Recognizing malnutrition in the data (Part 1)
Written by MatrixCare Director of Nutrition Management, Amy Wootton, and Senior Process Consultant, Connie French
Malnutrition is an even greater concern for our seniors in our new COVID world. MatrixCare makes it easier for post-acute care providers to assess and monitor the nutritional status of older adults to identify malnutrition and take quick and appropriate action to combat it. Learn how MatrixCare’s SNF, EMR, clinical platform and MealTracker can arm your nurses, dietitians, nutritionists, clinicians, and dietary managers to recognize malnutrition in your data to help you better manage malnourished resident needs.
The Institute of Medicine recognizes malnutrition as a geriatric syndrome (IOS, 2008). It is a real challenge for caretakers because it can be unrecognizable, and it can impact morbidity, mortality, and quality of life (Chen, Schilling, & Lyder, 2001). Malnutrition in older adults is defined as “faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting, and weight loss” (Chen et al., 2001). It is a precursor for frailty and health decline, and it increases mortality risk.
Identifying the risk factors
MatrixCare helps you recognize risk factors and combat malnutrition through effective use of your data, from point of admission and beyond. Long Term Care admission documentation can include multiple assessments, which captures nutrition information directly or indirectly related to malnutrition. Let’s consider how the data from the different assessment pieces can uncover the risk factors.
The Face Sheet contains vital data to help you identify nutritional risks for each resident. The risk of malnutrition in the older adult is multifactorial and includes dietary, economic, psychosocial, and physiological factors (DiMaria-Ghalili & Amella, 2005).
The Face Sheet demographic data includes age and personal information such as marital status, race, and religion. Age causes body composition changes. The older adult moving into post-acute care may already have lost lean body mass due to age, disease processes, and activity level. Information about marital status, race, and religion can lead to further identification of personal eating habits and potential for dietary restrictions or culturally based eating practices.
The Face Sheet contains a list of ICD-10 diagnoses and allergies, along with data insights into disease processes, food allergies, and intolerances. An initial diagnosis of Malnutrition may be identified here.
Malnutrition Screening Tool (MST)
MatrixCare is empowering facilities with tools and best practice standards for capturing malnutrition. Our prebuilt Malnutrition Screening Tool (MST) allows you to quickly identify and meet regulatory requirements in screening for nutritional status. The two-question tool related to weight loss and appetite can be completed by any health professional, including nursing, upon admission to the facility. The score can indicate residents who are at risk, and malnourished, so an immediate referral for further assessment can be made to a registered dietitian.
Research supports the latest two- question screening tool, Malnutrition Screening Tool (MST) to help make the identification. Aspen guidelines will reinforce these findings.
The Vitals page provides multiple layers of information relating to nutrition. Prior to COVID-19, the normal nursing home routine for enjoying a meal was a shared community experience in a dining room. Astute caregivers were often able to observe and assist those residents who either weren’t eating or ate little at mealtime.
Food consumption data is collected on the Vitals page in percentages. The weight, height, and BMI are also present on this page. In addition, bowel and urine output are documented. This information can be aggregated to evaluate a resident’s nutritional status.
- If a resident is consistently below 25% in food consumption, would it be true that a weight loss would follow?
- If a resident only eats 25% of their food, what essential macronutrients and vitamins are not being consumed?
- If a resident is having fewer bowel movements and less urine output, is that a result of poor food and fluid intake?
When vital data reveals a potential malnutrition risk, it is essential to look deeper so appropriate actions can be taken to help prevent, stop, or reverse malnutrition.
The significance of Observation information
Reviewing Observation information is a great place to start in understanding why a resident is potentially at risk for malnutrition. Observation data should be reviewed to identify information gathered surrounding diet, food, eating, and nutrition. Below are a few types of Observations to get started.
- Admission Observation: This data can include oral status, presence of dentures, vision, hearing, mental status, as well as a head to toe assessment. Poor food intake can result from oral or dental issues.
- PHQ9: This data provides an acuity score for assessing depression. Loss of appetite and motivation to eat are often associated with depression.
- Brief Interview for Mental Status: This data provides acuity scores essential in understanding if the resident realizes the outcome of poor nutrition on their health. It can also play an active role in improving their nutrition.
- Social Service Admission: This data reveals psychosocial and economic aspects of a resident’s life that can provide insight on how food was purchased, prepared, and the social aspect of eating that occurred.
- Malnutrition Screening Tool (MST): Nutrition screening is typically completed within the first 24 hours of admission, and it can immediately identify an at-risk resident.
MealTracker provides individual resident profile details to better manage the malnourished resident needs. Interventions can be implemented for improved intake at meals, honoring preferences, timing of meals, and adding snacks or supplements to increase and improve caloric intake. MealTracker can help you identify and manage weight loss with our Weight Alert Flag, while also monitoring for a criterion of malnutrition factors by comparing resident BMI. MealTrackers’ Malnutrition Risk Alert feature will help notify care providers of those at risk.
Being able to better manage a critical diagnosis like malnutrition will improve your reimbursement under PDPM, while improving overall interdisciplinary care.
The content in this presentation is for informational purposes only and is provided “as-is.” Information and views expressed herein, may change without notice. Given the fluidity of the current regulatory environment due to the pandemic, we encourage you to seek, as appropriate, regulatory and legal advice on any of the matters covered in this presentation.