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Education and documentation strategies to improve malnutrition diagnosis in hospitalized children: A quality improvement project.
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- Author(s): Rompca A;Rompca A; McCallister A; McCallister A; Cruse W; Cruse W; Webber EC; Webber EC; Webber EC; Vanderpool C; Vanderpool C; Vanderpool C
- Source:
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition [Nutr Clin Pract] 2024 Jun; Vol. 39 (3), pp. 696-701. Date of Electronic Publication: 2023 Oct 10.- Publication Type:
Journal Article- Language:
English - Source:
- Additional Information
- Source: Publisher: Wiley Country of Publication: United States NLM ID: 8606733 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1941-2452 (Electronic) Linking ISSN: 08845336 NLM ISO Abbreviation: Nutr Clin Pract Subsets: MEDLINE
- Publication Information: Publication: 2018- : [Hoboken, NJ] : Wiley
Original Publication: [Baltimore, Md. : Williams & Wilkins, c1986- - Subject Terms: Quality Improvement* ; Documentation*/standards ; Documentation*/methods ; Nutrition Assessment* ; Child, Hospitalized* ; Malnutrition*/diagnosis; Humans ; Child ; Child, Preschool ; Nutritionists ; Infant ; Child Nutrition Disorders/diagnosis ; Male ; Female ; Hospitalization ; Practice Guidelines as Topic
- Abstract: Background: The Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) published malnutrition guidelines in 2014. In 2015, our institution implemented a quality improvement project focused on malnutrition identification with the goal to improve the diagnosis of malnutrition in hospitalized children.
Methods: Our project included three approaches: education, nutrition assessment, and documentation initiatives. Education initiatives focused on physicians at all levels of training. Nutrition screening was completed on all patients admitted to our institution. Registered dietitians (RDs) conducted nutrition assessments and identified and documented malnutrition based on AND/ASPEN guidelines. Documentation initiatives included development of automatic text and template changes to allow import of RD-assigned malnutrition diagnosis into physician documentation. We met with members of our clinical documentation integrity team regularly to review the results of these initiatives starting in 2016.
Results: The total diagnosed cases of malnutrition increased from 208 cases in 2016 at the start of our monitoring to >800 cases per year in 2020-2022. Unspecified (no severity assigned) protein calorie malnutrition as a percentage of total malnutrition diagnoses decreased from 36.9% in 2016 to <10% since 2018. Children with severe malnutrition have remained the largest portion of children with a malnutrition diagnosis, with >40% of children with malnutrition diagnosed with severe malnutrition.
Conclusion: Our education and documentation initiatives have led to both improved diagnosis of malnutrition and accurate identification and documentation of malnutrition severity. These initiatives could be utilized to improve malnutrition diagnosis and documentation at other institutions caring for hospitalized children.
(© 2023 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.) - References: Mehta NM, Corkins MR, Lyman B, et al. Defining pediatric malnutrition: a paradigm shift toward etiology‐related definitions. JPEN J Parenter Enteral Nutr. 2013;37(4):460‐481.
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Bensinger A, Wilson F, Green P, Bloomfeld R, Dharod A. Sustained improvement in inflammatory bowel disease quality measures using an electronic health record intervention. Appl Clin Inform. 2019;10(5):918‐926. - Contributed Indexing: Keywords: hospitalized child; malnutrition; nutrition assessment; quality improvement
- Publication Date: Date Created: 20231011 Date Completed: 20240503 Latest Revision: 20240503
- Publication Date: 20240503
- Accession Number: 10.1002/ncp.11080
- Accession Number: 37817534
- Source:
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