Update on the Integrated Nutrition Pathway for Acute Care (INPAC): post implementation tailoring and toolkit to support practice improvements

Keller, Heather; Laur, Celia; Atkins, Marlis; Bernier, Paule; Butterworth, Donna; Davidson, Bridget; Hotson, Brenda; Nasser, Roseann; Laporte, Manon; Marcell, Chelsa; Ray, Sumantra; Bell, Jack J.

doi:10.1186/s12937-017-0310-1

Cited by 26 publications

(41 citation statements)

References 17 publications

(8 reference statements)

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“…The Integrated Nutrition Pathway for Acute Care (INPAC) (Figure ), an evidence‐ and consensus‐based pathway for use in hospitals, has patients who are screened at nutrition risk referred to a nutrition professional (dietitian or diet technician) to complete SGA and determine the patient's nutrition status . This process enables clinicians to triage patient care.…”

Section: Methodsmentioning

confidence: 99%

“…In clinical practice, SGA is designed to help a trained clinician determine a diagnosis for malnutrition and appropriate nutrition care plan based on the patient's nutrition status. It can also be used to triage patients for nutrition care, a necessary function in hospitals where malnutrition of varying degrees is prevalent . Although SGA is used regularly in research and in some clinical practice, its implementation could be expanded.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2019

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“…Furthermore, single‐meal data show that consuming half or less of the provided portion is an independent predictor of unwarranted hospitalization outcomes . These studies have led to initiation of the adoption of continuous in‐hospital food intake routine monitoring . Nevertheless, methods used for measuring intake in large‐scale surveys might not be practical in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Food intake assessment in acutely ill older internal medicine patients

Tonkikh

Shadmi

Zisberg

2019

Geriatrics Gerontology Int

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Aim: Poor food intake is a major concern among hospitalized older adults. This study investigated the frequency and optimal timing of in-hospital food intake assessment in terms of its ability to predict hospitalization functional outcomes.Methods: Secondary analysis of a cohort study of 699 older adults (age ≥70 years) admitted to internal medicine wards for non-disabling conditions was carried out. Daily food intake was assessed using self-reported estimation of portions consumed at each meal and calculated according to the caloric composition of the meals. Nutritional status on admission, baseline and discharge activities of daily living, and cognitive status were assessed using validated questionnaires. Repeated measures analysis of variance (n = 263) and multiple logistic regression models (n = 475) for predicting activities of daily living and cognitive decline were used to establish required frequency and optimal timing of food-intake monitoring.Results: Mean daily intake significantly increased from the first 48 h from admission (0.51 AE 0.30) to the second and third assessments (0.62 AE 0.30 and 0.63 AE 0.30, respectively). Eating half or less of the served meals both within the first 48 h of admission and after 48 h was associated with higher odds of cognitive decline (OR 1.93, 95% CI 1.27-2.94; OR 1.62, 95% CI 1.04-2.51, respectively). Low intake after 48 h of admission was associated with higher odds of activities of daily living decline (OR 1.66, 95% CI 1.03-2.67).Conclusions: Food intake increases from the first 48 h of admission onwards and becomes more consistent 3 days after admission. The associations between low food intake at various time points and worse functional outcomes show the importance of routine food intake monitoring for at least 3 days.

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“…Regular monitoring is recommended as part of the Nutrition Care Process, Step 4: Nutrition Monitoring and Evaluation, which encourages “food and nutrient intake” monitoring and weight monitoring . These 2 monitoring activities are also components of the Integrated Nutrition Pathway for Acute Care (INPAC) . INPAC is an evidence‐based and consensus‐based algorithm for the identification, prevention, treatment, and monitoring of malnutrition in hospital .…”

Section: Introductionmentioning

confidence: 99%

“…INPAC is an evidence‐based and consensus‐based algorithm for the identification, prevention, treatment, and monitoring of malnutrition in hospital . After identification and treatment, INPAC emphasizes the importance of regular monitoring of all patients, using food intake and body weight, as mechanisms for determining if interventions are sufficient …”

Section: Introductionmentioning

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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Update on the Integrated Nutrition Pathway for Acute Care (INPAC): post implementation tailoring and toolkit to support practice improvements

Cited by 26 publications

References 17 publications

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

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

Food intake assessment in acutely ill older internal medicine patients

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

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