Nutrition risk screening in acute care: a survey of practice

The Joint Commission-accredited acute care hospitals are required to screen patients for nutrition risk, but criteria and procedures in use have not been described. The purpose of this study was to survey managers of clinical nutrition services in acute care hospitals regarding procedures for screening for nutrition risk. Members of the Clinical Nutrition Management Dietetic Practice Group were surveyed using an e-mailed link to an electronic survey. Of 1668 members contacted, 522 usable surveys were completed (31%). Most respondents (84%) reported that nursing staff had primary responsibility for nutrition screening; 10% used nutrition services staff; 4% used a computerized system. Where nursing staff did nutrition screening (n=441), 57% (n=252) said that nutrition services staff do a secondary admission screen. Dietitians most often performed secondary screens (70%), followed by dietetic technicians (16%), 4-year-degreed staff (4%), and clerks (3%). Most nutrition services staff screens (61%) used different data than nursing staff screens; 12% collected the same data as nursing staff. Screening criteria most often used by nursing staff were a history of weight loss (95%), poor intake prior to admission (81%), nutrition support (79%), chewing/swallowing issues (75%), and skin breakdown (72%). Criteria most commonly used by nutrition services staff were diagnosis (90%), nutrition support (81%), nothing by mouth (NPO)/clear liquid diet order (78%), visceral proteins (71%), and specific diet orders (68%). Most respondents had not formally evaluated their screening systems for sensitivity or specificity. There is a need to further evaluate the nutrition screening systems used in acute care hospitals in the U.S.