Malnourishment: Your issue and mine
Martie L. Moore, RN, MAOM, CPHQ
I was amazed how I lost 10 pounds while being in the hospital. I made a joke with a friend of mine who is a dietician about the “hospital diet.” She became very serious and stated, “You know we do more harm than good to our patients by the lack of attention to malnourishment.”
She went on to explain my weight reduction was due to me not getting the nutrients my body needed. She also expressed most patients in care settings are actually malnourished and often we fail them by not understanding what is happening in their bodies.
In looking to the research, she is correct. We still hold the belief system that serum protein levels such as albumin and prealbumin determine nutritional status. It does not; current research indicates that serum protein levels may be influenced by inflammation, renal function, hydration and other factors. In fact experts with the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N) state, “Adult undernutrition typically occurs along a continuum of inadequate intake and/or increased requirements, impaired absorption, altered transport and nutrient utilization.”
Some studies have called malnourishment a national crisis for certain populations such as the elderly, frail and vulnerable. Turning again to the most current research, two emerging changes of practice are happening to address the issue of malnourishment. The first change in practice is to not rely upon protein serum levels but to utilize validated nutritional screening tools. Yet the research calls out to not let the tools be the only time nutrition is defined. One study called for nutrition to be included in handover reports to assure that focus and attention is on helping the body to heal and sustain through nutritional intake.
The second change is to rethink supplements. Most are part of meals or snacks and many times are not consumed. Miscommunication among care providers concerning protein and other nutritional intake also contributes to a lack of accounting of nutritional status.
To mitigate this issue, dense nutritional supplements are now being given during medication administration. A 30cc medication cup can hold the same amount of protein as a chicken breast. Giving the supplement during medication administration can result in higher compliance with supplements and better nutritional intake from meals and other intakes of nutrition.
What actions can you take to advance your practice?
Look at the practice within your care setting. Are you still utilizing protein serum levels as a tool for malnourishment? Does nursing defer nutrition to the registered dietician? Remember, most patients lying in a hospital bed are malnourished and are never seen by a dietician. Those patients become your residents.
How are supplements being given within your organization?
Consider monitoring and documenting intake of nutrients when utilizing a dense nutritional supplement with medication administration. Also look at sugar levels of supplements. Remember, four grams of sugar equals a teaspoon. Knowing what is in a supplement will help you provide nutrimental care that promotes health and healing.
The call to action for nurses and administrators is not to see nutrition as an afterthought. Science now tells us that protein can help wounds heal and promote skin health. There's also emerging science that supports how protein can help with surgical incisional healing.
If we crave different results, we need to think differently. Nutrition can be a key contributor to help drive new results and outcomes.
Martie Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline Industries Inc. and a corporate advisory council member for the National Pressure Ulcer Advisory Panel.