Purpose: In the United States, the literature suggests over the past decade that 30-50 % of patients admitted to the hospital are malnourished. Malnutrition is commonly overlooked and/or underre-ported in hospital settings. Some of the negative consequences of malnutrition are slower recovery, increased risk of hospital acquired pressure injuries (HAPI), mortality, postoperative infections, falls, and readmission rates. After hospital conversion to an electronic health record (EHR) and implementation of a malnutrition screening tool (MST) there was a high incidence of positive malnutrition screenings with referrals to the Dietitian for malnutrition consults. The readmission rate for under-weight malnourished elderly (≥65) patients was consistently higher than those who were 65 and old-er with a BMI ≤ 18.5. The primary aim of this project is to decrease the 30-day readmission rate of underweight, malnourished (BMI ≤ 18.5) patients 65 years of age and older.
Method: An inter-professional team consisting of Dietitians, Nurses, Pharmacist, Social Worker and Physicians collaborated on a performance improvement initiative and applied evidence-based interventions for improvement of the patients’ nutritional status. The project consisted of early and accurate identification of malnourished patients with a BMI ≤ 18.5 and patients 65 years of age and older, early initiation of appropriate diet including oral nutritional supplements, nutritional resources upon discharge, and post discharge follow-up from registered dietitians.
Findings: A total of 33 patients screened positive for underweight malnutrition and were ≥ 65 and agreed to participate in the performance improvement initiative. Six months post implementation of the project, the readmission rate for 100 patient days for the targeted population decreased by 61.5%. Whereas patients not included in the project (patients ≥ 65 with a BMI of >18.5) had increase in readmission rate of 30.7%.
Discussion: The collaborative effort and implementation of practical, evidence-based, low cost nutritional and educational interventions has shown to reduce the readmission rates for under-weight malnourished elderly patients. The reduction in readmission rates and the potential cost savings of implementing a project to monitor and reduce the incidence of malnutrition has proven effective when compared to patients ≥ 65 who did not participate in the project. Implications for Practice Implications for practice are to focus on evaluating current nutritional status assessments and to implement effective evidence-based validated screening tools and protocols that rapidly identify and treat all malnourished hospitalized patients along with aligning new evidence-based policies and procedures. Timely identification of malnutrition at any stage of the healthcare continuum could reduce unplanned admissions and improve overall patient outcomes while decreasing healthcare costs.
Objectives: Describe the impact of rapid initiation of oral nutritional supplements with high protein, high calorie intake for the malnourished elderly inpatient. Summarize some of the adverse consequences of the unrecognized malnourished elderly inpatients (BMI ≤ 18.5) without nutritional interventions.
Magnet Conference 2021
Miyar, Virginia and Goico, Elizabeth, "Taking a Bite Out of Malnutrition" (2021). All Publications. 4047.
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