Date on Paper

8-2019

Document Type

Doctoral Paper

Degree Name

D.N.P.

Department

Nursing

Committee Chair

Whitney Nash

Committee Member

Beverly Williams-Coleman

Author's Keywords

nutrition screening, malnutrition, dietitian referral, NRS-2002, MST, inpatient, Malnutrition Screening Tool, Nutritional Risk Screening-2002

Abstract

Thorough and appropriate nutritional screening upon admission to the hospital can mitigate the negative consequences often associated with secondary malnutrition. At a suburban hospital in the southeastern United States, there was an 250% increase in consults to dieticians upon initiating use of the Malnutrition Screening Tool (MST) as the primary form of nutrition screening, which has been previously shown to have a high false positive rate. As a result, the workload of the dieticians increased. This time spent on analysis of false positive screenings takes away from time that could be spent on truly malnourished or at-risk patients. This quality improvement project involved the use of the Nutrition Risk Screening-2002 (NRS-2002) as the primary nutrition screening tool on an adult inpatient unit at a suburban hospital in southeastern United States. Following staff education, the new tool was used to screen patients upon admission for a 30-day period. Chart audits were completed for the 30 days prior using the MST tool for baseline comparison. The chart audits were guided by the following measures: number of screenings completed, number of positive screenings, number of referrals to dietitians, and the number of positive screening diagnosed as malnourished by the dietitian. Compliance rate of screening for the NRS-2002 was significantly lower than the MST baseline data, 26.5% and 88.7% respectively. The MST had a consistently higher rate of referral to dietitians. However, 27% of positively screened patients with the MST did not receive consults. Results did not yield clear data to determine if the NRS-2002 is more sensitive or specific than the MST in this setting. Consider further research in other settings such as critical care or oncology, and studies to determine nurse barriers to placing consults to dietitians.

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