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AVENTURA HOSPITAL AND MEDICAL CENTER

Dept/Function:
NUTRITION SERVICES
Title: AUTOMATIC SUBSTITUTION OF
SERIAL PREALBUMIN LEVELS FOR
CALORIE COUNTS
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Origination/Effective Date:
06/2005
Revision Date(s):
04/12/2011
02/04/2014






Department Approval:


Review Date(s):
(no revisions)
01/2009
08/04/10
09/12


Administrative Approval:


Additional Approval:




OBJECTIVE:
To determine a patients capacity to meet his/her calorie and protein requirements.

SCOPE:

This policy applies to Dietitians, Physicians, Nurses, and Patients.

POLICY:

Traditional calorie counts are subjective and often dont represent patients actual intake. An
evidence-based alternative to the traditional calorie count is to draw prealbumin levels in a 72-96
hour interval. Prealbumin has a 2-day half-life and, over the course of 72 hours, will more
accurately reflect the adequacy of a patients PO intake. Calorie counts will not be used to assess
the adequacy of a patients intake due to their lack of reliability.

PROCEDURE:

Upon physicians order for a calorie count the following will take place:

1. A clinical dietitian will document the patients estimated calorie and protein needs in the
Patient Care Module within 24 hours of receipt of consult.

2. A clinical dietitian will provide the nurse with a calorie count form. The nurse will be
responsible for accurately and adequately completing the form for each meal over the period
of three consecutive days.
Nursing will fill out the specific type of food, beverage, and any oral supplement
consumed, as well as a specific measurable amount consumed for each meal.
Nutrition department in collaboration with Nursing Education will be responsible for
nursing in-services on proper completion of the calorie count form as deemed fit by
the Nursing Educator.
The calorie count form is to be transferred with the patient if a room change occurs.
Under the circumstance that a patient becomes NPO, the meal shall be skipped and
nursing will document that the patient was NPO for that meal and reasoning for NPO.

3. Once the calorie count is completed, the dietitian will retrieve the form from the
nurse/patients room up to 24-48 hours upon completion of the calorie count. The dietitian
AVENTURA HOSPITAL AND MEDICAL CENTER
Dept/Function:
NUTRITION SERVICES
Subject:


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will assess the patients intake based on the appropriately documented calorie count form.
The dietitian will file an original copy of the calorie count in the patients physical chart and
results will be documented in the PCI.

4. The dietitian will make the recommendation to the physician that he/she order 2 prealbumin
levels spaced 72 hours apart in lieu of the calorie count.

5. The clinical dietitian will document the patients prealbumin levels and assess their
nutritional status based on those levels and other clinical data. The assessment will be
documented in the Patient Care Module.

6. If indicated, a recommendation for aggressive nutrition intervention shall be made at the
discretion of the clinical dietitian.



REFERENCES:

Beck FK, Rosenthal TC. Prealbumin: A Marker for Nutritional Evaluation. Am Fam Physician
2002;65:1575-1578.

Mears E. Outcomes of continuous Process Improvemant of a Nutritional Care Program
Incorporting TTR Measurement. Clin Chem Lab Med 2002;40(12):1355-1359.

Holownia P, Newman DJ, Thakker H, Bedzyk WD, Crane H, Olabiran Y, Dabey CL, Price CP.
Development and validation of an automated latex-enhanced immunoassay for prealbumin.
Clinical Chemistry 1998:44:1316-1324.