Malnutrition Screening Pathway v.1.1

Transcription

1 Malnutrition Screening Pathway v.1.1 Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Inclusion Criteria Inpatients age 1 month and older Exclusion Criteria <1 month of age Rescreen Screening Height, weight, head circumference measurements on admission by nurse or nurse assistant (CNA) If weight/length z-score < -2, verify measurements are accurate (P&P: Weighing and Measuring Length for SCH only) Diet tech screens for nutrition risk within 4-12 hours of admission using Diagnosis Formula, Diet Order, TPN Nutrition Consult Height, weight Weight/length or BMI (z-score) and documents using Nutritional Risk Screen Info Form? Low risk Moderate risk Intermediate risk High risk 0-Unknown Not enough data to complete screen Diet technician rescreens within 24 hours 1-Low Risk Diet technician rescreens every 7 days 2-Moderate Risk Diet technician rescreens every 2-3 days 3-Intermediate Risk Diet tech-rd comanage 4-High Risk Diet tech pages dietitian to assess patient within 24 hours of admission (document within 48 hours) Malnutrition Assessment Dietitian assesses nutrition status. Identifies patients with malnutrition based on criteria. no Malnourished? Malnutrition Diagnosis Discuss with attending and team Document findings of malnutrition Add malnutrition diagnosis to diagnosis list Off Pathway Malnutrition Reassessment Reassess for resolution of malnutrition For questions concerning this pathway, contact: malnutrition@seattlechildrens.org 2016 Seattle Children s Hospital, all rights reserved, Medical Disclaimer Last Updated: April 2016 Next Expected Revision: April 2016

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3 Malnutrition Screening Approval & Citation Approved by the CSW Malnutrition Screening Pathway Team for April 21, 2016 Malnutrition Screening Pathway Team: Nutrition, Owner: Nutrition, Sponsor: QI Subcommittee Nutrition Co-chairs: Medical CNS: Maura Sandrock, MS, RD, CD Cheryl Davis, RD, CD, CNSC Dale Lee, MD Polly Lenssen, MS, RD, CD, FAND Kristi Klee, DNP, MN, RN-BC Anjanette Allard, MN, RN Clinical Effectiveness Team: Consultant: Project Leader: Analyst: CIS Informatician: CIS Analyst: Program Coordinator: Jennifer Hrachovec, PharmD MPH Pauline O Hare, MBA, RN James Johnson, BA Mike Leu, MD, MS, MHS Heather Marshall Asa Herrman Executive Approval: Sr. VP, Chief Medical Officer Sr. VP, Chief Nursing Officer Surgeon-in-Chief Mark Del Beccaro, MD Madlyn Murrey, RN, MN Bob Sawin, MD Retrieval Website: Please cite as: (please complete with relevant information) Seattle Children s Hospital, Sandrock, M., Davis, C., Hrachovec, J., Johnson, J., Lee, D., O Hare, P., Villavicencio, C., 2016 April. Malnutrition Pathway. Available from: pdf/malnutrition-pathway.pdf

4 Evidence Ratings This pathway was developed through local consensus based on published evidence and expert opinion as part of Clinical Standard Work at Seattle Children s. Pathway teams include representatives from Medical, Subspecialty, and/or Surgical Services, Nursing, Pharmacy, Clinical Effectiveness, and other services as appropriate. When possible, we used the GRADE method of rating evidence quality. Evidence is first assessed as to whether it is from randomized trial or cohort studies. The rating is then adjusted in the following manner (from: Guyatt G et al. J Clin Epidemiol. 2011;4: ): Quality ratings are downgraded if studies: Have serious limitations Have inconsistent results If evidence does not directly address clinical questions If estimates are imprecise OR If it is felt that there is substantial publication bias Quality ratings are upgraded if it is felt that: The effect size is large If studies are designed in a way that confounding would likely underreport the magnitude of the effect OR If a dose-response gradient is evident Guideline Recommendation is from a published guideline that used methodology deemed acceptable by the team. Expert Opinion Our expert opinion is based on available evidence that does not meet GRADE criteria (for example, case-control studies). To Bibliography

5 Summary of Version Changes Version 1.0 (04/21/2016): Go live Version 1.1 (07/12/2016): Updated risk categories

6 Medical Disclaimer Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor Seattle Children s Healthcare System nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information. Readers should confirm the information contained herein with other sources and are encouraged to consult with their health care provider before making any health care decision.

7 Bibliography Studies were identified by searching electronic databases using search strategies developed and executed by a medical librarian, Jackie Morton. The searches were performed in December The following databases were searched on the Ovid platform: Medline, Cochrane Database of Systematic Reviews; elsewhere Embase, National Guideline Clearinghouse, TRIP and Cincinnati Children s Evidence-Based Recommendations. Clinical questions regarding the assessment of malnutrition were searched from 2005 to date. Retrieval was limited to English language, age limits of 0-18 were imposed for specific clinical questions. In Medline and Embase, appropriate Medical Subject Headings (MeSH) and Emtree headings were used respectively, along with text words, and the search strategy was adapted for other databases using their controlled vocabularies, where available, along with text words. Concepts searched were the diagnosis and assessment of malnutrition, anthropometric measurements and optimal growth curves for various populations. All retrieval was further limited to certain evidence categories, such as relevant publication types, Clinical Queries filters for diagnosis and therapy, index terms for study types and other similar limits. Additional articles were identified by team members and added to the results. Jackie Morton, MLS April 14, 2016 Identification 497 records identified through database searching 1 additional record identified through other sources Screening 498 records after duplicates removed 498 records screened 443 records excluded Eligibility Included 55 records assessed for eligibility 51 full-text articles excluded, 8 did not answer clinical question 42 did not meet quality threshold 1 was not written in English 4 studies included in pathway Flow diagram adapted from Moher D et al. BMJ 2009;339:bmj.b2535 To Bibliography, Pg 2

8 Bibliography Bertapelli F, Martin JE, Goncalves EM, de Oliveira Barbeta VJ, Guerra-Junior G. Growth curves in down syndrome: Implications for clinical practice. Am J Med Genet A [Malnutrition]. 2014;164A(3): Accessed Huysentruyt K, Devreker T, Dejonckheere J, De Schepper J, Vandenplas Y, Cools F. Accuracy of nutritional screening tools in assessing the risk of undernutrition in hospitalized children. J Pediatr Gastroenterol Nutr [Malnutrition]. 2015;61(2): World Health Organization (WHO). World Health Organization (WHO). Guideline: updates on the management of severe acute malnutrition in infants and children.. content.aspx?id=49017&search=malnutrition. Updated Accessed 12/09, Zemel BS, Pipan M, Stallings VA, et al. Growth charts for children with down syndrome in the united states. Pediatrics. 2015;136(5):e Accessed ; 3/16/2016 1:31:03 PM.