Malnutrition Guidelines

ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
in CDI Talk Archive
Has anyone established any guidelines for when to query for malnutrition that they would be willing to share?

Thanks,
Greta

Greta Goodman
Clinical Documentation Improvement Specialist
Health Information Management
Virginia Hospital Center
1701 North George Mason Drive
Arlington, VA 22205
703-558-5336
ggoodman@virginiahospitalcenter.com
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Comments

  • Unknown
    edited May 2016
    We currently have a system in place where anytime one of our nutritionists documents malnutrition or a BMI >40 the system automatically sends an email alert to the appropriate Clinical Reviewer. The nutritionist also has a sticker they place right in the MD progress notes noting their clinical findings and the malnutrition diagnosis they feel is appropriate; the MD is suppose to mark whether or not they agree with the diagnosis and sign the form. The reviewer checks the chart and if the sticker is missing or the MD has not addressed it, we would then place a query in the chart.

    Thanks,
    Katherine Stummer, RN CCDS
    Clinical Reviewer
    UR/DRG Program
    St. Joseph's Hospital Health Center


  • cmorellcmorell
    edited May 2016
    We like to make sure that the documentation truly paints a picture of malnutrition.
    We look for words like undernourished, bitemporal wasting, cachexia, weight loss, poor appetite etc.
    Then for additional clinical indicators we check the BMI (< 19 is helpful as long as they are not just thin-it must be taken in context with other indicators) and people can be obese but malnourished.
    We look for low albumin (< 2.8) and/or low protein (< 6.0), low prealbumin, a dietary consult with documentation of inability to consume adequate calorie intake-also check the I & O record to see if they are eating < 50% of meals etc.
    I like to make sure there are many clinical indicators and treatment such as a dietary consult and monitoring, nutritional supplementation, perhaps megace.
    When present it impacts severity of illness because studies have show it increases the risk of mortality and inadequate healing can lengthen the hospitalization.

    Charrington "Charlie" Morell
    Lead CDI
    Regional Medical Center Bayonet Point
    Hudson, FL
  • robert.hodges2robert.hodges2
    edited May 2016
    I review all patients with a nutrition consult to see what the dietician has identified. If I see documented "protein calorie malnutrition" or a Stage IV or greater nutritional injury documented, I will query the provider as to the clinical significance of the dieticians finding and if clinically significant an associated diagnosis.

    Robert

    Robert S. Hodges, BSN, MSN, RN, CCDS
    Clinical Documentation Improvement Specialist
    Aleda E. Lutz VAMC
    Mail Code 136
    1500 Weiss Street
    Saginaw MI 48602
     
    P: 989-497-2500 x13101
    F: 989-321-4912
    E: Robert.Hodges2@va.gov
     
    "We are dealing with Veterans, not procedures; With their problems, not ours." --General Omar Bradley

  • Unknown
    We also wait for the nutrition consult to identify the patients diagnosis. But we also review the chart for specific symptoms or words such a cachexia, underweight, undernourished, etc. Also a calculated EMR BMI alerts us to a underwt pt or m. obese patient, so we are on the lookout for a nutrition consult. Protein malnutrition seems to be difficult but once it is documented by the nutritionist including treatment (TPN etc), I have an exchange with the physician about the diagnosis and reiterate the albumin and prealbumin values and ask if it is Mild, Moderate or Severe Malnutrition. The 3M encoder used to bring you to Kwashiokor. Now it gives you the choice to select severity or Kwashiokor. So that I ask for severity. Remember the ADA and ASPEN groups will have some updates this fall.

    Carla A. Heyn, RHIT, BS
    CDS
    Elliot Hospital
    One Elliot Way
    Manchester, NH 03104
    cheyn@elliot-hs.org
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