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

Abstract

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)

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

“…With respect to assessment, GLIM is a novel framework for categorizing malnutrition worldwide, 40,128 but clinically feasible methods for determination of FFM and comprehensive validation of GLIM are still needed. Regarding nutrition interventions, food-first approaches 17,129,130 improved food intake, but studies on patient-centered mealtime interventions, such as provision of nutrient-dense foods or reduction in barriers, had mixed results. 87 Future work needs to determine the effectiveness of these strategies on patient outcomes now that feasible and acceptable interventions have been developed.…”

Multidisciplinary Nutrition Care: Benefitting Patients with Malnutrition Across Healthcare Sectors

“…Standard care practices to promote food intake are commonly identified and implemented by nursing staff, such as reducing barriers to food intake (e.g., the need for eyeglasses and dentures, positioning patients for meals) or determining if the patient is at risk for dysphagia. Monitoring food intake is commonly completed by nursing staff members, such as care aides or dietary aides, to identify improvements and determine if a patient needs intervention before there are significant weight changes [37]. Weight monitoring is also completed.…”

“…), the pathway was tailored to the context of each hospital. For example, in one site, physical therapists supported nutrition monitoring by walking patients to weigh scales for their biweekly weights [37]. In another site, dietary team members completed admission screening while providing patients with menus and determining their preferences.…”

“…In another site, dietary team members completed admission screening while providing patients with menus and determining their preferences. Food intake monitoring was completed in some sites by the nursing staff, while in one site this was the domain of dietary staff who delivered and picked up trays [37]. Regardless of how the pathway was tailored, success in implementation was demonstrated, including improved practices and patient-reported outcomes and, in four of the five sites, decreased length of stay [32,40].…”

How to Sustain and Spread Nutritional Care Improvements

“…Five hospitals across Canada were tasked with implementing the Integrated Nutrition Pathway for Acute Care (INPAC), a consensus-based pathway for the prevention, detection, and treatment of hospital malnutrition [15,16]. After 1 year, a multidisciplinary team of hospital staff and management had implemented nutrition screening and a standardized assessment [12], decreased barriers to food intake (i.e., when the meal tray is too far from the patient), and increased food intake monitoring [12,17]. Another year later, those changes continued [14], and six new hospitals that had started INPAC implementation were able to reach similar levels with less support from a research team [14].…”