After falling at home and sustaining a left hip fracture, Charlotte struggled to regain her lost independence.
As the pain medications led to constipation and nausea, Charlotte became less and less interested in eating.
At 350 pounds, some of the staff commented that the unplanned weight loss of 20 pounds during the past two weeks might be good for her.
But is it?
The face of malnutrition isn’t always what you would anticipate. Unplanned weight loss and poor nutritional intake is never a benefit to healing or improved physical functioning.
Our new interdisciplinary course “Malnutrition Alert! How to Improve Patient Outcomes” for nurses, dietitians and physicians is designed to help you recognize the role that protein-calorie malnutrition plays in adult morbidity and mortality and to focus on the tasks required of the interprofessional team in preventing, diagnosing and treating malnutrition.
What’s behind the weight loss?
For many people who already have had a decline in muscle mass associated with aging, the addition of disease or injury leads to further loss of lean body mass and decline in functional abilities.
Up to 50% of hospitalized patients are at risk for or already have malnutrition, but only 7% actually receive a diagnosis during their hospital stay, according to an article in Clinical Interventions in Aging and the Agency for Healthcare Research and Quality.
Malnutrition diagnoses can significantly impact Medicare reimbursement and the case mix index for a facility.
Patients who are malnourished may not only have longer lengths of stay of up to four to six days, but also hospital costs twice as high for patients with malnutrition, according to the Agency for Healthcare Research and Quality and International Journal of Environmental Research and Public Health.
In the new interdisciplinary course “Malnutrition Alert! How to Improve Patient Outcomes,” Terese Scollard, MBA, RDN, LD, FAND, a leading expert in malnutrition and a member of the Academy of Nutrition and Dietetics work group that designed and released the Consensus Statement on malnutrition in 2012, provides the guidelines you need to tackle this important condition.
According to the Agency for Healthcare Research and Quality, malnutrition also can lead to:
- An increased risk of adverse events and complications
- A 54% higher likelihood of hospital 30-day readmission
- Up to 5 times more likely to die in the hospital than a non-malnourished patient
It was difficult to diagnose malnutrition in the past as there were no widely accepted characteristics that clinicians could use to classify this condition consistently throughout all care settings.
But that all changed in 2012 with the publication of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition Consensus Statement on identifying and diagnosing malnutrition.
From the ED to the ICU, it’s important all healthcare providers document malnutrition characteristics accurately.
When a physician automatically clicks “Appears well nourished,” when the patient actually isn’t, facilities risk ignoring a condition that increases costs, length of stay and even the patient’s chance of readmission.
All clinicians should be aware of the guidelines and working as a team to treat malnutrition.
One study, which assessed the impact of an interdisciplinary malnutrition treatment program in several hospitals within a large accountable care organization, reduced 30-day readmission rates by 27% and the average length of stay in the hospital by almost two days for patients with malnutrition.
The impact of these interventions has the potential for significant savings for a healthcare system.
Another study from suburban Chicago-based Advocate Health Care resulted in a $4.8 million cost reduction after implementation of a nutrition-focused quality improvement program at four facilities. The savings of approximately $3,800 per patient was attributed to decreased readmission rates and shorter lengths of stay.
A successful malnutrition treatment program requires an interdisciplinary team to assess, document and prioritize interventions that improve the nutritional status of those under our care.
What can you do to help?
- Recognize that malnutrition can have a significant impact on healing, length of stay and readmission rates.
- Refer patients of concern to your registered dietitian nutritionist for a comprehensive nutrition assessment.
- Avoid weight bias in identifying malnutrition. Patients of any size can become malnourished.
- Ensure that accurate weights and meal percentages are documented.
- Communicate your concerns with the primary care provider.
Check out this excerpt from the course “Malnutrition Alert! How to Improve Patient Outcomes” that touches on some of the most important and challenging issues in addressing malnutrition.
“The medical diagnosis of protein-calorie malnutrition should be carried downstream to alert all providers of the client’s condition,” write the course authors. “Providing a diagnosis helps other practitioners recognize the situation and intervene and promotes better interprofessional care. It also enables the client and family to discuss root causes.
“The term ‘malnutrition’ can be stigmatizing, leading some to fear labeling it because of the implication that someone in the healthcare facility or family is responsible,” the authors continued. “The primary focus should be on the client’s condition and interventions that can lead to recovery and prevention. Because of disease, many medical conditions are not within the client’s or healthcare team’s control, and malnutrition is no different.”
Malnutrition is no one’s fault, but together we can work to find solutions.
- Wells JL, Dumbrell AC. Nutrition and Aging: Assessment and treatment of compromised nutritional status in frail elderly patients. Clin Interv Aging. 2006; 1(1):67-69.
- Weiss AJ, Fingar KR, Barrett ML, et al. Characteristics of hospital stays involving malnutrition, 2013. HCUP Statistical Brief #210. Rockville, MD: Agency for Healthcare Research and Quality. Available at: http://www.hcup-us.ahrq. gov/reports/statbriefs/sb210-Malnutrition-Hospital-Stays-2013.pdf.
- Barker LA, Gout BS, and Crowe TC. Hospital malnutrition: Prevalence, identification, and impact on patients and the healthcare system. Int J of Environ Res and Public Health. 2011;8:514-527.
- Fingar KR, Weiss AJ, Barrett ML, et al. All-cause readmissions following hospital stays for patients with malnutrition, 2013. HCUP Statistical Brief #218. December 2016. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb218-Malnutrition-Readmissions-2013.pdf
- White JV, Guenter P, Jensen G, et al; Academy of Nutrition and Dietetics Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012;112(5):730–738.
- Sriram K, Sulo S, VanDerBosch G, et al. A comprehensive nutrition-focused quality improvement program reduces 30-day readmissions and length of stay in hospitalized patients. JPEN J Parenter Enteral Nutr. 2017;41(3):384-391.
- Sulo S, Feldstein J, Partridge J, et al. Budget impact of a comprehensive nutrition-focused quality improvement program for malnourished hospitalized patients. Am Health Drug Benefits. 017;10(5):262-270.
- Scollard T. Malnutrition Alert! How to Improve Patient Outcomes. Brookfield, WI: OnCourse Learning.
Check out these courses related to nutrition:
Malnutrition Alert! How to Improve Patient Outcomes
(2 contact hrs)
What would you do if potentially half of your hospitalized clients, and 5% or more of your ambulatory clients, had a condition that was compromising their health, yet it was undiagnosed and untreated? An estimated 30% to 60% of those hospitalized have malnutrition with significant consequences such as increased 30-day mortality, more infections, reduced wound healing, and increased length of stays, not to mention higher costs. In 2012, a practical approach to diagnosing malnutrition became available and is shedding light on the problem. The strategy is based on our current understanding of metabolism in disease states and is a structured bedside approach that uses clinical characteristics as markers and indicators of malnutrition. Learn the facts about the causes, definition, and incidence of malnutrition and how a team approach can dramatically improve outcomes in the malnourished.
Importance of Nutritional Status in Pregnancy Outcomes
(1 contact hr)
The most important controllable factors in pregnancy outcome are prenatal medical care and adequate nutrition during pregnancy. The health and eating habits of the mother directly affect the fetus and the pregnancy’s outcome. In a country such as the United States where the food supply is plentiful and women should be well nourished, it is disheartening to realize that malnutrition and poor eating habits lead to maternal, fetal and neonatal complications. Not only are there short-term complications but later-in-life chronic diseases may be experienced by the baby based on the mother’s prenatal diet and its impact on the mother and the baby’s epigenetics. Learn what nutrients are necessary for a healthy pregnancy.
When the Nose No Longer Knows
(1 contact hr)
Although smell and taste disorders in elders are often not directly life threatening, they can have a major impact on quality of life. More worrisome, they often lead to malnutrition and even weight loss. They create dangerous health risks when someone cannot recognize the odor of gas leaks, smoke or spoiled food. Although these disorders can arise simply from the physiological changes of aging, they can also indicate other more serious medical problems. Healthcare professionals can improve an elder’s quality of life by performing a careful assessment to identify the cause of the smell and taste disorders, and by assisting them with ways to cope with the problem.