Malnutrition screening among elderly people in a community setting: a best practice implementation project
|
|
- Brandon Moore
- 5 years ago
- Views:
Transcription
1 Malnutrition screening among elderly people in a community setting: a best practice implementation project Dana Craven APD 1 Zachary Munn PhD 2 Clint Moloney PhD 3 Melissa Taylor RN BNurs 3 1. Community and Aged Care Dietitian, Anglicare Southern Queensland, Sunshine Coast 2. Senior Research Fellow, The Joannna Briggs Institute, School of Translational Health Science, Faculty of Health Sciences, The University of Adelaide 3. University of Southern Queensland Primary Contact Dana Craven DCraven1@usc.edu.au Key Dates Commencement date: July 2013 Completion date: December 2013 Executive Summary Background The prevalence of malnutrition in older adults within the community is high and presents a major cost to the health care system. Overlooking malnutrition is concerning because this is an aspect of health care that greatly impacts on quality of life. Community care based organizations are in the ideal position to address this issue. The implementation of routine malnutrition screening amongst community care clients may assist with improving the nutritional status of individuals within the community and subsequently assist with achieving better health outcomes. Objectives To promote evidence based practice in relation to the nutritional management of malnutrition for Anglicare clients in the community. doi: /jbisrir Page 433
2 Methods An organizational audit was conducted across four service Zones within the Anglicare Sunshine Coast branch. The method was in accordance with the Joanna Briggs Institute s Practical Application of Clinical Evidence System and Getting Research into Practice tools. A three phase process of change was followed using a baseline audit, feedback and re-audit cycle to implement evidence based practice. Results The baseline audit revealed poor compliance with malnutrition screening and implementation of action plans. Following the implementation phase there was significant improvement in compliance across all criteria. Conclusions Overall this implementation project has been a great success. It has achieved the aim of promoting evidence based practice in relation to nutritional management of malnutrition. Follow-up audit data indicates malnutrition screening of new clients at admission occurred almost 100% of the time compared to 50% at baseline. Keywords community, elderly, malnutrition, MST, nutrition screening. Background Worldwide the number of older people is growing. 1 In Australia 3.1 million people are aged 65 years and over, with most living in private dwellings. Of these one in five require assistance with basic daily care and activities. 2 Active and healthy ageing can be affected by a number of contributors, including nutritional status. 1 Across all settings, including acute hospital, rehabilitation, residential aged care facilities and community settings (i.e. individuals living freely in their own homes) malnutrition (defined as under nutrition) is prevalent. 3 Recent studies have reported the prevalence of malnutrition in the community setting ranges between 10-30%. 3 Malnutrition occurs for many reasons, and is both a cause and result of ill health. 3,4 In Australia, malnutrition in older adults presents a major cost to the health care system. 3 Therefore overlooking or failing to treat malnutrition is concerning because this is an aspect of health care that greatly impacts on quality of life. As the prevalence of malnutrition in older adults within the community is high, community based organizations are in the ideal position to address this. The implementation of routine malnutrition screening amongst community care clients may assist with improving the nutritional status of individuals within the community and subsequently assist with achieving better health outcomes. 3,5 Evidence based recommendations from the National Health and Medical Research Council (NHMRC) state that malnutrition should be identified in the community setting. The NHMRC also recommends doi: /jbisrir Page 434
3 that treatment and action should take place in order to reduce prevalence of malnutrition in community dwelling adults. 3 Anglicare Southern Queensland is a not-for-profit organization committed to social and community welfare issues and aged and community care needs. Services provided by the Sunshine Coast Branch include nursing, allied health, personal care, domestic assistance, social support, in-home respite and Pastoral care. The majority of service provision is funded by HACC (Home and Community Care) and most clients are 65 years or older. One of the goals of home health care provided by Anglicare is to enable the elderly to maintain their independence and grow older in the comfort of their own homes. Currently the branch has over 1000 clients distributed across a large geographical area (>3000km 2 ) divided into four service Zones. Nutrition and Dietetics is a relatively new service to this Branch and there is currently one part time Dietitian servicing the whole of the Sunshine Coast branch. Typically a referral for nutrition care is provided to the Dietitian by another health care professional or in some cases clients may self refer. Often the referral process can be triggered by a particular event or process such as disease, unintentional weight loss or changes in appetite. overlooked, particularly malnutrition. 3 However, in many cases nutrition may be Nutrition screening is a process that can identify clients at risk of malnourishment. The American Society for Parenteral and Enteral Nutrition define nutrition screening as a process to identify an individual who is malnourished or who is at risk for malnutrition to determine if a detailed nutrition assessment is indicated. 6 Nutritional screening is a quick process that can be completed by anyone using a simple tool. Various screening tools have been validated according to the setting. 3 Validated tools for the community setting include the Mini Nutritional Assessment Short-Form (MNA-SF) and, the Malnutrition Universal Screening Tool (MUST). 3 Currently at Anglicare Sunshine Coast there is no formal process of nutrition screening using a validated tool. As this is not in adherence with the current best available evidence, it was decided to implement malnutrition screening as a best practice implementation project for the Joanna Briggs Institute (JBI) Clinical Fellowship program. Objectives The overall aim was to promote evidence based practice in relation to the nutritional management of malnutrition for Anglicare clients in the community. Specifically, the aims of this project were: 1. To audit current practice regarding compliance with the best available evidence regarding malnutrition screening in the community. 2. Incorporate malnutrition screening into the standard admission process. 3. To implement a dietetic referral system to enable nutrition care planning. doi: /jbisrir Page 435
4 Methods The method was in accordance with the JBI Practical Application of Clinical Evidence Systems (PACES) and Getting Research into Practice (GRIP) tools. This online tool follows a three phase process of change using a baseline audit, feedback and re-audit cycle to implement evidence based practice. The implementation project was conducted across all four service Zones, and therefore an organizational audit was conducted. This method enabled comparison between compliance with best practice across the four Zones. The project was conducted over a four month period from July 2013 to November The project was registered as a Quality Improvement Activity within the Branch. Formal ethics committee approval was not indicated as there was no direct patient contact by auditors. Phase 1 Using the evidence summary for Nutritional Screening: Community Settings, 7 the following audit criteria were created, which represent the best available evidence on this topic: A validated screening tool is used to identify clients at risk for malnutrition. New clients are screened at admission. The screening tool has been completed accurately. Action plans are initiated when at risk patients for malnutrition are identified. It was decided to use the Malnutrition Screening Tool (MST) 8 for this project. The MST is a valid and reliable malnutrition screening tool for adult acute hospital patients. 8 Although the MST is not currently validated in the community setting, 3 it was used because it is already incorporated in the admission documentation used by Anglicare. The MST is located within the Health Behaviors Profile section of the Ongoing Needs Assessment (ONI) (refer Appendix 1). The MST has two questions and provides a total score. A total score of two or greater indicates the patient is at risk of malnutrition. A client who scores two or higher should be referred to the Dietitian for nutrition assessment. A retrospective baseline chart audit was conducted by the project leader to determine current compliance with the audit criteria. Twenty client charts were randomly selected from each of the four Zones (total 80 charts). Each chart was assessed to determine compliance with four audit criteria, outlined as follows: Criterion 1: A validated screening tool is used to identify clients at risk for malnutrition. All charts that had an MST completed met this criterion as the MST was the only tool available within the admission paperwork. If screening was not completed this option was scored N/A. N/A was used rather than No because No may imply that a non-validated screening tool was used Criterion 2: New clients are screened at admission. If the MST was completed (regardless of accuracy) this criterion was met. doi: /jbisrir Page 436
5 Criterion 3: The screening tool has been completed accurately. Both questions on the MST must have been completed and a total score entered in order for this criterion to be met. Criterion 4: Action plans are initiated when at risk patients for malnutrition are identified. If the score was 2 the chart was checked to locate a referral to the Dietitian. As paperwork is not always entered into the chart this was cross checked with the Dietician s referral spreadsheet. This master spreadsheet tracks and manages all Dietetic referrals received. If there was no evidence of a referral this criterion was not met. Results were recorded manually over a four week period and the data entered into the JBI PACES program by the project leader. Phase 2 Due to time constraints, baseline audit results were not presented to stakeholders prior to commencing Phase 2. However it had previously been identified by the project leader that malnutrition screening compliance was poor. This led to project endorsement and support from the Branch Manager and other senior staff. Prior to implementation of nutrition screening, the project leader met individually with relevant stakeholders to discuss the implementation process and to identify potential barriers. Stakeholders included the Branch Manager, a senior Clinical Nurse and the Allied Health Team Leader. The JBI Getting Research into Practice (GRIP) tool was utilized to assist this process and to inform the development of strategies (Table 3). A pathway for the management of malnutrition was developed by the Dietitian (refer Appendix 2) that outlined required action based on MST score. All twelve Registered Nurses (RN) and ten Allied Health (AH) staff members who perform client admissions attended an education session regarding malnutrition screening. This was facilitated by the project leader on 31 st July for RNs and 7 th August for AH staff. Staff who were not present at these sessions were ed the information and followed up individually by the project leader. The education sessions provided an overview of the issue of malnutrition in the community, instructions on how to complete the MST accurately and the referral process. Information handouts and how to guides were provided to all staff. It was noted that client s whose score indicate malnutrition risk may decline dietetic referral. The project leader requested that staff advise when this occurs. Phase 3 A follow-up retrospective chart audit was conducted by the project leader to compare compliance with the audit criteria. Clients admitted to Anglicare Sunshine Coast between 1 st August and 30 th November were selected. It was expected to audit twenty new admissions per zone to match the baseline audit, however new admissions during this time period were lower than anticipated. The number of follow up audits per zone are shown in Table 1. doi: /jbisrir Page 437
6 Table 1 Number of charts audited in Phase 1 and Phase 3 by Zone Number of Charts Number of Charts Zone Baseline (Phase 1) Follow Up (Phase 3) Difference New admissions were identified by running a client report in the Anglicare client management system Procura. The audit was completed online by the project leader by accessing the Health Behavior Profile section in Procura, the organization s system for client management, for each client. Charts were assessed as per the Phase 1 baseline audit for each criterion. Results Baseline Audit For the baseline audit, the frequency of each criterion is shown in Table 2. The compliance rates (%) are shown in Figures 1-4. Table 2 Frequency of criteria in baseline audit Criteria Frequency Zone 1 (n=20) Zone 2 (n=20) Zone 3 (n=20) Zone 4 (n=20) Total (n=80) Yes A validated screening tool is used to identify clients at risk for malnutrition. No N/A Yes Action plans are initiated when at risk patients for malnutrition are identified. No N/A Yes New clients are screened at admission. No N/A Yes The screening tool has been completed accurately. No N/A doi: /jbisrir Page 438
7 Figure 1 Baseline compliance against audit criteria Zone 1 Figure 2 Baseline compliance against audit criteria Zone 2 Figure 3 Baseline compliance against audit criteria Zone 3 Figure 4 Baseline compliance against audit criteria Zone 4 Across all criteria, Zone 4 performed highest overall. As expected, all Zones were 100% compliant with Criterion 1. Zone 4 displayed 50% compliance for Criterion 2, with the remaining three Zones reaching 0% compliance. Zone 4 was highest for Criterion 3 at 80% followed by Zone 3 at 45%, Zone 1 at 40% and Zone 2 at 35%. Zone 1 was highest at 88% for Criterion 4 followed by Zone 4 at 75%, Zone 2 at 71% and Zone 3 at 67%. doi: /jbisrir Page 439
8 Strategies for GRIP Barriers, strategies, resources and outcomes identified are presented in Table 3. Table 3 GRIP Implementation Barriers Strategies Resources Outcome Malnutrition screening Incorporate screening Staff time Decided to use existing not currently used as into standard admission MST located in Core standard practice process Assessment tool ONI. Provide education to Staff time Project leader attended clinical staff who perform admissions on how to complete the MST How To Guide Team leaders (CN, AH Leader) team meetings to educate staff. Develop and implement Dietitian Pathway developed. pathway for Dietetic referral based on screening score Handout Copies provided to all staff. Staff not compliant with Discuss with CN to Staff time CN reinforced to all completing section of admission paperwork confirm with staff Communication staff that completion is required component of that contains MST admission paperwork at this time. Poor knowledge Dietetic referral Staff time Staff are aware of role regarding impact of malnutrition and management of those at risk guidelines provided in management pathway Handout Discussion at meeting and examples of screening and dietetic referral process for those with scores 2 Staff do not attend Follow up via and Staff time Contacted all staff not meetings phone call present Client with score 2 Client has right to Staff time Potential future declines assessment nutrition refuse. refusal Staff to note Data collection research project All strategies were implemented as outlined in the GRIP table. doi: /jbisrir Page 440
9 Follow-up Audit Criteria frequency for the follow-up audit is shown in Table 4. The compliance rates (%) are shown in Figures 5-8. Table 4 Frequency of criteria in baseline audit Criteria Frequency Zone 1 (n=20) Zone 2 (n=13) Zone 3 (n=17) Zone 4 (n=16) Total (n=66) Yes A validated screening tool is used to identify clients at risk for malnutrition. No N/A Yes Action plans are initiated when at risk patients for malnutrition are identified. No N/A Yes New clients are screened at admission. No N/A Yes The screening tool has been completed accurately. No N/A Figure 5 Percentage compliance with best practice for audit criteria of baseline and follow up audits Zone 1 doi: /jbisrir Page 441
10 Figure 6 Percentage compliance with best practice for audit criteria of baseline and follow up audits Zone 2 Figure 7 Percentage compliance with best practice for audit criteria of baseline and follow up audits Zone 3 Figure 8 Percentage compliance with best practice for audit criteria of baseline and follow up audits Zone 4 doi: /jbisrir Page 442
11 Overall, Zone 4 demonstrated highest compliance across all four Criteria. There was no change for Criteria 1 across all four Zones. For Criteria 2 there was a 40% increase for Zone 1, 67% increase for Zone 2, 50% increase for Zone 1 with Zone 4 remaining stable. There was an increase for Criteria 3 for all four Zones. Zones 1 and 2 reached 100% compliance followed by Zone 4 at 94% (18% increase) and Zone 3 at 88% (96% increase). Criteria 4 saw an increase in error for Zones 1 (15%) and 2 (13%), however accuracy increased for Zones 3 (13%) and 4 (16%). Figure 9 Percentage compliance with best practice for audit criteria of baseline and follow up audits: all zones aggregated Across all Zones there was no change in compliance for Criteria 1 and 4. However, the largest increases in compliance were for Criteria 2 and 3. Collectively malnutrition screening occurred 95% of the time upon admission compared to 50% at the baseline. Action plans also saw a considerable increase from 11% at baseline to 50% at follow-up. Discussion Overall the implementation of malnutrition screening of clients has been successful. This is evidenced by near 100% compliance across all four Zones for audit Criterion 3 (new clients are screened at admission). Zones 1 and 2 achieved 100% compliance, with Zones 3 and 4 performing screening 88% and 94% of the time. The highest change was for Zone 3 which almost doubled the amount of screening between pre- and post-implementation audit. Action plan implementation (Criterion 2) also increased across Zones 1-3 and remained stable for Zone 4 at 50%. It was interesting to note that some clients declined nutrition assessment. In the case where a client declined Dietetic referral, this was recorded as a positive value for the criteria. The reasons varied and this requires further investigation as to why. Additionally further investigation may be required regarding clients who score 2 on the MST but are not obviously malnourished, for example someone who appears overweight or obese. Also it is likely that some action plans were attempted but declined and not communicated to the project leader. It was interesting to note that Criterion 4 (the screening tool has been completed accurately) decreased for Zones 1 and 2. It would be expected that after training and with reference materials for completing doi: /jbisrir Page 443
12 the tool that this would increase. The audit revealed that the inaccuracy occurred by failure to complete question 2 of the MST. This requires follow up with staff and if necessary further education provided to ensure accuracy. However it should be noted that the sample size was small and a 15% decrease across 20 charts represents a small number (3) of clients. Although the audit was conducted across four Zones, trends cannot be attributed to particular staff members. The RNs do not work in one dedicated Zone; their run is dictated by client need. It should also be noted that all post audit charts were completed by RNs and none by AH members. This is due likely to a reduction of new admissions during this project period. Therefore it is not clear at this time if AH staff are compliant with the audit criteria. It should be noted that the follow up audit was conducted online using the online client management system Procura. Therefore it is likely that there may be some error between the handwritten chart documentation and its transferral to the system, such as the second score being accidentally omitted. Unfortunately time constraints and geographical location of charts across four Zones did not allow for physical chart audit for the follow-up cycle. Moving forward, the results of this audit will be presented to all clinical staff. Re-education regarding tool completion will be provided where needed and feedback from staff regarding the project and the results collected. The end goal is to achieve 100% compliance. Periodic chart auditing will be conducted to ensure this is occurring and to identify any new barriers. Conclusion Overall this project has been successful and has achieved the aim of promoting evidence based practice in relation to nutritional management of malnutrition. Malnutrition screening of new clients at admission is occurring almost 100% of the time. The initiation of action plans has greatly improved across the Zones. More work is required to improve the accuracy of tool completion and this will be discussed with staff for feedback. Further research is necessary to establish why nutrition treatment may be declined by an individual when flagged at risk of malnutrition after nutrition screening. Conflict of Interest Nil identified. Acknowledgements Funding for this fellowship was received by the Department of Social Services: Teaching and Research Aged Care Services (TRACS); Aged and Community Care Education and Research Training project between Anglicare Southern Queensland and the University of Southern Queensland. I would like to thank my fellow staff members at Anglicare, in particular Caroline Bell CN and all the wonderful RNs I work with every day. Thank you to my AH team for your interest and support. Thank you to our fabulous administration team in particular Tina Kennedy and Catherine McKay. Also thank you to Clint Maloney and Melisa Taylor from USQ and the team at JBI, especially Zac Munn for your input and patience. Thank you to Prof Liz Isenring for answering my questions and generously giving me your time. Finally, a thank you to the other Fellows who experienced this journey with me. doi: /jbisrir Page 444
13 References 1. World Health Organization. Nutrition for older persons: a growing global challenge. [Internet]. C2013 [cited 2013 Oct 13]. Available from: 2. Australian Bureau of Statistics. Population by age and sex, regions of Australia, 2012 (cat. no ). [updated 2013 Aug 29; cited 2013 Oct 13]. Available from: OpenDocument#PARALINK2 3. Dietitians Association of Australia. Evidence based practice guidelines for the nutritional management of malnutrition in adult patients across the continuum of care. Nutr Diet. 2009; 66 (Suppl. 3): S1 4. Blaikley, C. Mind the hunger gap: a review of malnutrition in the community. Br J Community Nurs. 2012:S Leggo M, Banks M, Isenring E, Stewart L Tweeddale M. A quality improvement nutrition screening and intervention program available to home and community care eligible clients. Nutr Diet 2008;65: American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors and Clinical Practice Committee. Definition of terms, style, and conventions used in A.S.P.E.N. Board of Directors approved documents. American Society for Parenteral and Enteral Nutrition [Internet] [cited 2013 Jul 11]. Available from: 7. Munn Z. Nutritional Screening: Community Settings. Joanna Briggs Institute COnNECT+. 9/7/ Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 1999; 15: doi: /jbisrir Page 445
14 Appendix 1: Health Behaviors Profile doi: /jbisrir Page 446
15 Appendix 2: Anglicare Sunshine Coast Pathway for Management of Malnutrition Anglicare Sunshine Coast Pathway for Management of Malnutrition August The Malnutrition Screening Tool (MST) is located within the Health Behaviors Section of the ONI. Complete this tool upon admission. 2. Use the flowchart below to determine course of action based on MST score. LOW RISK MST score = 0-1 MODERATE RISK MST Score = 2 HIGH RISK MST Score = 3-5 No recent weight loss and no nutrition impact symptoms. Client unlikely to be at risk of malnutrition. Eating poorly and/or recent weight loss of <2kg. Client is at risk of malnutrition. Eating poorly and recent weight loss of >2kg. Client is at high risk of malnutrition. Subsequent visits any changes (e.g. illness, wounds) - rescreen Refer to Dietitian. Refer to Dietitian. Generating the Referral: Prefer to receive referrals electronically i.e. scan the Allied Health Referral form. If referral related to MST note this in the Comments/Reason for Referral section of form, for example, MST Score = 2. Referrals will be prioritized based on the score and associated nutrition impact factors. doi: /jbisrir Page 447
16 Correctly Completing the Tool Applies to the last six months If unsure, ask if they suspect they have lost weight e.g. clothes or rings are looser, dentures may be looser. For example, less than three quarters of usual intake. Are they eating poorly because of any reason? Not always just chewing or swallowing problems, could be depression, unnecessary dietary restrictions, etc. Add up values and refer to flow chart to determine course of action doi: /jbisrir Page 448
MQii Malnutrition Knowledge and Awareness Test
MQii Malnutrition Knowledge and Awareness Test This test intends to assess hospital staff members knowledge of the impact of malnutrition and importance of optimal malnutrition care practices, specifically
More informationModel of care to address malnutrition among community living older adults receiving care from a home nursing service in Victoria, Australia
Model of care to address malnutrition among community living older adults receiving care from a home nursing service in Victoria, Australia Georgina Rist (APD, AN) Dr Gail Miles, Dr Leila Karimi Helen
More informationWithin both PCTs, smokers were referred directly to the local stop smoking service at the time of the health check.
Improving Healthy Lifestyles Pilot Site Evaluation Report Key findings The health check is a good opportunity to deliver brief lifestyle behaviour advice to patients, most of which is recalled three months
More informationMALNUTRITION UNIVERSAL SCREEING TOOL (MUST) MUST IS A MUST FOR ALL PATIENTS
MALNUTRITION UNIVERSAL SCREEING TOOL (MUST) MUST IS A MUST FOR ALL PATIENTS Eimear Digan Senior Dietitian, Tallaght Hospital Groups at Risk of Pressure Ulcers Critically ill. Neurologically compromised
More informationThis is an Example of the Main. And This is Where the Subtitle Would Appear with More Info
MQiiTitle Implementation of a Presentation: Training Presentation Roadmap 1 2 3 4 Review of Project Teams and Toolkit Resources Understanding the Recommended Clinical Workflow Training on Malnutrition
More informationFood Monitoring Tools: Mealtime Audit Tool (MAT) and My Meal Intake Tool (M-MIT)
Food Monitoring Tools: Mealtime Audit Tool (MAT) and My Meal Intake Tool (M-MIT) Summary of Hospital Malnutrition in Canada Nutrition Care in Canadian Hospitals Study 45% of medical and surgical patients
More informationBegin Implementation. Train Your Team and Take Action
Begin Implementation Train Your Team and Take Action These materials were developed by the Malnutrition Quality Improvement Initiative (MQii), a project of the Academy of Nutrition and Dietetics, Avalere
More informationCASE MANAGEMENT POLICY
CASE MANAGEMENT POLICY Subject: Acuity Scale Determination Effective Date: March 21, 1996 Revised: October 25, 2007 Page 1 of 1 PURPOSE: To set a minimum standard across Cooperative agencies regarding
More informationA comparison of two measures of hospital foodservice satisfaction
Australian Health Review [Vol 26 No 1] 2003 A comparison of two measures of hospital foodservice satisfaction OLIVIA WRIGHT, SANDRA CAPRA AND JUDITH ALIAKBARI Olivia Wright is a PhD Scholar in Nutrition
More informationIs nutrition a patient safety problem?
Is nutrition a patient safety problem? What have we learnt? 1 A nutrition related patient safety incident is an incident where the provision of nutrition (or nutritional services) either caused harm or
More informationReview of National Aged Care Quality Regulatory Processes
Review of National Aged Care Quality Regulatory Processes July 2017 The Dietitians Association of Australia (DAA) is the national association of the dietetic profession with over 6000 members. DAA is a
More informationContents Meal and Dietary Services
Contents 10.1 Introduction... 1 10.2 Policy statement... 1 10.3 Meals as a hospitality service... 1 10.4 Monitoring of food intake or of adherence to therapeutic diets... 3 10.5 Living at risk... 3 Appendix
More informationNational Update on Malnutrition
National Update on Malnutrition Dr Trevor Smith Consultant Gastroenterologist University Hospital Southampton BAPEN Executive Officer Chair, British Artificial Nutrition Survey British Association for
More informationFifth National Mental Health Plan Submission by: Dietitians Association of Australia 30 th November, 2016
Fifth National Mental Health Plan Submission by: Dietitians Association of Australia 30 th November, 2016 Part A About You To help us understand the views expressed through this survey, we need to gather
More informationQuality Improvement Plan (QIP): 2015/16 Progress Report
Quality Improvement Plan (QIP): Progress Report Medication Reconciliation for Outpatient Clinics 1 % complete medication reconciliation on outpatient clinic visit assessments ( %; Pediatric Patients; Fiscal
More informationMalnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum. May 2015 avalere.com
Malnutrition Quality Improvement Opportunities for the District Hospital Leadership Forum May 2015 avalere.com Malnutrition Has a Significant Impact on Patient Outcomes MALNUTRITION IS ASSOCIATED WITH
More informationThe JBI Database of Systematic Reviews and Implementation Reports (JBISRIR)
Clinical Fellowship Course Program 2017 Program Details Healthcare systems globally are facing mounting and competing pressures which is impacting healthcare practice at the point of care. The Joanna Briggs
More informationCMS QUALITY MEASURES, COULD MEAN TO YOU MALNUTRITION, AND WHAT IT. Part I of Nutrition Division Webinar Series
CMS QUALITY MEASURES, MALNUTRITION, AND WHAT IT COULD MEAN TO YOU Part I of Nutrition Division Webinar Series Welcome! During the webinar, the phone lines will be muted. There will be a 15 minute Q&A session
More informationIntroduction to the Malnutrition Quality Improvement Initiative (MQii)
Introduction to the Malnutrition Quality Improvement Initiative (MQii) 1 Overview The Case for Malnutrition Quality Improvement Background on the Malnutrition Quality Improvement Initiative (MQii) The
More informationAB Nursing Homes Regulations Consultation
AB Nursing Homes Regulations Consultation SUBMITTED BY REGISTERED DIETITIANS Dietitians of Canada (DC) provides this written submission to the Government of Alberta in response to the public consultation
More informationThe Perspective from a Home Service Retailer. Meeting the Dietary Needs of Older Adults: A Workshop 10/29/15
The Perspective from a Home Service Retailer Meeting the Dietary Needs of Older Adults: A Workshop 10/29/15 Agenda How we deliver nutrition to the aging and vulnerable Opportunities Mom s Meals NourishCare
More informationIt is well known that healthcare is costly. There is a need to apply the general
Healthcare Landscape and Benefits of Aggressive Nutrition Intervention in Hospital Systems in the Philippines Marianna S. Sioson, MD, DPBCN, MSCN It is well known that healthcare is costly. There is a
More informationA pilot study examining nutrition and cancer patients: factors influencing oncology patients receiving nutrition in an acute cancer unit.
A pilot study examining nutrition and cancer patients: factors influencing oncology patients receiving nutrition in an acute cancer unit. WARNOCK, C., TOD, A., KIRSHBAUM, M., POWELL, C. and SHARMAN, D.
More informationWeighing In A Care Home: The Complete Guide.
www.marsden-weighing.co.uk Contents Introduction 2 Why does weighing in a care home take place? 3 Using weight to monitor resident health 4 When should care home residents be weighed? 5 BMI Chart 6 How
More informationwith Food, Nutrition, and Dining
by Brenda Richardson, MA, RDN, LD, CD, FAND 1 HOUR CE CBDM Approved Reducing Hospital Admissions with Food, Nutrition, and Dining NUTRITION CONNECTION FOOD, NUTRITION, AND DINING ARE INTEGRAL COMPONENTS
More informationObservations: Observe the resident at a minimum of two meals:
Use this pathway for a resident who is not maintaining acceptable parameters of nutritional status or is at risk for impaired nutrition to determine if facility practices are in place to identify, evaluate,
More informationMind the Hunger Gap Case Studies
Mind the Hunger Gap Case Studies Team Alpha Queen Elizabeth Hospital, London As part of London s Queen Elizabeth Hospital s long-standing battle against malnutrition in the acute setting, they put together
More informationImplementation of The Nursing Care Standards for Patient Food in Hospital, 2007
Implementation of The Nursing Care Standards for Patient Food in Hospital, 2007 Report complied by Fiona Wright, Assistant Director Nursing Governance Mary Burke, Care Pathway Project Manager August 2010
More informationBuilding the rural dietetics workforce: a bright future?
Building the rural dietetics workforce: a bright future? Leanne Brown 1, Lauren Williams 2, Kelly Squires 1 1 The University of Newcastle, Department of Rural Health, 2 University of Canberra Introduction
More informationDisclosures. Copyright 2013 Abbott Nutrition - Part 2 2/28/2013 OUTLINE. Kelly Tappenden OBJECTIVE
Disclosures Faculty Consultant Speaker s Bureau Grants Terese Scollard No relevant financial relationships to disclose. Kelly Tappenden Abbott Nutrition NPS Pharmaceuticals Nutricia Nestlé Abbott Nutrition
More informationMalnutrition Knowledge, Attitudes and perceived Practices (M-KAP)
Malnutrition Knowledge, Attitudes and perceived Practices (M-KAP) This malnutrition knowledge, attitudes and practices (M-KAP) questionnaire is an important way to determine the knowledge and perceptions
More informationSlide 1. Slide 2. Slide 3. Overview of Program Objectives. Program Addresses Barriers to Adoption of Technology
Slide 1 Technology Focused DNP/NP Projects as Practice Implementation Tools Laurel Shepherd, PhD, PNP Slide 2 Overview of Program Objectives Provide students with projects that will aid them in implementing
More informationStory. Segmentation. Targeting. Positioning
Story Segmentation Dietitians plan food and nutrition programs, supervise meal preparation, and oversee the serving of meals. They prevent and treat illnesses by promoting healthy eating habits and recommending
More informationManaging Patients with Multiple Chronic Conditions
Managing Patients with Multiple Chronic Conditions Sponsored by AMGA and Merck & Co., Inc. 1 Group Pre-work Affinity Medical Group Heart, Lung & Vascular Center COURAGE Clinic 2 Medical Group Profile Affinity
More informationIndianapolis Transitional Grant Area Quality Management Plan (Revised)
Indianapolis Transitional Grant Area Quality Management Plan 2017 2018 (Revised) Serving 10 counties: Boone, Brown, Hamilton, Hancock, Hendricks, Johnson, Marion, Morgan, Putnam and Shelby 1 TABLE OF CONTENTS
More informationPatient and carer experiences: palliative care services national survey report: November 2010
University of Wollongong Research Online Australian Health Services Research Institute Faculty of Business 1 Patient and carer experiences: palliative care services national survey report: November 1 -
More informationOn-Time Quality Improvement Manual for Long-Term Care Facilities Tools
On-Time Quality Improvement Manual for Long-Term Care Facilities Tools Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville,
More informationLove your heart. Quick guide to support heart recovery
Love your heart Quick guide to support heart recovery In hospital Leaving hospital Recovery plan In hospital What has happened to my heart? Understanding your heart condition and treatment can help your
More informationManis Aged Care Limited
Manis Aged Care Limited Introduction This report records the results of a Surveillance Audit of a provider of aged residential care services against the Health and Disability Services Standards (NZS8134.1:2008;
More informationNUTRITION SCREENING SURVEY IN THE UK AND REPUBLIC OF IRELAND IN 2010 A Report by the British Association for Parenteral and Enteral Nutrition (BAPEN)
NUTRITION SCREENING SURVEY IN THE UK AND REPUBLIC OF IRELAND IN 2010 A Report by the British Association for Parenteral and Enteral Nutrition (BAPEN) HOSPITALS, CARE HOMES AND MENTAL HEALTH UNITS NUTRITION
More informationCitation for final published version: Publishers page: <http://dx.doi.org/ /jbisrir >
This is an Open Access document downloaded from ORCA, Cardiff University's institutional repository: http://orca.cf.ac.uk/85903/ This is the author s version of a work that was submitted to / accepted
More informationCNA OnSite Series Overview: Understanding Restorative Care Part 1 - Introduction to Restorative Care
Series Overview: Understanding Restorative Care Part 1 - Introduction to Restorative Care Administering the Program Read the Guide View the Video Review the Suggested Questions Complete Post-Test Answer
More informationOUR IMPACT. December 2014
OUR IMPACT December 2014 IMPACT MEASURING WHAT MATTERS: THE IMPORTANCE OF IMPACT The Joanna Briggs Institute is now approaching its 20th year of operation (in 2016), which is an impressive organisational
More informationEVOLENT HEALTH, LLC. Asthma Program Description 2017
EVOLENT HEALTH, LLC Asthma Program Description 2017 1 Evolent Health Asthma Program Description 2017 Table of Contents Section Page Number I. Introduction.. 3 II. Program Scope 3 III. Program Goals 4 IV.
More informationESPEN Congress Florence 2008
ESPEN Congress Florence 2008 Malnutrition in the elderly - in the community Development of a Nutrition Education Intervention in the Community: Can it help GPs and Nurses with care of patients receiving
More informationIndependent Hospital Pricing Authority Tier 2: Non-Admitted Care Clinic Definitions NEW NUMBER
Independent Hospital Pricing Authority Tier 2: Non-Admitted Care Clinic Definitions NEW NUMBER 1 PULMONARY REHABILITATION 40.60 The IHPA has introduced a new Activity based Funding item specifically for
More informationDialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions
Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions Dialogue Proceedings / Advancing Patient-Centered Malnutrition Care Transitions As people age, their health needs are likely
More informationEVOLENT HEALTH, LLC. Heart Failure Program Description 2017
EVOLENT HEALTH, LLC Heart Failure Program Description 2017 1 Evolent Health Heart Failure Program Description 2017 Table of Contents Section Page Number I. Introduction. 3 II. Program Scope. 3 III. Program
More informationTube Feeding Status Critical Element Pathway
Use this pathway for a resident who has a feeding tube. Review the Following in Advance to Guide Observations and Interviews: Most current comprehensive and most recent quarterly (if the comprehensive
More informationEVOLENT HEALTH, LLC. Asthma Program Description 2018
EVOLENT HEALTH, LLC Asthma Program Description 2018 1 Evolent Health Asthma Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...
More informationMalnutrition Diagnosis and Outcomes GISELE LEBLANC, MS, RDN, LDN, CNSC, FAND
Malnutrition Diagnosis and Outcomes GISELE LEBLANC, MS, RDN, LDN, CNSC, FAND October, 2017 Disclosures No disclosures to report Objectives Establish a quality assessment process to demonstrate patient
More informationAppendix Five Decision Pathway Pressure Ulcers and safeguarding Adults (A3 format)
Appendix Five Decision Pathway Pressure Ulcers and safeguarding Adults (A3 format) Pressure ulcer is observed. Concern is raised that a person has significant skin damage. Category / Grade 3 and 4 or Multiple
More informationMateus Enterprises Limited
Mateus Enterprises Limited Introduction This report records the results of a Surveillance Audit of a provider of aged residential care services against the Health and Disability Services Standards (NZS8134.1:2008;
More informationUTILIZATION MANAGEMENT AND CARE COORDINATION Section 8
Overview The focus of WellCare s Utilization Management (UM) Program is to provide members access to quality care and to monitor the appropriate utilization of services. WellCare s UM Program has five
More informationThe influence of workplace culture on nurses learning experiences: a systematic review of the qualitative evidence.
The influence of workplace culture on nurses learning experiences: a systematic review of the qualitative evidence. Kate Davis, RN, BNsg, Master of Clinical Science (Evidence Based Healthcare) The School
More informationMALNUTRITION QUALITY IMPROVEMENT INITIATIVE (MQii) FREQUENTLY ASKED QUESTIONS (FAQs)
MALNUTRITION QUALITY IMPROVEMENT INITIATIVE (MQii) FREQUENTLY ASKED QUESTIONS (FAQs) What is the MQii? The Malnutrition Quality Improvement Initiative (MQii) aims to advance evidence-based, high-quality
More informationHospice and End of Life Care and Services Critical Element Pathway
Use this pathway for a resident identified as receiving end of life care (e.g., palliative care, comfort care, or terminal care) or receiving hospice care from a Medicare-certified hospice. Review the
More informationI. Description. Getting Started Intake Case Management is an individual level intervention for HIV+ individuals. Currently/Formally Incarcerated
18 Currently/Formally Incarcerated Getting Started Intake Case Management Getting Started Intake Case Management is an individual level intervention for HIV+ individuals to help ease their transition from
More informationAppendix 5. Safeguarding Adults and Pressure Ulcer Protocol: Deciding whether to refer to the Safeguarding Adults Procedures
Appendix 5 Safeguarding Adults and Pressure Ulcer Protocol: Deciding whether to refer to the Safeguarding Adults Procedures Safeguarding Adults and Pressure Ulcer Protocol: Deciding whether to refer to
More informationNURSING FACILITY ASSESSMENTS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL NURSING FACILITY ASSESSMENTS AND CARE PLANS FOR RESIDENTS RECEIVING ATYPICAL ANTIPSYCHOTIC DRUGS Daniel R. Levinson Inspector General
More informationIdentification and treatment of undernutrition in care homes
Distance learning workbook Identification and treatment of undernutrition in care homes Developed January 2012 www.focusonundernutrition.co.uk Focus on Undernutrition is part of the Nutrition and Dietetics
More informationA program for collaborative research in ageing and aged care informatics
A program for collaborative research in ageing and aged care informatics Gururajan R, Gururajan V and Soar J Centre for Ageing and Agedcare Informatics Research, University of Southern Queensland, Toowoomba,
More informationA settings approach: a model of a health promoting workplace
A settings approach: Healthy@Work a model of a health promoting workplace Kate Robertson Department of Health, NT Introduction The Northern Territory (NT) has the highest burden of disease among all jurisdictions
More informationFlexible care packages for people with severe mental illness
Submission Flexible care packages for people with severe mental illness February 2011 beyondblue: the national depression initiative PO Box 6100 HAWTHORN WEST VIC 3122 Tel: (03) 9810 6100 Fax: (03) 9810
More informationNHS Greater Glasgow and Clyde Equality Impact Assessment Tool For Frontline Patient Services
NHS Greater Glasgow and Clyde Equality Impact Assessment Tool For Frontline Patient Services It is essential to follow the EQIA Guidance in completing this form Name of Current Service/Service Development/Service
More informationthe nutritional management of adult patients with head and neck cancer
Clinical Oncological Society of Australia 38 th ASM Perth, WA COSA Nutrition Group Clinical Professional Day 14 November 2011 Implementing evidence-based practice guidelines for the nutritional management
More informationDevereux Advanced Behavioral Health Devereux Pennsylvania Children s Behavioral Health Center: Community Health Needs Assessment
1 Devereux Advanced Behavioral Health Devereux Pennsylvania Children s Behavioral Health Center: Community Health Needs Assessment and Implementation Strategy 2014-2016 Table of Contents Executive Summary
More informationAlberta Breathes: Proposed Standards for Respiratory Health of Albertans
Alberta Breathes: Proposed Standards for Respiratory Health of Albertans The concept of Alberta Breathes and these standards was developed in consultation with over 150 health professionals and stakeholders
More informationYour go to guide on physical activity
Your go to guide on physical activity A Health Professional s guide to physical activity programmes for patients in Greater Glasgow and Clyde Telephone 0141 232 1860 On average, adults should be undertaking
More informationA Comparison of Job Responsibility and Activities between Registered Dietitians with a Bachelor's Degree and Those with a Master's Degree
Florida International University FIU Digital Commons FIU Electronic Theses and Dissertations University Graduate School 11-17-2010 A Comparison of Job Responsibility and Activities between Registered Dietitians
More information2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines Survey
Butler University Digital Commons @ Butler University Scholarship and Professional Work COPHS College of Pharmacy & Health Sciences 10-2006 2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
More informationThe Hospital Transfer Pathway. The Red Bag Initiative: Guide to Implementation
` The Hospital Transfer Pathway The Red Bag Initiative: Guide to Implementation Foreword The Health Innovation Network, the Academic Health Science Network for South London is working with Boroughs across
More informationA break-even analysis of delivering a memory clinic by videoconferencing
A break-even analysis of delivering a memory clinic by videoconferencing Author Comans, Tracy, Martin-Khan, Melinda, C. Gray, Leonard, Scuffham, Paul Published 2013 Journal Title Journal of Telemedicine
More informationWhen preparing for an ACE certification exam,
Introduction to Coaching CHAPTER 1 APPENDIX B Exam Content Outline For the most up-todate version of the Exam Content Outline, please go to www.acefitness.org/ HealthCoachexamcontent and download a free
More informationUNC2 Practice Test. Select the correct response and jot down your rationale for choosing the answer.
UNC2 Practice Test Select the correct response and jot down your rationale for choosing the answer. 1. An MSN needs to assign a staff member to assist a medical director in the development of a quality
More informationNational Resource Center on Native American Aging at the UNDSMHS Center for Rural Health
Assessing Elder Needs How to Measure Benefits and Develop Links to Long-term Care Alan Allery, Ph.D. Richard L. Ludtke, PhD Leander R. McDonald, PhD National Resource Center on Native American Aging at
More informationFOOD INSECURITY, FOOD BANKS, & HEALTH CARE: A JOURNEY HILARY SELIGMAN MD MAS
FOOD INSECURITY, FOOD BANKS, & HEALTH CARE: A JOURNEY HILARY SELIGMAN MD MAS Triple Aim of Health Care Lower Costs Triple Aim Better care for the whole population at the lowest cost Improve Patient Care
More informationDietitians of Canada (Newfoundland and Labrador)
DIETITIANS OF CANADA (NEWFOUNDLAND AND LABRADOR) PRE-BUDGET RECOMMENDATIONS February 2016 Dietitians of Canada (Newfoundland and Labrador) Dietitians of Canada (Newfoundland and Labrador) is pleased to
More informationAre National Indicators Useful for Improvement Work? Exercises & Worksheets
Session L5 These presenters have nothing to disclose These presenters have nothing to disclose Are National Indicators Useful for Improvement Work? Exercises & Worksheets Robert Lloyd, PhD Göran Henriks,
More information(NAME OF AGENCY) Procedures Manual
(NAME OF AGENCY) Procedures Manual Title: ASSISTING SERVICE USERS WITH EATING AND DRINKING (KLOE) 1.0 Scope 1.1 Assistance for Service Users with eating and drinking. 2.0 Aims and Values 2.1 To ensure
More informationInnovation in Residential Aged Care: Addressing Clinical Governance and Risk Management
Innovation in Residential Aged Care: Addressing Clinical Governance and Risk Management Ms Maree Cameron Aged Care Branch Department of Health Dr Cathy Balding Qualityworks Pty Ltd Professor Rhonda Nay
More informationImprovement Action Plan Declaration
Improvement Action Plan Declaration It is the responsibility of the NHS board Chief Executive and NHS board Chair to ensure the improvement action plan is accurate and complete and that the actions are
More informationReturn to independent living Self manage breathing techniques, secretion clearance Recognize early symptoms of COPD exacerbation
CLINICAL PATHWAY Chronic Obstructive Pulmonary Disease Exacerbation (COPD-E) Civic General Clinical Frailty Scale (At baseline, at least 2 weeks before hospitalization) Init. Diagram Frailty Scale Description
More informationInnovation Fund Small Grant Guidelines
Innovation Fund Small Grant Guidelines Round One Supporting community driven preventive health initiatives across the NSW Mid North Coast Applications open 29 March 2018 Applications close 15 May 2018
More informationBeaumont Healthy Kids Program
Childhood overweight and obesity are increasing at an alarming rate. The prevalence has tripled over the past 3 decades. Overweight children are at risk for developing: Type 2 diabetes High cholesterol
More informationEvidence Based Practice and identifying a clinical problem. Key Learnings 2/02/2017. Evidence based practice in Dietetics
Evidence Based Practice and identifying a clinical problem Dr Shelley Wilkinson, Queensland Health Health Research Fellow Mater Health Services Key Learnings To challenge your own approach to (how you)
More informationInnovations to Stop Pressure Ulcers among Patients at Critically High Risk for Pressure Ulcer Development a Multidisciplinary Approach
Innovations to Stop Pressure Ulcers among Patients at Critically High Risk for Pressure Ulcer Development a Multidisciplinary Approach October 14 2016 Disclosures The speakers have nothing to disclose.
More informationPediatric Nurse Practitioners, Family History & Children s Health
Pediatric Nurse Practitioners, Family History & Children s Health Agatha M. Gallo, PhD, RN, CPNP University of Illinois at Chicago Department of Maternal-Child Nursing agallo@uic.edu Pediatric Nurse Practitioners
More informationEmergency admissions to hospital: managing the demand
Report by the Comptroller and Auditor General Department of Health Emergency admissions to hospital: managing the demand HC 739 SESSION 2013-14 31 OCTOBER 2013 4 Key facts Emergency admissions to hospital:
More informationPSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence
PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence Rachel Brunt, RN, BSN, MBA-HCA, CIC, CPHQ, Director Quality Jessie Hanks, BS, RHIA, Director HIM Lafayette General
More informationfrom the association
from the association The 2010 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit: Distinguishing between Educational Attributes Kevin Sauer, PhD, RD, LD; Brian Ward; Dick Rogers;
More informationA Step-by-Step Guide to Tackling your Challenges
Institute for Innovation and Improvement A Step-by-Step to Tackling your Challenges Click to continue Introduction This book is your step-by-step to tackling your challenges using the appropriate service
More informationEVOLENT HEALTH, LLC Diabetes Program Description 2018
EVOLENT HEALTH, LLC Diabetes Program Description 2018 1 Evolent Health Diabetes Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...
More informationJanuary 4, Via Electronic Mail to file code CMS-3317-P
701 Pennsylvania Ave., NW, Suite 800 Washington, DC 20004-2654 Tel: 202 783 8700 Fax: 202 783 8750 www.advamed.org Via Electronic Mail to file code CMS-3317-P Andrew M. Slavitt Acting Administrator Centers
More informationBowling Green State University Dietetic Internship Program
Rotation: Acute Care Pre-rotation check-list Readings completed Complete quizzes Bowling Green State University Dietetic Internship Program Nutrition Care Process Worksheet printed and ed Review formal
More informationInformation for guided chronic disease self-management in community settings.
Information for guided chronic disease self-management in community settings. Jeffrey Soar 1 and Zoe Wang 2 1 School of IS, Faculty of Business and Collaboration for Ageing & Aged-care Informatics Research,
More informationCenter for Quality Aging
Center for Quality Aging Nutritional Issues in Long-Term Care: Research Findings and Practice Implications Sandra F. Simmons, PhD Associate Professor of Medicine, Vanderbilt VA Medical Center, GRECC Goals
More informationMeeting cultural food needs: essential or just icing on the cake? Dr Danielle Gallegos
Meeting cultural food needs: essential or just icing on the cake? Dr Danielle Gallegos Meet Franco Franco lost his wife Maria 20 years ago his daughters looked after him until he had a fall After assessment
More informationBOARD OF DIRECTORS PAPER COVER SHEET. Meeting Date: 1 st December 2010
BOARD OF DIRECTORS PAPER COVER SHEET Meeting Date: 1 st December 2010 Agenda Item: 9 Paper No: E Title: Management of Pressure Ulcers Purpose: For Information Summary: This paper provides a report on the
More informationCQC Inpatient Survey Results 2015
CQC Inpatient Survey Results 2015 Board Item: 12 Date: 27 th July 2016 Purpose of the Report: Enclosure: H The CQC Annual Inpatient Survey 2015 results were published in June 2016. The Board are provided
More information