Our centre implemented a malnutrition treatment pathway to identify, diagnose and monitor malnutrition.

Dietetic technicians and dietitians were trained on the Canadian Nutrition Screening Tool (developed and validated by the Canadian Malnutrition Task Force) and the subjective global assessment (SGA). Patients at risk who are screened by the dietetic technician are flagged to the dietitian to assess for malnutrition and its severity using the SGA. The SGA includes a physical assessment that is a new practice for the dietitians. In-services were provided to the multidisciplinary team on the consequences of malnutrition and the team’s role. A monitoring pathway to evaluate consumption was developed and implemented, adapted from the Integrated Nutrition Pathway Acute Care (INPAC) pathway.

Through quality nutrition audits, the number of at-risk patients assessed by the dietitian improved from 59 to 83%. The documentation of malnutrition improved from 55 to 80%. The majority of our malnourished patients were in the mild to moderate category (58% of those assessed). There was a 50% greater length of stay in the malnourished patients compared to those not malnourished. There was also an improvement in patients consuming more than 50% of their food tray, improving from 18 to 36%.

The process involved a change in practice for the screening and treatment of malnutrition and provided a structured approach to care.

Recommendations: The malnutrition pathway has now been expanded to the rehabilitation centers within our organization. Future plans are to expand further in the community to ensure that malnutrition treatment continues along the continuum of care.

This work serves and has served as a framework for other organizations that want to address and increase awareness about malnutrition. The process improves patient flow, helps to provide timely access to care, and is cost-effective.

The training of the SGA was funded partly by Abbott Nutrition