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Patient nutrition focus of new alliance

Organizations band together to improve patient malnutrition rates

 With a number of studies indicating that one in three patients enters U.S. hospitals malnourished and many more becoming malnourished once admitted, five organizations decided to band together to launch the Alliance to Advance Patient Nutrition.

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The Academy of Medical-Surgical Nurses (AMSN), Academy of Nutrition and Dietetics (AND), American Society for Parenteral and Enteral Nutrition (ASPEN), Society of Hospital Medicine (SHM) and Abbott Nutrition, which together represent more than 100,000 dietitians, nurses and physicians, launched the partnership in May to advance and improve early nutrition screening, assessment and intervention in hospitals.

"Johns Hopkins did a study showing that when they actively treated patients for malnutrition they decreased length of stay by two days, so we know that nutrition can make a difference," said Beth Quatrara, a member of AMSN and a clinical nurse specialist at the University of Virginia Health System. "With so many hospital quality measures already in play, I think nutrition needs to be on the checklist. So many measures are already checked, and for whatever reason, nutrition hasn't always been prioritized. Data is showing the importance of nutrition. Patients that we treat early for nutrition heal faster and feel better."

Kelly Tappenden, registered dietitian and an Alliance to Advance Patient Nutrition representative from AND, said that nutrition intervention via a nutritional supplement has been shown to reduce patient hospitalization cost by 21.6 percent or $4,734 per episode, according to an American Journal of Managed Care study of over one million patients across 400 hospitals.

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"Malnourished patients have increased chances of complications, infections and length of stays. If we intervene with even a nutritional supplement – it's a simple thing we can do to achieve great results," said Tappenden.

Tappenden said additionally there was a 6.7 percent reduction in the probability of a 30-day readmission with patients who had at least one known subsequent readmission and were offered oral nutrition supplements during hospitalization, according to the study.

Gary Fanjiang, divisional vice president of scientific and medical affairs at Abbott Nutrition, said the high numbers of malnourished patients are occurring for multiple reasons.

"One is that a lot of the people hospitalized in the U.S. are elderly and they are certainly at risk because of a combination of underlying medical conditions, but also some elderly patients are at risk because of socioeconomic or access issues. Another reason is there isn't a large awareness of nutrition, and it's a big underlying problem. There isn't a lot of awareness in the healthcare system regarding this problem. It's not being adequately addressed," he said.

He added that the Alliance has recommended that clinicians now take three important steps for decreasing malnutrition levels in patients:

1.    Screen 100 percent of patients for malnutrition risk upon admission.
2.    Immediately prescribe a nutrition plan to at risk patients.
3.    Give every at-risk screened patient a documented nutrition care plan tailored to meet their needs from admission through discharge.

"It's going to require nurses to find these patients who may be malnourished immediately upon admission and actively design a nutrition plan for them. Those patients who are at risk and are taken care of from the start will less likely have the possibility of complications," said Quatrara. "It needs to be one of those things we talk about from shift to shift. How much did the patient eat? Did they tolerate it? It needs to be imbedded into our routine, hardwired into everyone's practices."

Fanjiang said the Alliance launched a website at to provide hospital-based clinicians with the following resources:

• Research and fact sheets about malnutrition and the positive impact nutrition intervention has on patient care and outcomes.
• An Alliance Nutrition Toolkit to facilitate clinician collaboration and nutrition integration.
• Information about educational events, such as quick learning modules, continuing education and continuing medical education programs.

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