities today. It negatively affects everything from clinical outcomes to quality of life to the bottom line. If you are not participating in a full-on campaign at your facility to identify, diagnose, and treat malnutrition, what are you waiting for? Here’s a step-by-step guide to help you get started. 

Step 1: Collect baseline data 

Once you have decided that you’re really ready to do this, press the pause button and evaluate what you are currently doing when it comes to malnutrition. What screening tool are you using? How are at-risk patients referred to the dietitian? How many patients were discharged from your facility with a true and accurate malnutrition diagnosis in the past six months to one year? And how about your baseline reimbursement? Don’t feel discouraged if your docs are still using albumin to diagnose malnutrition; we all have to start somewhere. These baseline data will help you demonstrate improvement once you launch your program. Onward and upward! 

Step 2: Assemble your team 

What’s a superhero without her trusty sidekick? Malnutrition is a widespread and multifaceted problem that is too much for one person to tackle. Dietitians lead the way as likely the only clinicians with malnutrition in their sights, but trust me when I say, it really does take a village. So, start talking about malnutrition at every opportunity. Staff meetings, P&T committee, even invite yourself to Med Exec (bring snacks and they’ll invite you back). Recruit some heavy-hitters like your nursing leadership, key physicians, coding experts, EMR gurus, and case managers. Think of it as your Malnutrition All-Star Team. 

Step 3: Develop a game plan 

Based on your baseline data, identify some areas that need improvement and focus your attention there. For example, maybe you are already using a validated nutrition screening tool and your team of dietitians are totally awesome, but there’s no real communication between the dietitians and the physicians…so no one is receiving a diagnosis of malnutrition. The solution? Host a pow-wow and invite all the dietitians and docs. Don’t talk shop, just mix and mingle. If you feed them, they will come. (Trust me. I have recruited so many docs to my team using nothing more than cookies, candy, and pie.) 

If you aren’t quite sure where to start, then start at admission to your facility and follow a patient through discharge. What happens to patients when they are first admitted to your facility? Are they screened for nutrition risk? If so, how and by whom? What happens to nutritionally at-risk patients? Are dietitians notified to assess these patients? How and what does that timeline look like? Once the dietitian assesses, what criteria is he/she using to determine malnutrition risk? And how is that communicated with the provider? Is the provider diagnosing malnutrition? If so, how often, based on what information, and using which diagnostic codes? Are those diagnostic codes actually listed on the patient’s record? Did they yield any additional reimbursement for your facility? If so, how much? See what I mean? It takes a village. 

Step 4: Put this process on ‘repeat’ 

They don’t call it “continuous improvement” for nothing. The process of launching and maintaining a malnutrition program at your facility won’t happen overnight. Because there are so many steps in the process of diagnosing malnutrition and it requires the collaboration of so many different disciplines, it will take time to get this ball rolling. Keep collecting data, keep talking about malnutrition, and keep collaborating with your Malnutrition All-Star Team. Celebrate even the smallest victories to keep your team pumped up. You can do this!

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