• Evidence-Based Approach for Identification of Malnutrition and Prevention of Skin Breakdown

      Bederak, Dmitry; Windemuth, Brenda (2021-05)
      Problem: Geriatric patients have an increased risk for skin breakdown due to advanced age, immobility, comorbidities, and poor nutrition. As malnutrition contributes to impaired skin integrity, patients may experience ulceration, infection, and pain. Administrators within a long-term care (LTC) facility expressed concerns about undetected malnutrition or the risk of malnutrition leading to skin breakdown. The incidence rate of skin breakdown in January of 2020 was 6.37%. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate use of the Mini Nutritional Assessment (MNA) for patient admissions/readmissions within a LTC setting, for early recognition of malnutrition and prompt intervention to prevent skin breakdown. Methods: Implementation relied on Lewin’s Change Theory, utilizing evidence to manifest and sustain change. Strategies/tactics included meetings with administrative and nursing staff to review current processes for patient admission and dietary evaluation, training nursing staff on use of the MNA, and implementation of an improved communication system for dietary referrals. The project was implemented at a 130-bed LTC facility and clinicians included 12 nurses, 2 providers, and 1 dietician. Inclusion criteria included all admissions/readmissions. Implementation data was collected at weekly intervals using electronic reports and chart audits. Protection of confidentiality/privacy included collection of anonymous data. Data was analyzed using run charts to evaluate trends and variation in MNA use. Results: Over 14-weeks of implementation, 38 patients were admitted/readmitted to the LTC facility. The MNA was completed for 32 (84.1%) of patients, and 18 (56.3%) of those patients were identified as being malnourished or at risk for malnutrition. Run chart analysis indicated no shifts, trends, astronomical data points or abnormal variation in runs. Prior to implementation of the practice change, the rate of compliance in utilizing the MNA increased from 0% at baseline to vary weekly between 40% and 100%, indicating initial adoption of the screening tool by nurses. Conclusions: The MNA provided an effective means for establishing nutritional status in order to prompt early nutritional intervention to prevent skin breakdown. The MNA has the potential to enhance prevention efforts, reduce costs associated with in-house acquired wounds, and minimize factors contributing to patient decline.