As a nutrition professional, you have likely heard the startling statistics about malnutrition. It is a massively prevalent and costly issue. The Academy of Nutrition and Dietetics estimates that up to 60 percent of acute care patients are malnourished,1 and patients who are affected have significantly longer lengths of stay,2,3 higher readmission rates,2,3 and higher mortality rates.4 With this in mind, we—the nutrition experts—should feel a sense of responsibility to tackle malnutrition head-on. But, how?
Identify malnourished patients and residents using the standardized criteria.
In 2012, the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition established standardized criteria to identify and diagnose malnutrition. Print and distribute the criteria to your dietitian peers, and encourage them to use it as a reference to interpret weight loss, changes in energy intake, and to guide physical assessments. Document your findings in your assessment notes using the same language found in the standardized criteria. You can find a link to the criteria here.
Communicate with the provider.
When you have identified a patient or resident who meets criteria for a diagnosis of malnutrition, relay that information to the attending physician, nurse practitioner, or physician’s assistant. The provider must make an official medical diagnosis of malnutrition in his/her progress note to demonstrate the higher acuity level and need for additional resources to care for a malnourished patient or resident. This, too, is the only chance for increased reimbursement.
Brush up on the Nutrition-Focused Physical Exam
Four of the six criteria used to diagnose malnutrition relate to physical characteristics, and you have to have at least two criteria to get a malnutrition diagnosis. If you aren’t using NFPE on a regular basis, you’re likely under-diagnosing malnutrition and missing opportunities to provide better care to your patients.
The nutrition-focused physical exam (NFPE) is the best tool a dietitian can use to identify malnutrition. If you’re not using it, or aren’t comfortable using it, there are many training options available, including virtual NFPE training.
Properly identifying, documenting, and diagnosing malnutrition is a HUGE step forward, but to really impact patient outcomes, we must go a step beyond. Consider more aggressive nutrition interventions for these patients or residents. This could mean earlier and more aggressive nutrition support, ordering oral nutrition supplements, or collaboration with another discipline, like nursing or social work, to offer feeding assistance or include nutrition care as a component in the discharge plan.
We at Dietitians On Demand challenge YOU to jumpstart the fight against malnutrition at your own facility using these three steps.
Like most issues, a team approach will be your best shot at success. So designate a dietitian to be your Malnutrition Champion, and invite a “pro-nutrition” physician, nurse leader, and coding specialist to join you in leading the fight against malnutrition.
Sara Glanz, MS, RD, LD, CNSC worked as a traveling dietitian for Dietitians On Demand for two years before joining the team as the corporate dietitian. In this role, she has championed the continuing education program to empower dietitians everywhere to achieve their professional goals.
Dietitians On Demand is a nationwide staffing and recruiting company for registered dietitians, specializing in short-term, temporary and permanent-hire positions in acute care, long term care and food service positions. We’re dedicated to dietitians and helping them enhance their practice and excel in the workplace. Check out our job openings, request your coverage, or visit our store today!
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1. White JV, Guenter P, Jensen G, Malone A, Schofield M, et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN. 2012;36(3):275-283.
2. Tangvik RJ, Tell GS, Eisman JA, et al. The nutritional strategy: four questions predict morbidity, mortality and health care costs. Clin Nutr. 2014;33:634-641.
3. Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clinical Nutrition. 2012;31:345-350.
4. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. JAND. 2013;113(9):1219-1237.