Malnutrition

Posted on Dec 5, 2017 in Uncategorized | 0 comments

Malnutrition is common in hospitalized patients but under recognized and undertreated.  Since patients with malnutrition are at increased risk for poor outcomes, including a 4-5-fold higher mortality rate, it’s worth learning how to recognize this condition.

Most physicians aren’t familiar with the diagnostic guidelines published by the American Academy of Nutrition and Dietetics (the Academy) and the American Society for

Parenteral and Enteral Nutrition (ASPEN).  Fortunately, the hospital registered dieticians (RDs) are a great resource for evaluating, verifying clinical indicators and assigning appropriate nutritional diagnoses and treatment plans for these patients.

If you suspect malnutrition (eg patients with weight loss, pressure ulcers, cancer or SNF residents), order a dietician consult.  And before saying that your patient is “well-nourished, well-developed”, pause to consider whether this description is accurate.  Proper nutritional assessment is actually quite complicated AND even obese patients can be malnourished.  For these reasons, it might be better if we use the description “well-developed” when appropriate but leave the nutritional assessment to the RDs.

In order for the diagnosis of malnutrition to be properly coded, the diagnosis and the degree of malnutrition (mild, moderate or severe) must be documented by the physician.

Make it a habit to read the RD notes (located under the “Care Team” tab in Notes section of EPIC) and if you agree with the diagnosis and treatment plan, document this in your note and discharge summary and monitor the condition during the hospitalization.

To avoid getting a query about malnutrition, read the RD notes and if you agree with the diagnosis and treatment plan, including degree of severity of malnutrition, document this in your note and discharge summary.   The diagnosis of malnutrition can impact both severity of illness (SOI) and risk of mortality (ROM) so remember to check the RD notes for help with recognizing malnutrition.

Beth Gong, MD–  CDI Physician Champion

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