Nutrition Care Plan for Patients Identified as Malnourished after a Completed Nutrition Assessment

A nutrition care plan for those patients who are found to be malnourished based on a nutrition assessment

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Patients who are malnourished while in the hospital have an increased risk of complications, readmissions, and length of stay, which is associated with a significant increase in costs. Malnutrition is also associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. (Corkins, 2014), (Barker et al., 2011), (Amaral, et al., 2007), (Kruizenga et al. 2005). Screening for the risk of malnutrition in care settings is important for enabling early and effective interventions. 

A randomized controlled trial of 652 hospitalized, malnourished older adults over the age of 65 evaluated the use of a high-protein oral nutrition supplement for its impact on patient outcomes of non-elective readmission and mortality. The study found no effects towards improving 90-day readmission rate compared to placebo, but saw a significant reduction of 90-day mortality (p = 0.018) (Deutz, 2016).

Nutrition support intervention in patients identified by screening and assessment as at risk for malnutrition or malnourished may improve clinical outcomes (Mueller, 2011). Several research studies associated early nutritional care after risk identification with improved outcomes such as reduced length of stay, reduction in risk of readmissions, and cost of care (Lew, 2016), (Meehan, 2016), (Milne, 2009), (Kruizenga, 2005).

"The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends the following:
3. Nutrition support intervention is recommended for patients identified by screening and assessment as at risk for malnutrition or malnourished.  (Grade Evidence C)

A consensus statement between the Academy of Nutrition and Dietetics and the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommends that assessment of malnourished patients or those at increased risk of malnutrition should be incorporated into the nutrition care process of the medical, nursing and/ pharmacy professions.

The Alliance to Advance Patient Nutrition recommends that a nutrition diagnosis be formally documented in a central area on the medical record or in the EHR as a part of a nutrition care plan."

Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, et al. The economic impact of disease-related malnutrition at hospital admission. Clin Nutr. 2007 Dec;26(6):778–84.

Barker et al., Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System.  J Environ Res Public Health. Feb 2011; 8(2): 514–527. Published online Feb 16, 2011.  

Corkins MR, Guenter P, DiMaria-Ghalili RA & Resnick HE. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014;38(2):186-95.

Deutz NE, Matheson EM, Matarese LE, et al. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016;35(1):18-26.

Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MAE. Effectiveness and cost-effectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005 Nov;82(5):1082–9.

Lew CC, Yandell R, Fraser RJ, Chua AP, Chong MF, Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr. 2016

Mueller C, Compher C & Druyan ME and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. Clinical Guidelines: Nutrition Screening, Assessment, and Intervention in Adults. J Parenter Enteral Nutr. 2011;35: 16-24.

Patients age 65 years and older admitted to inpatient care who have  a completed nutrition assessment documented in their medical record.

Patients from the initial population with completed nutrition assessment documented in their medical record with findings of malnutrition.

Patients with a length of stay of less than 24 hours;

Patients with a nutrition care plan documented in the patient's medical record. 

Care plan components include, but are not limited to: Completed assessment results; data and time stamp; treatment goals; prioritization based on treatment severity; prescribed treatment/intervention; identification of members of the Care Team, timeline for patient follow-up

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.