Q&A: Malnutrition query troubles

January 18, 2018

CDI Blog - Volume 11, Issue 14

Q: I am having issues with push back from some of our physicians regarding responding to queries regarding malnutrition. We do not query for malnutrition unless we have documentation of a nutritional assessment from our dietitians. The dietitians are triggered by certain criteria: weight loss, low body mass index, etc., or a physician’s order.

Lately, however, we have been receiving responses of “did not assess or treat” or “this is a chronic stable medical problem not associated with the patient’s presentation,” although the nutritional assessment such as severe malnutrition is clearly documented in the chart under nutritional assessment and the physician has been sent a copy of the assessment. We have been attempting to address these physicians individually as we catch them but this seems to be the long road home. Any ideas?

A: You might try to re-word the query in such a way as to ask if the physician agrees with the dietician’s assessment of severe malnutrition and providing the location of that assessment within the medical record to make it easier for the physician to locate it. Alternatively, you might ask if the physician is monitoring or treating the diagnosis of severe malnutrition as documented in the nutritional assessment and pull in any additional clinical indicators or dietician assessment findings such as muscle wasting per the American Society for Parenteral and Enteral Nuttition (ASPEN) criteria. Finally, additional education for the physicians regarding how severe malnutrition affects the patient’s severity of illness, risk of mortality, and length of stay may be in order.

Some programs provide extensive collaboration between the CDI and dieticians to identify common clinical indicators and then provide outreach to physicians. Some programs have even used internal video screens and articles in weekly inhouse newsletters to provide education. All of which can help.

Editor’s Note: This question was in response to information shared within the CDI leadership networking group. For additional information, email ACDIS Editorial Director Melissa Varnavas at mvarnavas@acdis.org.