A more in-depth nutrition assessment is generally performed by an RD or a member of a nutrition support service. This further delineates the malnutrition diagnosis and is the basis for the nutrition plan of care. Again, documentation and communication of this assessment should be part of the multidisciplinary longitudinal plan of care.
The NP should anticipate ongoing nutritional needs and ensure case-management strategies that include referrals to primary and specialty providers, appropriate skilled facilities, and community services; home infusion and medical equipment companies should be implemented as indicated. The use of a transition of care plan initiated by NPs as shown in the ASPEN Nutrition Care Pathway may prevent a vulnerable patient from being readmitted (www.nutritioncare.org/malnutrition).15
NPs should look to the admission nursing screen for indications that a patient may be at risk for malnutrition, expand on that nutrition assessment, then make note of any nutrition recommendations and implement interventions as suggested by the RD. Nutrition needs to be included in transitions of care, including discharge to home and the outpatient arena. NPs should incorporate the following principles into care, no matter the acute care specialty:
NPs can contribute to other quality and regulatory outcomes for their patients and organizations by championing thorough nutrition assessment and documentation. Anticipating and noting nursing nutritional screens and dietitian consultative recommendations hold all team members accountable regarding this important clinical and regulatory step. Acting on the recommendations shows a commitment as a provider to address potentially avoidable conditions, conveys respect for the clinicians, and reinforces the importance of nutrition in the therapeutic setting. The appropriate medical diagnosis categorizing the degree of malnutrition and the presence of associated preexisting conditions facilitates early intervention and appropriate coding for severity of illness for reimbursement compliance.33
Nutrition assessment and intervention contributes significantly to the well-being of patients. Florence Nightingale stated that the avoidance of starvation requires “observation, ingenuity, and perseverance.”1 Nurses and NPs should partner together as advocates to ensure patients are appropriately evaluated and recommendations implemented as a part of a comprehensive care plan to avoid malnutrition. The return on investment illustrated through positive clinical and quality outcomes should result.
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