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Interprofessional Practice Based Research

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Names: St. Michael’s Nutrition Screening Implementation Team

Roles: Nursing management, registered dietitians, nurses, portering, patient food services, volunteers, volunteers management, directors and others

Project goal: early identification of patients at risk for malnutrition

Interesting fact: 71 per cent of patients of the 936 patients diagnosed and managed as malnourished were over the age of 55 years.


February 20, 2019

Nutrition is an important part of healing and mental wellness

Healing takes a lot of energy. Good nutrition is really important to enable the body to have the energy it needs to fight off infection and heal wounds. If you are malnourished, your body is less equipped to fight off illness and this can lead to negative health outcomes. Therefore, treating patients for malnutrition is an important part of holistic care.

March is National Nutrition month. At St. Michael’s Hospital we have a strong focus on assessing, and addressing the nutrition needs of each patient that walks through our doors. Quite literally. We have implemented a hospital-wide protocol in which every patient on almost every inpatient unit is screened for their risk of malnutrition. Patients that screen positive are followed up by a registered dietitian that can determine a plan of care to address their nutritional needs. In 2018 more than 10,000 patients were screened at St. Michael’s, almost 1,500 were assessed for malnutrition by an RD and almost 1,000 patients managed as malnourished. This initiative is a team effort that includes managers, nurses, dietitians, food services, portering, volunteer services, patients and others.

The key to the success of this initiative is having a quick and easy screening tool that sensitively detects patients at risk for malnutrition. However, screening tools have not been validated for use in every patient population or setting.

Our dedicated group of dietitians have taken on this challenge. They are conducting studies to assess which screening tools are the most sensitive and reliable to identify malnutrition risk in different populations. For example, Arti Sharma-Parpia, a dietitian in the Hemodialysis unit, is conducting a study to determine the best malnutrition screener for patients with end-stage renal disease, a population who is at high risk of malnutrition. Similarly, dietitian Sabrina Janes is currently evaluating the effectiveness of screening tools in identifying malnutrition risk in the mental health population. Both projects involve testing out several different screeners and comparing the accuracy and sensitivity of the screeners to the gold standard malnutrition diagnostic assessment tool.

The results of these projects will inform which screener is best for identifying malnutrition risk. “Patient access to expert nutrition support, oral nutritional supplements, dysphagia management, community-based nutrition programs, and food security counseling starts with the reliable and valid identification that a patient is malnourished”, said Kim Bradley, practice manager for the Dietitian group. “When this can happen in an acute care context it can guide all players, including the patient, in managing nutrition as an important part of healing and mental wellness.”



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