Nutrition screening and assessment: current practices and dietitians' leadership roles

To ascertain hospital nutrition screening and assessment practices and the need for additional resources to facilitate these processes.

A survey questionnaire was developed to ascertain screening protocols, assessment procedures and tools, relevant training and research needs, and respondent characteristics.

The survey was sent to 988 members of Dietitians in Nutrition Support, a dietetic practice group of The American Dietetic Association; 388 (39.3%) responses were used for analysis.

Descriptive statistics were used to calculate response frequency. chi 2 Statistics were used to test associations between nutrition assessment practices and association membership, nutrition support team activity, patient load, time allocations, and type and size of hospital.

Most institutions had policies for screening (90.2%); 68.7% of dietitians were involved in screening either alone or with others. Assessment practices within hospitals varied widely: 45.9% used a standard form; 66.8% assessed patients at risk; and 10.6% assessed all patients. Typical assessments included height and weight, diagnosis, weight history, albumin, food intolerance, and allergies. Social histories and sophisticated methods such as indirect calorimetry were used infrequently. Most assessments (54.5%) took 31 to 59 minutes; 35.0% of the dietitians spent more than half their time doing assessments. A large percentage (48.7%) of respondents viewed the dietitian as having greatest influence on assessment policies; others thought physicians (23.2%), administrators (15.7%), nurses (6.2%), or pharmacists (6.5%) had the greatest influence.

Recommended improvements include improved standards of practice, development of written protocols and practice guidelines, better use of human resources, standardization of assessment procedures throughout the profession, and empowerment of dietitians to assume a stronger leadership role in this dimension of dietetics practice.