malnutrition, making the diagnosis and anthropometrics

doug.campbelldoug.campbell
in CDI Talk Archive
I know without clear universally accepted standardized definitions of malnutrition in pediatrics - that I have trouble getting the physicians to diagnose malnutrition - even in a child that is clearly malnourished. Clinicians may use terms like undernourished or underweight but have reluctuance in diagnosing malnutrition. Is anyone using anthropometrics to help establish this diagnosis?

Does anyone have any insight as to how to better get this diagnosis done with queries?

Comments

  • rcramos@texaschildrens.orgrcramos@texaschildrens.org
    edited April 2016
    Good day.

    I would recommend having a collaboration with the Nutrition Department to include their diagnosis on their notes. It would be a great addition to your clinical indicators when you present the query.

    Thank you.

    Raymond C Ramos
    Clinical Documentation Integrity
    Texas Children's Hospital
    832-824-3196
    rcramos@texaschildrens.org


  • lfaustlfaust
    In 2013, The American Society for Parenteral and Enteral Nutrition published a consensus paper on pediatric malnutrition endorsed by the American Academy of Dietetics and The American Academy of Pediatrics. This article emphasizes the use of Z scores, which many dieticians now routinely include in their assessments. We have been successful in reducing malnutrition queries by developing processes in which malnutrition diagnoses are vetted by a registered dietician using credible criteria and then incorporated into the problem list or clinical notes for verification by the attending. This makes it easier for the attending to include the diagnosis in their documentation, reduces the CDS's query workload, and enhances the credibility of this documented diagnosis in the event an outside auditor is to challenge it.
    I'd be happy to discuss this with you further.
    Larry Faust, MD, FAAP
    CDIMD
    lfaust@cdimd.com
    931-216-4635
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