Left to right: Ingrid
Verduyn, Lillian Hung, Leila Goharian, Sepi Sarbazi
Plenty of research has been done on validated nutrition screening tools in hospital settings. In hospitals, these screening tools target early intervention and have demonstrated decreased length of stay, particularly among malnourished elderly patients. If followed by Registered Dietitians (RD), they have shown shorter lengths of stay and fewer complications.
The Canadian Malnutrition Task Force has identified that 45% of patients are malnourished upon hospital admission, 1 in 5 patients get worse during their hospital and upon hospital discharge, 48% of patients are malnourished after a stay of more than seven days. Research indicates that malnutrition is one of the leading causes of hospital re-admissions and only 11% of patients are seen by an RD in the community setting which is defined as ‘in home and/or health unit visits.’ Among the Vancouver community health units, 80-90% of the referrals come from hospital yet, strangely enough, use of a nutrition screening tool did not exist to identify these clients. It stands to reason then that screening by clinicians and intervention by an RD in the home situation can prevent severe malnutrition, decrease readmissions and complexity of care.
As a team of home health dietitians we have been on a mission to incorporate a nutrition screening tool in the community home setting to better identify malnourished clients. In 2016, we used the mini Nutritional Assessment tool (MNA-SF) and determined that the prevalence of malnutrition was high at 64%, in the North East area of Vancouver the second largest elderly population. This was the first study in Canada to examine malnutrition in the community home health setting.
Thereafter, we shared our findings with staff and management to raise awareness about the importance of nutrition screening and the need to implement a screening tool at all the community home health centers. Interested and curious as to what the clinicians' and the managers had to say about their experiences using the nutrition screening tool in the community setting led us to conduct another research project: the first systematic approach to evaluate the impact of a validated nutrition screening tool in the community setting with respect to clinicians' and manager's acceptance of use.
A qualitative inquiry was conducted using focus groups with 5 disciplines and a manager to investigate their experiences using the MNA screening tool. Here's a list of their experiences using the MNA-SF screening tool:
- Easy to do
- Quick and short
- More clear and formalized approach to determine if RD referral required or not
- A reminder to screen for nutrition
- Clients liked the MNA tool questions as they appreciated the concerns targeting their nutritional state.
- Staff learned a lot
- Nutrition screening is needed
- MNA is validated and well suited for home health settings
- Management is supportive
To improve the experience, however, we determined that further education on calculations and additional weighing scales are needed. As well, limited RD resources may pose a challenge to its implementation and sustainability. The results of these findings were shared among the home health teams, managers, director, and Chief Operating Officer at VCH to foster the successful implementation and sustainability of the tool.
After two research projects and countless hours of knowledge translation, our commitment to change practice for the better came to fruition. We are proud to announce that the MNA-SF nutrition screening tool has been implemented in all six Vancouver Community Health Centres. All newly referred Home Health clients will now be screened for malnutrition and referred to the dietitian. This change in practice will help to lower hospital re-admissions, shorten hospital length of stay, improve patient care, and reduce healthcare costs associated with malnutrition. We are proud to support our One VCH values and key priorities: “exceptional care" and “innovating for impact."
For more information on the studies, contact:
Leila Goharian, MSc. RD. CDE., Registered Dietitian
Community Home Health Care, Evergreen Community Health Centre