The goal of nutrition screening is to identify patients within 24 hours of admission who are malnourished and/ or at risk of nutritional deterioration. Screening is the first step in the pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC), and allows for early identification of patients who need further assessment and who may benefit from nutrition interventions to prevent further nutrition deterioration, reduce severity of complications of disease, accelerate recovery and reduce burden on the health system 1,2.
Numerous nutritional screening tools exist for use in the mixed group of hospitalized children3-13. When selecting the proper tool for clinical use it is important to think about the purpose of screening, who will be the users, and what the setting is (including diseases and age groups).
For use in Canadian pediatric hospitals and P-INPAC, the following criteria were considered:
P-INPAC recommends the use of a validated pediatric malnutrition screening tool, such as STRONGkids (A)14 or PNST (B) 15. These 2 tools have previously been used in studies in the Canadian setting16, 17.
This nutritional screening tool was developed in the Netherlands to be performed within 24 h of admission in children aged 1 month to 18 years. It is comprised of questions covering 4 areas and does not include actual measurements.
Risk levels are then assigned by point totals: 0 = low risk, 1-3 = medium risk, and 4-5 = high risk.
This screening tool was developed in Australia and aims to identify hospital inpatients at nutritional risk. The tool consists of four simple questions to assist in the clinical diagnosis of patients up to 16 years.
Nutrition screen is positive in case of “yes” to at least 2 questions. There is no classification into moderate or high risk.
There are other validated nutritional screening tools available for general pediatric hospital patients. These tools, including links and references are described HERE.
There are also malnutrition screening tools available for specific age groups, settings and diseases. References that describe these studies can be found HERE.
Can be completed by any health care professional (doctors, nurses, support staff etc). The majority of hospitals would have nurses perform the screening questions during their admission process.
Assessment of children that screen “at risk” is an important step in the P-INPAC pathway. Screening tools identify risk that must be confirmed by assessment, so patients with a positive screening should undergo further assessment in the form of SGNA.
A registered dietitian (RD) can complete SGNA and further assessments to identify and diagnose malnutrition. The RD can ensure those most at risk are properly identified and treated.
In order to ensure malnutrition screens are done well, education must be done with the healthcare professionals conducting the screening about:
Implementation is:
Who Screens? |
Where are the Questions? |
How is the RD notified? |
---|---|---|
Nurses |
Initial Nursing Assessment (electronic) |
Electronic referral to RD to complete full assessment |
Nurses |
Initial Nursing Assessment (electronic) |
First a review by physician and then a referral to RD by physician |
Nurses |
Paper admission form |
Nursing calls RD - OR - |
An Electronic Medical Record (EMR) provides the opportunity to hardwire nutrition screening and other P-INPAC care elements into the workflow of clinicians.In addition, EMRs provide the opportunity to aggregate data on nutrition screening and evaluate compliance with the nutrition care pathway19.
It is essential to understand what the EMR offers in terms of tools available to assist with nutrition screening.Specifically, consider whether the following tools are available in the EMR:
Work with other health disciplines and the EMR implementation team to determine whether the tools are appropriate to implement in your care setting and ensure that they are feasible for each discipline’s workflow19.
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CONTACT info@nutritioncareincanada.ca
Contact info@nutritioncareincanada.ca if you would like to join the Community of Practice.
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