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Hazreen Abdul Majid - One of the best experts on this subject based on the ideXlab platform.
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response to validity and reliability of a Nutrition Screening tool in identifying malNutrition among hospitalized adult patients
Nutrition in Clinical Practice, 2019Co-Authors: Pei Chien Tah, Chee Cheong Kee, Hazreen Abdul MajidAbstract:BACKGROUND MalNutrition among hospitalized patients is closely associated with various medical complications. This study aimed to determine the validity and reliability of a 3-Minute Nutrition Screening (3-MinNS) tool in identifying the risk of malNutrition among hospitalized patients that can be administered by healthcare professionals. METHODS A cross-sectional study was conducted between January and December 2012. A total of 350 adult patients in a teaching hospital were screened for risk of malNutrition using 3-MinNS and Subjective Global Assessment (SGA). To assess interrater reliability, each patient was screened for risk of malNutrition using 3-MinNS by 2 different nurses on 2 different occasions within 24 hours after admission. To assess the validity of 3-MinNS, the level of risk of malNutrition identified by the nurses using 3-MinNS was compared with the risk of malNutrition as assessed by a dietitian using SGA within 48 hours after the patients' enrolment into the study. The sensitivity, specificity, and predictive values were calculated in detecting patients at risk of malNutrition. Interrater reliability was determined using κ statistics. RESULTS Using SGA, the estimated prevalence of moderate to severe malNutrition was 36.3% (127/350). There was 94% proportional agreement between 2 nurses using 3-MinNS, and interrater reliability was substantial (κ = 0.79, P < .001). The analysis showed that 3-MinNS had moderate sensitivity (61.4%-68.5%) but high specificity (95.1%). CONCLUSIONS The 3-MinNS is a reliable and valid Screening tool for use by healthcare professionals for identifying newly admitted medical and surgical patients who are at risk of malNutrition.
Lynne Daniels - One of the best experts on this subject based on the ideXlab platform.
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Improving the performance of Nutrition Screening through a series of quality improvement initiatives
2014Co-Authors: Su Lin Lim, Maree Ferguson, Jamie Lye, Wai Chiong Loke, Lynne DanielsAbstract:Background Nutrition Screening identifies patients at risk of malNutrition to facilitate early Nutritional intervention. Studies have reported incompletion and error rates of 30-90% for a range of commonly used Screening tools. This study aims to investigate the incompletion and error rates of 3-Minute Nutrition Screening (3-MinNS) and the effect of quality improvement initiatives in improving the overall performance of the Screening tool and the referral process for at risk patients. Methods Annual audits were carried out from 2008-2013 on 4467 patients. Value Stream Mapping, Plan-Do-Check-Act cycle and Root Cause Analysis were used in this study to identify gaps and determine the best intervention. The intervention included 1) implementing a Nutrition Screening protocol, 2) Nutrition Screening training, 3) nurse empowerment for online dietetics referral of at-risk cases, 4) closed-loop feedback system and 5) removing a component of 3-MinNS that caused the most error without compromising its sensitivity and specificity. Results Nutrition Screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009 respectively. For patients at risk of malNutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After intervention, the latter decreased to 7% (2010), 4% (2011) and 3% (2012 and 2013), and the mean turnaround time from Screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p < 0.001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012) and 5% (2013) and percentage of blank or missing forms reduced to and remained at 1%. Conclusion Quality improvement initiatives are effective in reducing the incompletion and error rates of Nutrition Screening, and led to sustainable improvements in the referral process of patients at Nutritional risk.
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Improving the Performance of Nutrition Screening Through a Series of Quality Improvement Initiatives
The Joint Commission Journal on Quality and Patient Safety, 2014Co-Authors: Su Lin Lim, Maree Ferguson, Jamie Lye, Wai Chiong Loke, Lynne DanielsAbstract:Article-at-a-Glance Background Nutrition Screening identifies patients at risk of malNutrition to facilitate early Nutritional intervention, yet incompletion and error rates of 30%–90% have been reported for commonly used Screening tools. The effect of a series of quality improvement initiatives in improving the referral process and the overall performance of the 3-Minute Nutrition Screening (3-MinNS) tool was assessed for patients at National University Hospital (Singapore) at risk for malNutrition. Methods Annual audits were carried out from 2008 through 2013 on 4,467 patients. Performance gaps were identified and addressed through interventions, including (1) implementing a Nutrition Screening protocol, (2) Nutrition Screening training, (3) nurse empowerment for online dietetics referral of at-risk cases, (4) a closed-loop feedback system, and (5) removing a component of 3-MinNS that caused the most errors without compromising its sensitivity and specificity. Results Nutrition Screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009, respectively. For patients at risk of malNutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After the interventions, nonreferrals decreased to 7% (2010), 4% (2011), and 3% (2012 and 2013), and the mean turnaround time from Screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p Conclusion Quality improvement initiatives were effective in reducing the incompletion and error rates of Nutrition Screening and led to sustainable improvements in the referral process of patients at Nutritional risk.
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Validity and Reliability of Nutrition Screening Administered by Nurses
Nutrition in Clinical Practice, 2013Co-Authors: Su Lin Lim, Maree Ferguson, Emily Ang, Yet Li Foo, Chung Yan Tong, Lynne DanielsAbstract:Background: Nutrition Screening is usually administered by nurses. However, most studies on Nutrition Screening tools have not used nurses to validate the tools. The 3-Minute Nutrition Screening (3-MinNS) assesses weight loss, dietary intake, and muscle wastage, with the composite score of each used to determine risk of malNutrition. The aim of the study was to determine the validity and reliability of 3-MinNS administered by nurses, who are the intended assessors. Methods: In this cross-sectional study, 3 ward-based nurses screened 121 patients aged 21 years and over using 3-MinNS in 3 wards within 24 hours of admission. A dietitian then assessed patients’ Nutrition status using Subjective Global Assessment within 48 hours of admission, while blinded to the results of the Screening. To assess the reliability of 3-MinNS, 37 patients screened by the first nurse were rescreened by a second nurse within 24 hours, who was blinded to the results of the first nurse. The sensitivity, specificity, and best cutoff...
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development and validation of 3 minute Nutrition Screening 3 minns tool for acute hospital patients in singapore
Faculty of Health; Institute of Health and Biomedical Innovation, 2009Co-Authors: Su Lin Lim, Maree Ferguson, Emily Ang, Chung Yan Tong, Wai Chiong Loke, Evan J C Lee, Yuming Chen, Lynne DanielsAbstract:It is important to detect and treat malNutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a Nutrition Screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malNutrition. A dietitian blinded to the Nutrition Screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. The sensitivity and specificity were established using the Receiver Operator Characteristics (ROC) curve and the best cutoff scores determined. The Nutrition parameter with the largest Area Under the ROC Curve (AUC) was chosen as the final Screening tool, which was named 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3-MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cutoff point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cutoff score to identify subjects at risk of severe malNutrition is five (sensitivity 93%, specificity 86%). 3-Minute Nutrition Screening is a valid, simple and rapid tool to identify patients at risk of malNutrition in Singapore acute hospital patients. It is able to differentiate patients at risk of moderate malNutrition and severe malNutrition for prioritization and management purposes.
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development and validation of 3 minute Nutrition Screening 3 minns tool for acute hospital patients in singapore
Asia Pacific Journal of Clinical Nutrition, 2009Co-Authors: Su Lin Lim, Maree Ferguson, Emily Ang, Chung Yan Tong, Wai Chiong Loke, Evan J C Lee, Yuming Chen, Lynne DanielsAbstract:It is important to detect and treat malNutrition in hospital patients so as to improve clinical outcome and reduce hospital stay. The aim of this study was to develop and validate a Nutrition Screening tool with a simple and quick scoring system for acute hospital patients in Singapore. In this study, 818 newly admitted patients aged above 18 years old were screened using five parameters that contribute to the risk of malNutrition. A dietitian blinded to the Nutrition Screening score assessed the same patients using the reference standard, Subjective Global Assessment (SGA) within 48 hours. Sensitivity and specificity were established using the receiver operator characteristics (ROC) curve and the best cut-off scores determined. The Nutrition parameter with the largest area under the ROC curve (AUC) was chosen as the final Screening tool, which was named the 3-Minute Nutrition Screening (3-MinNS). The combination of the parameters weight loss, intake and muscle wastage (3- MinNS), gave the largest AUC when compared with SGA. Using 3-MinNS, the best cut-off point to identify malnourished patients is three (sensitivity 86%, specificity 83%). The cut-off score to identify subjects at risk of severe malNutrition is five (sensitivity 93%, specificity 86%). The 3-Minute Nutrition Screening is a valid, simple and rapid tool that identifies acute hospital patients at risk of malNutrition in Singapore. It is able to differentiate patients at risk of moderate malNutrition and severe malNutrition for prioritization and management purposes.
Leah Gramlich - One of the best experts on this subject based on the ideXlab platform.
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multi site implementation of Nutrition Screening and diagnosis in medical care units success of the more 2 eat project
Clinical Nutrition, 2019Co-Authors: Heather Keller, Paule Bernier, Renata Valaitis, Celia Laur, Tara Mcnicholl, Joel A Dubin, Lori Curtis, Suzanne Obiorah, Sumantra Ray, Leah GramlichAbstract:Summary Background Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. Aim To describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based Nutrition care algorithm. To demonstrate that following this algorithm leads to increased detection of malNutrition and increased treatment to mitigate this condition. Methods Sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including Screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. Implementation occurred over a 24-month period, including developmental (Period 1), implementation (Periods 2–5), and sustainability (Period 6) phases. Audits (n = 36) of patient health records (n = 5030) were conducted to identify Nutrition care practices implemented with a variety of strategies and behaviour change techniques. Results All sites increased Nutrition Screening from Period 1, with three achieving the goal of 75% of admitted patients being screened by Period 3, and the remainder achieving a rate of 70% by end of implementation. No sites were conducting SGA at Period 1, and sites reached the goal of a 75% completion rate or referral for those identified to be at Nutrition risk, by Period 3 or 4. By Period 2, 100% of patients identified as SGA C (severely malnourished) were receiving a comprehensive Nutritional assessment. In Period 1, the Nutrition diagnosis and documentation by the dietitian of ‘malNutrition’ was a modest 0.37%, increasing to over 5% of all audited health records. The overall use of any Advanced Nutrition Care practices increased from 31% during Period 1 to 63% during Period 6. Conclusion The success of this multi-site study demonstrated that implementation of Nutrition Screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in Nutrition care while minimizing the risk of missing malnourished patients. Trial registration Retrospectively registered ClinicalTrials.gov Identifier: NCT02800304 , June 7, 2016.
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Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting
European Journal of Clinical Nutrition, 2014Co-Authors: Manon Laporte, Heather Keller, Hélène Payette, Johane P. Allard, Donald R. Duerksen, Paule Bernier, Khursheed N. Jeejeebhoy, Leah Gramlich, Bridget Davidson, Elisabeth VesnaverAbstract:Validity and reliability of the new Canadian Nutrition Screening Tool in the ‘real-world’ hospital setting
Johanna T. Dwyer - One of the best experts on this subject based on the ideXlab platform.
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Renal DETERMINE Nutrition Screening Tools for the identification and treatment of malNutrition
Journal of Renal Nutrition, 1998Co-Authors: June Leung, Johanna T. DwyerAbstract:Nutrition Screening is the first step in identifying and treating Nutrition-related problems in renal patients. The Renal DETERMINE Nutrition Screening Tools help health care professionals recognize the risk factors for malNutrition in renal patients and suggest interventions to prevent, control, or ameliorate problems when they are present. The Renal DETERMINE Nutrition Awareness Checklist provides a series of questions for the health care professional to ask the renal patient to better identify Nutrition problems. It can also be used with renal patients to help educate and increase awareness of Nutrition issues. The Renal DETERMINE Nutrition Screening Reference Sheets are then used to help the health care professional identify appropriate interventions for the Nutrition problem. The Reference Sheets list the most common Nutrition-related concerns for chronic renal insufficiency, hemodialysis, peritoneal dialysis, and post kidney transplant patients. For each risk factor, rationales are presented and interventions to resolve the Nutrition related problems are provided.
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Development of Renal Determine Nutrition Screening Tool for Health Care Professionals and Renal Determine Checklist for Patients
Journal of the American Dietetic Association, 1997Co-Authors: June Leung, Johanna T. Dwyer, P. Cunniff, R. HenryAbstract:Abstract LEARNING OUTCOME: To identify malNutrition in renal patients using the renal Nutrition Screening tools. MalNutrition is associated with increased mortality and morbidity, and decreased quality of life among renal patients. Therefore, it is critical for health care professionals who care for renal patients to be able to identify potentially malnourished patients and to provide the appropriate interventions to prevent or resolve any Nutrition related problems. Nutrition Screening is the first step in identifying and treating Nutrition related problems stemming from the medical, physiological, Nutritional, psychosocial and economical factors. The Renal DETERMINE Nutrition Screening Tool was developed to help health care professionals recognize the risk factors of malNutrition in renal patients and provide suggestions for interventions to prevent. control, or ameliorate Nutrition related problems. Using the mnemonic DETERMINE from the Nutrition Screening Initiative as the fundamental structure, the tool lists the most common Nutrition related concerns for end stage renal disease, hemodialysis, and peritoneal dialysis patients. Post kidney-transplant patients have different Nutritional concerns and these are addressed separately. For each risk factor, rationales are presented, and simple interventions to resolve the Nutrition related problems are provided. A Renal DETERMINE Checklist, adapted from the Nutrition Screening Initiative's "DETERMINE Your Nutrition Health" was also developed for patients to help educate and increase patient awareness of the importance of Nutrition. This Checklist provides a set of simple questions that help renal patients identify Nutrition related problems. Once patients are aware of their Nutritional problems, they can correct them by seeking help from a health care professional. These Nutrition Screening tools have been reviewed and refined by expert renal Nutritionists.
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A vital sign: progress and prospects in Nutrition Screening of older Americans.
Aging (Milan Italy), 1993Co-Authors: Johanna T. DwyerAbstract:The population of older Americans over 65, and particularly over 75 and 85 years of age, when daily activities affecting eating and food-getting are often compromised, is growing rapidly. Screening to identify risk factors to Nutritional and general health, and further assessment and intervention for those who are found to be at risk is essential. The Nutrition Screening Initiative is a voluntary effort of several major health professional organizations focused on promoting better Nutrition Screening and Nutritional care for our nation's elderly. This article describes some of the Nutrition-related problems faced by older Americans. The progress of the Nutrition Screening Initiative is reviewed, and some simple steps to implement the Initiative's recommendations in physician offices and other health care settings serving older Americans are provided. By adopting and using the simple Screening and assessment tools that are provided, or by developing individualized tools, the practicing physician can incorporate these essential components of comprehensive geriatric assessment into office practice. This will do much to alleviate remediable problems early, and to control or ameliorate those that cannot be prevented. Some useful supportive continuing medical education efforts, resources available, and measures that are being taken at the community level are summarized. A case study of some potential problems and how they might be alleviated is provided. Finally, some potential avenues in both the health and social services system for more effective interventions to deal with problems are identified.
L Wedlake - One of the best experts on this subject based on the ideXlab platform.
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comparison of a novel simple Nutrition Screening tool for adult oncology inpatients and the malNutrition Screening tool mst against the patient generated subjective global assessment pg sga
Supportive Care in Cancer, 2015Co-Authors: C Shaw, Catherine Fleuret, Jennifer M Pickard, Kabir Mohammed, Gayle Black, L WedlakeAbstract:Background Oncology inpatients are at high risk of malNutrition. Identification of at risk patients by Nutrition Screening requires a practical and easy to use tool. In this study, we have compared a simple, novel Nutrition Screening tool designed for an oncology inpatient setting and the MalNutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA).
