Need for the Integrated Nutrition Pathway for Acute Care (INPAC): gaps in current nutrition care in five Canadian hospitals

Valaitis, Renata; Laur, Celia; Keller, Heather; Butterworth, Donna; Hotson, Brenda

doi:10.1186/s40795-017-0177-8

Cited by 16 publications

(14 citation statements)

References 45 publications

(71 reference statements)

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“…It was designed to be feasible, using the Canadian Nutrition Screening Tool 79 (CNST) that requires no objective measures (24), followed by a standardized 80 diagnostic tool, the subjective global assessment (SGA) (25) (26). Sites are described in detail in a prior publication 99 (27), but in brief were 150-1100 bed hospitals, while units ranged from 27 to 50 100 beds, with some offering specialized programs (e.g. respiratory, Accountable Care 101 Unit, acute stroke).…”

Section: Methods 75mentioning

confidence: 99%

“…The study was 104 conducted over a 24-month period, including developmental (9 months), 105 implementation (12 months), and sustainability phases (3 months). Baseline 106 evaluation collected during the developmental phase identified several gaps in 107 practice (27,28). protocol provides details on all study procedures, measures and the theoretical 110 basis for implementation (26 Research Ethics Committee).…”

Section: Methods 75mentioning

confidence: 99%

“…Behaviour (COM-B)) (29,30), and to use Plan-Do-Study-Act (PDSA) cycles to support 170 development and embedding of practice change into the routine (31). A key starting 171 point for implementation was building a nutrition culture (8) and raising awareness 172 among the team that there was a need for change in practices (27,31). INPAC audits 173 completed during the developmental phase were a key mechanism to help the unit 174 team recognize that improvements in practice were required.…”

Section: Inpac Audits 122mentioning

confidence: 99%

“…All but one 262 site achieved a 75% rate of SGA referral or completion by Period 3 with the 263 remaining site (E) achieving a rate of 75% by Period 4. At baseline, no sites were 264 using SGA and there were gaps in care with respect to comprehensive dietitian 265 assessment for patients identified to be at risk (27). Screening processes that were being instituted in the latter parts of the implementation to 294 meet the needs of some SGA B patients (e.g., initially some sites decided to assess all 295 SGA B patients until medpass was instituted).…”

Section: Inpac Audits 122mentioning

confidence: 99%

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

et al. 2019

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Section: Methods 75mentioning

confidence: 99%

Section: Methods 75mentioning

confidence: 99%

Section: Inpac Audits 122mentioning

confidence: 99%

Section: Inpac Audits 122mentioning

confidence: 99%

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

et al. 2019

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“…Four of the 5 M2E study units focused on monitoring food intake and/or body weight and are the focus of this case study. Details on the hospitals are provided in Table and in prior papers …”

Section: Methodsmentioning

confidence: 99%

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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Consensus‐based nutrition care pathways for hospital‐to‐community transitions and older adults in primary and community care

Keller

Donnelly

Laur

et al. 2021

J Parenter Enteral Nutr

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Background Practical guidance for providers on preventing, detecting, and treating malnutrition in primary care (PC) and the community is limited. The purpose of this study was to develop nutrition care pathways for adult patients (aged ≥18 years) transitioning from hospital to community and community‐dwelling older adults (aged ≥65 years) who are at risk for malnutrition. Methods A review of best‐practice nutrition evidence and guidelines published between 2009 and 2019 was performed using PubMed and CINAHL. Findings were summarized into two draft care pathways by the Primary Care Working Group of the Canadian Malnutrition Task Force. Diverse stakeholders (n = 21) reviewed and suggested revisions at a 1‐day meeting. Revisions were made and an online survey was conducted to determine the relevance and importance of discrete care practices, and to establish consensus for which practices should be retained in the pathways. Providers (e.g., dietitians, physicians, nurses; n = 291) across healthcare settings completed the survey. Consensus on relevance and importance of practices was set at ≥80%. Results One hundred twenty‐eight resources were identified and used to develop the draft pathways. Survey participants assigned ratings of ≥80% for relevance and importance for all nutrition care practices, except community service providers monitoring patient weight and appetite. Conclusion These evidence‐ and consensus‐based nutrition pathways offer guidance to healthcare and service providers on how to deliver nutrition care during hospital‐to‐community transitions for malnourished adult patients and community‐dwelling older adults at risk for malnutrition. These pathways are flexible for diverse PC and community models.

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Need for the Integrated Nutrition Pathway for Acute Care (INPAC): gaps in current nutrition care in five Canadian hospitals

Cited by 16 publications

References 45 publications

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

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

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

Consensus‐based nutrition care pathways for hospital‐to‐community transitions and older adults in primary and community care

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