Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project

Keller, Heather; Valaitis, Renata; Laur, Celia; McNicholl, Tara; Xu, Yingying; Dubin, Joel A.; Curtis, Lori; Obiorah, Suzanne; Ray, Sumantra; Bernier, Paule; Gramlich, Leah; Stickles-White, Marilee; Laporte, Manon; Bell, Jack J.

doi:10.1016/j.clnu.2018.02.009

Cited by 29 publications

(36 citation statements)

References 40 publications

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“…Almost 4000 individual patient audits were completed during the study periods for these sites: Site A (n = 1127), Site B (n = 860), Site D (n = 988), Site E (n = 968). The average age of patient participants was 73.2 years (SD: 16.3), with 48% male …”

Section: Resultsmentioning

confidence: 99%

“…M2E sites had autonomy to determine what INPAC activities would be implemented at their site. After 1 year, all M2E hospitals had implemented a unique nutrition screening and assessment triaging process that supported patients to receive appropriate nutrition care in hospital . Advanced care practices, such as use of high energy and protein diets, snacks between meals, and oral nutritional supplement at medication delivery, were also implemented and increased treatment options for patients.…”

Section: Methodsmentioning

confidence: 99%

“…Advanced care practices, such as use of high energy and protein diets, snacks between meals, and oral nutritional supplement at medication delivery, were also implemented and increased treatment options for patients. Standard care activities that were implemented included monitoring of food intake and body weight, institution of volunteer programs to support meals, and staff communication at bedside for mealtime needs of patients (eg, providing eye glasses) . Four of the 5 M2E study units focused on monitoring food intake and/or body weight and are the focus of this case study.…”

Section: Methodsmentioning

confidence: 99%

“…Although only 4 of the 5 hospitals are included in this analysis, the site identification letters have remained consistent with prior M2E publications. Site C is not included because although they implemented screening and assessment as did other sites, they chose to focus on discharge planning rather than either form of monitoring. In Site A, an Accountable Care Unit (ACU) system was being piloted along with M2E.…”

Section: Methodsmentioning

confidence: 99%

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Impact of Facilitated Behavior Change Strategies on Food Intake Monitoring and Body Weight Measurements in Acute Care: Case Examples From the More‐2‐Eat Study

et al. 2018

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Background: Assessing and monitoring food intake and body weight of all hospital patients is considered part of "best practice" nutrition care. This study presents case examples describing the impact of behavior change strategies on embedding these 2 monitoring processes in hospitals. Methods: Four hospital medical units that participated in the More-2-Eat implementation study to improve nutrition care focused on improving food intake and/or weight monitoring practices. The percentage of admitted patients who received these care practices were tracked through chart audits over 18 months. Implementation progress and behavior change strategies were documented through interviews, focus groups, scorecards, and monthly telephone calls. Case examples are explored using mixed methods. Results: Of the 4 units, 3 implemented food intake monitoring. One provided food service workers the opportunity to record food intake, with low intake discussed by an interdisciplinary team during bedside rounds (increased from 0% to 97%). Another went from 0% to 61% of patients monitored by introducing a new form ("environmental restructuring") reminding staff to ask patients about low intake. A third unit increased motivation to improve documentation of low intake and improved from 3% to 95%. Two units focused on regularity of body weight measurement. One unit encouraged a team approach and introduced 2 weigh days/week (improved from 14% to 63%), while another increased opportunity by having all patients weighed on Saturdays (improved from 11% to 49%). Conclusion: Difficult-to-change nutrition care practices can be implemented using diverse and ongoing behavior change strategies, staff input, a champion, and an interdisciplinary team. (Nutr Clin Pract. 2019;34:459-474)

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of Facilitated Behavior Change Strategies on Food Intake Monitoring and Body Weight Measurements in Acute Care: Case Examples From the More‐2‐Eat Study

et al. 2018

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“…M2E Champions led the implementation of INPAC in their unit and also led their site implementation team who made the changes. Research associates were involved in data collection, as well as the implementation of INPAC . Data, including these dietitian interviews, were collected before hospitals began INPAC implementation, after 1 year of implementation, and again 1 year after project completion.…”

Section: Methodsmentioning

confidence: 99%

Perceptions on Use of the Subjective Global Assessment Before and After It Became Part of Regular Practice

2019

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Background: Subjective global assessment (SGA) is a standardized diagnostic tool for malnutrition and identifies those who would benefit from nutrition treatment. SGA has been validated in several patient populations; however, implementation in clinical practice is inconsistent. The objective of this study was to understand and contrast the perceptions on use of SGA before and after it became a regular practice for hospital dietitians. Methods: The More-2-Eat implementation project provided the opportunity to undertake this qualitative study, as 5 hospitals adopted INPAC (Integrated Nutrition Pathway for Acute Care), which includes the use of SGA. Between 2015 and 2018, interviews were conducted with dietitians at baseline (n = 9), a year after implementation (n = 18), and a year after project completion (n = 6). Thematic analysis was conducted. Results: Themes before SGA adoption included a desire for a malnutrition diagnosis and care planning; lacking comfort in use of SGA; and reflecting on SGA training needs.After a year of implementing INPAC and a year after project completion, themes described becoming a better clinician; allowing dietitians to see the right people, sooner; recognizing the variability in the treatment path for mildly/moderately malnourished (SGA B) patients; improving overall efficiency in delivery of care; and establishing policy and procedures to sustain and spread use of SGA. Conclusion: Initially, dietitians were hesitant to use SGA. Adoption through a focused implementation study and experience with implementation of SGA changed these perceptions. Understanding these perceptions before and after use may support adoption of this useful diagnostic tool. (Nutr Clin Pract. 2019;34:906-915)

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Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

Keller¹,

Laur

Dhaliwal

et al. 2020

J Parenter Enteral Nutr

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Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solutionfocused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.

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Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project

Abstract: Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304, June 7, 2016.

Cited by 29 publications

References 40 publications

Impact of Facilitated Behavior Change Strategies on Food Intake Monitoring and Body Weight Measurements in Acute Care: Case Examples From the More‐2‐Eat Study

Impact of Facilitated Behavior Change Strategies on Food Intake Monitoring and Body Weight Measurements in Acute Care: Case Examples From the More‐2‐Eat Study

Perceptions on Use of the Subjective Global Assessment Before and After It Became Part of Regular Practice

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

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