CE3
Approved for 1 hour of CCM, CDMS, and nursing education credit Exam expires on August 15, 2022
Improving Patient Outcomes by Addressing Malnutrition Rajitha Bommakanti, RN, CCM
F
ood is the most important of the basic human needs; it nourishes and heals the body and allows our body to grow and survive. The risk of malnutrition and food insecurity issues in patients is often not addressed when patients are admitted to hospital. Malnutrition is simply defined as a nutritional imbalance: either undernutrition or overnutrition.16 When patients are sick and admitted to the hospital it is as important to eat nutritious food for healing and well-being as it is to take prescribed medications. Historically, health care facilities are not known for good food options. While patients are sick and laying in bed, the food tray does not look very appetizing, and patients often do not finish their food. Malnutrition is often not recognized as a health problem in health care facilities. A 2019 study showed that about 1 in 3 patients who are hospitalized in the United States are at risk for malnutrition.1 The impact of malnutrition has many negative outcomes, including immune suppression, increased infection rate, impaired wound healing, high risk for pressure ulcers, muscle wasting, increased length of hospital stay, increased cost of treatment, higher readmission rates, and high mortality.2 Many of the adverse outcomes influenced by malnutrition are preventable. If a patient’s nutritional status is addressed in a timely manner, adverse events can be prevented and can reduce the length of hospital stay, decrease morbidity and mortality, and reduce the hospital’s liability risk.16 According to a study published in 2019, malnutrition affects 30%-50% of hospitalized patients worldwide.1 Konturek et al. conducted a study to review the prevalence of malnutrition in hospitals.21 The results of this study showed that 53.6% of patients had malnutrition and that the prevalence of malnutrition was increased in patients with gastrointestinal diseases and with depression or dementia.21 It is disconcerting to see that nutritional status is not being addressed while patients are in a health care facility to heal; this results in poorer outcomes for both the patient and the hospital. A study conducted by Ramos, Fontanilla, and Lat (2011) showed that noncritical adult malnourished patients with type 2 diabetes had a significantly longer length of
hospital stay than well-nourished patients.3 Malnutrition in hospitalized patients is widespread: it is estimated that at least one third of patients have some degree of malnutrition on admission and if untreated these patients’ nutritional status will decline during their inpatient stay.16 There is a lack of awareness about malnutrition in hospitalized patients, and thus medical staff need to be educated on the importance of nutrition in patients.14 Malnutrition is not seen as a standard practice, so it is often missed as a diagnosis and, therefore, it is not treated.14 The risk of malnutrition increases while patients are hospitalized.21 Clear protocols need to be established to address the underreported and hidden problem of malnutrition.14 If malnutrition screening is included during initial patient assessment, not only would nutritional therapy be improved, but with appropriate coding, financial reimbursement could be maximized.21 Nutrition care goes unaddressed because physicians are not trained to look at nutrition as a part of healing. Medical students get about 20-25 hours of nutrition education, and medical students report that they are not well prepared to address nutritional needs of patients.22 Traditionally, registered dietitians are responsible for reviewing a patient’s nutritional status and for giving recommendations to physicians who write the order. Hospital data review shows that recommendations from registered dieticians are not being ordered by physicians.1 Patients and family would be more receptive to nutritional advice if the conversation is initiated by a physician, after which the dietitian can provide additional information and resources. It is important that Rajitha Bommakanti, RN, CCM, has been a nurse for over 30 years in various medical specialties and currently works as an ER case manager. She is a health partner in educating, inspiring, and empowering people to make small changes to their lives to improve their health. She is the founder of the Healthy You Lifestyle Center (www.healthyoucenter.com). You can contact her at healthyoucenter@gmail.com. February/March 2022 CareManagement 21
