Of older adults hospitalized, 40-60% are malnourished or at risk for malnutrition. Progression to malnutrition may be subtle or undetected. Geriatric patients face nutrition related complications including: loss of muscle mass, compromised immune systems, increased complications with illness and premature death. These complications can manifest themselves as falls, prolonged hospitalizations, readmission following discharge and pressure ulcers. While individual outcomes related to these complications are important, the cost of adverse events affects the overall financial health of the entire healthcare system as most are non reimbursable by Medicare, Medicaid and many private insurances. The facility houses the only elective total joint replacement program in the healthcare enterprise. From February 1, 2012 through April 30, 2012, 342 total joint replacement were performed. Of these, 57.67% of the patients were 65 and older. Only 7.6% of the consults were triggered by a nurse admission risk screen. Utilizing the ACE Star Model, this project evaluated nursing adherence screening patients for malnutrition during pre admission testing (PAT) utilizing the Mini Nutritional Assessment Short Form (MNA-SF) created by Nestle. Additionally, nursing adherence consulting dietary for the nutritionally compromised patients was evaluated. Kotter’s 8 Step change model was used to drive the system change during PAT. This program was evaluated every 7 days for 90 days. The goal was to achieve 80% adherence in screening and intervention. Nursing screening adherence was measured by comparing the number of eligible patients to the number of patients screened with the MNA-SF. Nursing intervention adherence was evaluated by comparing the number of patients scoring less than 12 on the tool to the number of patients that had immediate dietitian consult triggered by the nursing staff. During the pilot, 193 patients were eligible to be screened using the MNA-SF. Of these, 88% were screened. Of the 169 patients, 5% were found to have scores less than 12. Nursing consulted the dietitian for 77%. The number of at risk patients identified with the tool was lower than the baseline and literature references. In review of the completed tools, it was found 4% contained errors which may have impacted identification. The MNA-SF focuses on low BMI. Only 11% received a nutritional consultation based on a low BMI while 88% identified had psychologic or neurologic changes. Overall, 69% of the patients had a BMI greater than 25 and of those 18% had a BMI of greater than 35. BMI less than 19 or greater than 35 is tied to increased Medicare reimbursement. Moving forward, inclusion of BMI, psychologic and neurologic triggers as components of the nutrition screen across the Enterprise may lead to improved patient outcomes and improved revenue.
