Problem:
90% of older adults are at risk or already malnourished on admission to our Geriatric Wards. Malnutrition leads to increased risk of delirium, infections, functional decline, and mortality. We aim to reduce the proportion of inpatients in the Dementia Ward with inadequate oral intake from 75% to less than 10% in 6 months.
Design Methods:
Our standards are obtained from the 2018 ESPEN Guidelines. From our Affinity Diagram, Fishbone Diagram and Pareto chart, and identified 3 key causes: “Not reviewing oral intake daily”, “Speech therapist(ST)/dietician not ordered by doctor” and “Not aware of effects of dietary restrictions”. For our first Plan-Do-Study-Act cycle (PDSA), we empowered nurses to directly refer to the dietician/ST if oral intake is inadequate. For our second PDSA, we placed a poster in the Doctors’ Room to raise awareness about how dietary restrictions contribute to malnutrition.
Practice change:
We protocolised the new referral process for ST/dieticians. The night-shift nurse reviews patients’ daily oral intake, and hands over to the morning-shift nurse to refer to the dietician/ST if indicated.
Re-audit:
After implementation of the new protocol, the proportion of patients taking <50% meals per day decreased from 70.0% to 8.6%. On average, it decreased from 72.3% to 14.1% (p<0.001). Length of stay decreased from 13.1days to 9.97days (p=0.018), which translates to a cost avoidance of $2,200 per patient.
Conclusions:
We reduced the proportion of inpatients with inadequate oral intake by the improvement of our referral process for dieticians/ST, and using a poster to raise awareness about malnutrition.