Futu e Di e sio s i Cli i al Nut itio P a ti e Wi te

Nut itio S ee i g i the A ute Ca e Setti g:

Ho to Choose the Right Tool
B We d Phillips, MS, RD, CNSC, CLE, FAND a d Je ife Dole , MBA, RD, CNSC, FAND

The Nut itio Ca e P o ess NCP is a sta da dized
app oa h to p o idi g a d do u e ti g ut itio
a ei ultiple health a e setti gs, i ludi g a ute
a e hospitals. Nut itio s ee i g is the p o ess of
ide tif i g patie ts at isk fo p otei - alo ie al u-
t itio a d/o those ho a ha e a ut itio diag-
osis a d e efit f o ut itio assess e t a d i -
te e tio a egiste ed dietitia ut itio ist
RDN . I the hospital setti g, the ut itio s ee is
the efo e the usual poi t of e t i to the NCP.
Si e hospitals do ot ha e e ough RDNs to o -
plete a full ut itio assess e t fo all patie ts, a
effe ti e p io itizatio p o ess is esse tial to dete -
i e hi h patie ts ill e see a d ithi hat
ti ef a e. Nut itio s ee i g is o e o po e t of
that o e all p io itizatio p o ess; the ut itio
s ee i g tool NST should ide tif hi h patie ts
a e al ead al ou ished o at isk fo al ut itio
a d i eed of ut itio i te e tio . Ma hospi-
tals use additio al ite ia to t igge a RDN assess-
e t, su h as the p ese e of p essu e i ju ies, o -
olog diag oses a d gast oi testi al diseases aus-
i g o st u tio o ala so ptio . RDNs a also e-
ei e efe als fo patie ts ased o hospital i itia-
ti es that i lude a ut itio o po e t, su h as e-
du i g ead issio s fo patie ts ith hea t failu e.
A s ste ati e ie of NSTs i the hospital setti g i
o luded that the e is o o se sus o a si -
gle est ut itio s ee i g o assess e t tool to
use fo all atego ies of hospitalized patie ts. I the
hospitals studied, a ide a iet of ut itio s ee -
i g uestio s e e e plo ed a d ased o patie t
populatio eeds a d/o ultidis ipli a i put.
A editi g age ies that ha e dee ed status fo the
Ce te s fo Medi a e a d Medi aid Se i es CMS ,
su h as The Joi t Co issio TJC a d Det No ske
Ve itas DNV , spe if that a ute a e hospitals ust
ha e a ut itio s ee i g p o ess to ide tif pa-
tie ts i eed of a o plete ut itio assess e t
a d a e pla see Ta le . TJC o lo ge spe ifies
ithi hat ti ef a e the ut itio s ee should
e o pleted see Side a , ut DNV does stipu-
late that the s ee ust e o pleted u si g
ithi hou s of ad issio . Neithe age spe i-
fies the a tual uestio s o p o ess that ust e
used to o plete that ut itio s ee .
Ho Are NSTs Validated?
A NST is alidated o pa i g the esults agai st
a othe sta da d, ofte the Su je ti e Glo al As-
sess e t SGA , to dete i e if the tool a u atel
p edi ts ut itio isk o poo e health out o es i a

The Joi t Co issio

PC. . . The hospital assesses a d eassesses its patie ts.
. The hospital defi es, i iti g, the s ope a d o te t of s ee i g, assess e t, a d eassess e t i -
fo atio it olle ts. Note : The s ope ay also add ess the eed fo o e i -depth assess e ts, su h
as a ut itio al, fu tio al, o pai assess e t fo patie ts ho a e at isk.
. The hospital has defi ed ite ia that ide tif he ut itio al pla s a e de eloped.
DNV Health are
NS. Nu si g staff shall o plete a assess e t of a patie t s o ditio ithi t e t fou hou s of
ad issio to a i patie t setti g.
SR. a The u si g assess e t ill i lude ut ot e li ited to: Dieta e ui e e ts.
Ta le . The Joi t Co issio a d DNV Health a e egulato sta da ds elated to ut itio s ee i g
e ui e e ts fo a ute a e hospitals.
Futu e Di e sio s i Cli i al Nut itio P a ti e
Effe ti e Jul , , TJC deleted o ha ged a of
thei Sta da ds of Ca e a d asso iated Ele e ts of
Pe fo a e EPs , stati g that the e e lea i g
o e de isio s up to the hospital s dis etio , a d
e o i g EPs that the felt e e dupli ati e. The
e o ed ultiple patie t assess e t a d patie t
a e EPs, i di ati g that the a e o o side ed
pa t of the li i al a e p o ess . TJC did ot defi e
hat this te ea s, ut it see s e ide t that the
a ted to eli i ate e ess sta da ds a d o e lose-
l alig thei egulatio s to CMS s Co ditio s of Pa ti -
ipatio .
The e ui e e t to gathe i fo atio o a patie t s
ut itio a d h d atio status ithi hou s of ad-
issio as deleted p e iousl PC. . . EP ,
ith the atio ale that this ut itio s ee i g is al-
ead pa t of the li i al a e p o ess ,
ide tifi atio of o po e ts of the assess e t
should e defi ed the o ga izatio , a d the e-
ui e e t as also o e ed at PC. . . , EPs a d
see Ta le . Effe ti el , this e o ed ut itio
s ee i g ithi hou s as a a solute e ui e e t
fo TJC a edited hospitals, ut hospitals a e still e-
ui ed to ha e defi ed ite ia that ide tif he u-
t itio al pla s a e de eloped.
Side ar . Re ie of ut itio s ee i g e ui e-
e ts fo hospitals a edited TJC.
gi e patie t populatio . As oth se siti it a d
spe ifi it ust e easu ed to t ul alidate a tool
o p o ess, it is helpful to u de sta d these o epts
as the elate to NST alidatio .
Se siti it is the a ilit of the tool to o e tl ide ti-
f patie ts at ut itio isk, hile spe ifi it is the
a ilit of the tool to ot ide tif patie ts ot at isk.
See Ta le . The se siti it of a NST is elati el
eas to assess. Fo a gi e ti e f a e, all patie ts
e ei i g a efe al ge e ated f o the tool
should e assessed the RDN, a d the
desig ated as t ue positi es the NST o - Se siti ity Ide tified at isk AND is
e tl ide tified at- isk patie ts o false
positi es the NST i o e tl ide tified pa-
tie ts as at- isk he the e e ot . Mo e Spe ifi ity Not ide tified at isk
detail o o du ti g a p oje t to assess the
se siti it of a NST is p o ided late i this Ta le . Des iptio of the statisti al te s se siti it a d
a ti le. spe ifi it as the elate to ut itio isk ide tifi atio .
Wi te
Spe ifi it is o e halle gi g to assess. I o de to
aptu e all t ue egati es a d false egati es, e e
patie t ad itted du i g a spe ified ti e f a e ust
e assessed the RDN to dete i e if the a e al-
ou ished o at isk fo al ut itio . Those patie ts
that did ot t igge a efe al a the e atego ized
as t ue egati es ot ide tified as at- isk the NST,
a d ot at- isk as dete i ed the RDN a d false
egati es ot ide tified as at- isk the NST, ut
ide tified as at- isk the RDN . Be ause all patie ts
ust e assessed the RDN, this is a ti e a d la o
i te si e p o ess, a d e o d the a ilit of ost hos-
pitals to o du t. The efo e, use o a NST that has
al ead ee alidated fo use i a si ila patie t
populatio a d a e setti g is e o e ded.
Choosi g a Validated NST
The ideal NST has the highest se siti it possi le
hile ot sa ifi i g spe ifi it , ea i g the tool
ould aptu e ost patie ts ho a e t ul at ut i-
tio isk t ue positi es hile i i izi g false posi-
ti es. A oidi g high u e s of false positi es is
p efe a le, i o de to ese e RDN ti e a d ut i-
tio a e esou es fo patie ts ho eed it ost;
ho e e this ust e ala ed o side i g the
isk of ge e ati g o e false egati es at- isk pa-
tie ts ho ould e efit f o ut itio i te e tio ,
ut a e ot ide tified as su h.
A othe i po ta t fa to to o side is the i te -
ate elia ilit of the tool, o the a ilit fo t o
diffe e t li i ia s to get the sa e esult usi g the
NST i the sa e i u sta e. Si pli it a d ease of
use o t i ute to a high elia ilit , so o l s ee i g,
ot assess e t, uestio s should e asked, o al u-
latio s should e e ui ed, a d the fe est u e of
uestio s possi le should e used.
TRUE POSITIVES FALSE POSITIVES
Ide tified at isk BUT
at ut itio isk is ot at ut itio isk
TRUE NEGATIVES FALSE NEGATIVES
Not ide tified at isk
AND ot at ut itio isk BUT at ut itio isk
Futu e Di e sio s i Cli i al Nut itio P a ti e Wi te

Tool Populatio Se siti ity % Spe ifi ity % asked a out the ut itio
A ute hospitalized s ee i g p o ess to de-
Mal ut itio S ee i g = te i e if patie ts at u-
Tool MST
t itio isk a e ei g a u-
A ute hospitalized atel ide tified a d e-
= fe ed to the RDN; a e -
Mal ut itio U i e sal Hospitalized ed/su g pla atio of ea h uestio
S ee i g Tool MUST = is i luded i this se tio .
It is i po ta t to ote
Hospitalized ed/su g
that usi g this he klist to
Nut itio Risk S ee - =
assess the appli a ilit of
i g NRS A ute hospitalized a NST fo use i a pa ti -
= ula hospital is ot the
Ta le . NSTs alidated i the a ute a e setti g usi g the SGA as a efe e e sta da d sa e as o pleti g a ali-
datio stud of the tool.
Cli i al ut itio a age s CNMs a o sult the This sa e p o ess a e used to help de ide hi h
A ade of Nut itio a d Dieteti s E ide e A al - alidated NST to use.
sis Li a fo thei a al sis of NSTs, i ludi g
epo ts of the alidit a d elia ilit of ea h tool. . Does the NST ha e o e uestio s tha eeded?
Co o l used s ee i g tools i lude the Mal u-
Nu ses ha e se e al s ee i g a d assess e t
t itio S ee i g Tool MST a d the Mal ut itio
do u e tatio tasks the ust o plete he a
U i e sal S ee i g Tool MUST . The MST has
patie t is ad itted to the hospital. I easi g the
uestio s a out eight loss a d e e t i take, does
u e of ut itio s ee i g uestio s a f us-
ot e ui e al ulatio s, a d as e aluated i fou
t ate u ses a d lead to skipped uestio s o i -
oss se tio al studies fo use ith patie ts i a ute
eased e o s, the e edu i g the useful ess of
a e hospitals a d a ulato o olog e te s.
the NST. The li i al ut itio tea should e alu-
The MUST is a o e o p ehe si e fi e step NST
ate if a of the uestio s o the s ee i g tool
ith easu es of disease se e it , eight loss, a d
a e eli i ated, o if the ele t o i health e -
od ass i de BMI . It has a lo e se siti it of
o d EHR fu tio alit a d o kflo desig a
a d spe ifi it o pa ed to the SGA, ut patie ts
e adjusted a d usa ilit tested ith u si g to
ho e e ide tified as al ou ished usi g the
eate a o e i tuiti e o kflo . The easiest a
MUST e e a u atel p edi ted to ha e a lo ge
to do this is to t a k hethe patie ts o siste tl
le gth of sta . See Ta le fo o e details o so e
a s e es to the sa e uestio s. See Side a
NSTs alidated i the a ute a e setti g.
fo a h potheti al s e a io.
The li i al ut itio tea should o k ith u si g
. A e o -RDN staff ei g asked to ake a de isio
a d ph si ia s to ide tif hi h NST o othe ues-
ased o a a s e the patie t p o ides?
tio s to use du i g the ut itio s ee i g p o ess,
a d do u e t the hoi e i the ut itio poli ies . Does the NST ha e o e uestio tha a e eeded?
a d p o edu es P & P . The e aluatio p o ess de-
. A e o -RDN staff ei g asked to ake a de isio
s i ed i the e t se tio a help guide the hoi e
ased o a a s e the patie t p o ides?
of alidated NST.
. A e al ulatio s e ui ed?
Periodi Assess e t of the No - alidated NST . Do uestio s i the NST t igge a high u e of
false positi es?
If a hospital does ot use a alidated NST a d
. Does the NST fail to i di ate patie ts ho a e at isk
s ee i g uestio s a e i stead hose li i ia s,
fo al ut itio false egati es ?
the uestio s should e e aluated pe iodi all . Ta-
le i ludes a he klist of uestio s that should e Ta le . Che klist of uestio s to ask he
assessi g the ut itio s ee i g p o ess.
Futu e Di e sio s i Cli i al Nut itio P a ti e
T o of the ut itio s ee i g uestio s a e
. Do ou ha e p o le s he i g o s allo i g?
. Ha e ou lost eight e e tl ithout t i g?
Fo t o o ths, the li i al ut itio tea t a ks all
patie ts ho t igge positi el o the ut itio s ee .
Ni et pe e t of patie ts ith p o le s he i g o
s allo i g ha e lost eight e e tl , a d the efo e
a s e ed es to oth uestio s. Those ith he i g
a d s allo i g diffi ulties ho did ot lose eight
al ead o pe sated odif i g food te tu e a d
li uid thi k ess, thus o fu the ut itio i te e -
tio s e e eeded. Additio all , so e patie ts lost
eight u i te tio all fo easo s othe tha p o -
le s he i g o s allo i g, so that uestio ould
e eeded i depe de tl of the he i g/s allo i g
uestio . F o this i fo atio , the li i al ut itio
tea a de ide that uestio # i this s e a io
ould e eli i ated, e ause it is ot aptu i g pa-
tie ts ho eed a RDN assess e t a d i te e tio
a o e a d e o d the othe uestio s i the NST.
Side ar . H potheti al s e a io illust ati g dupli a-
ti e uestio s
Nut itio s ee i g uestio s should e li ited to
es o o uestio s, o othe losed-e ded
uestio s ith o je ti e ua titati e data. Fo
e a ple, a patie t ould espo d ith a ua tifi-
a le u e to the uestio Ho u h eight
ha e ou lost e e tl ithout t i g? . The
u se ould ot eed to judge hethe the
eight loss is sig ifi a t, ut ould si pl e o d
the a s e gi e . I this ase, a p e-dete i ed
alue ould eed to e esta lished to dete i e
the a ou t of eight loss that ould t igge a
efe al to the RDN.
. A e al ulatio s e ui ed?
If RDNs a e e ui ed to o plete a full ut itio
assess e t fo patie ts ith a BMI elo o
a o e a spe ifi alue, this i fo atio should al-
ulate a d t igge a efe al to the RDN auto ati-
all i a othe se tio of the EHR. The u se
should ot e asked to al ulate a BMI, o go to
a othe se tio of the EHR to fi d the BMI a d
the e te it i the ut itio s ee ; this i eases
the ti e e ui ed a d the likelihood of hu a
e o . Si ila l , the u se should ot e asked to
Wi te
al ulate the pe e t of eight loss o pe e t of
usual od eight ased o eight histo p o id-
ed the patie t. I ost ases, the EHR ill ha e
the fu tio al a ilit to o plete al ulatio s fo
use s.
. Do uestio s i the NST t igge a high u e of
false positi es?
As p e iousl dis ussed, false positi es a e e o s
that ide tif a effe t o o ditio he it is ot
p ese t; i.e. i di ati g that a patie t is at isk fo
al ut itio he he/she is ot. A s ee i g e-
fe al a e lassified as false positi e if the
patie t s a s e s o the NST i di ate a isk fo
al ut itio , ut the RDN did ot ide tif a ut i-
tio diag osis o i te e tio fo the patie t upo
o pleti g a full ut itio assess e t. If e tai
uestio s f e ue tl t igge false positi e efe -
als, the li i al ut itio tea should e o e d
e o i g o eph asi g those uestio s. See Side-
a fo a h potheti al s e a io.
. Does the NST fail to i di ate patie ts ho a e at
isk fo al ut itio false egati es ?
As p e iousl dis ussed, it is ti e i te si e to ade-
uatel a s e this uestio , e ause a RDN
Be ause ut itio is i po ta t fo ski i teg it , so e
u ses a d ph si ia s thi k that all patie ts at isk fo
o ith a u e t p essu e i ju should e e aluated
the RDN; the efo e, a B ade S ale s o e of o
less is added to the ut itio s ee , t igge i g a ut i-
tio efe al. Ho e e , if the patie t is ot al ou -
ished a d is eeti g ut itio eeds, o ut itio di-
ag osis is ide tified a d o fu the i te e tio the
RDN is eeded. This B ade S ale s o e uestio
the efo e eates false positi es a d o t i utes to
o - alue added o k fo the RDN. Patie ts at isk fo
al ut itio ould ha e al ead ee ide tified a d
efe ed to the RDN th ough the othe NST uestio s.
I this s e a io, the li i al ut itio tea should
o k ith the ou d a e tea to dete i e ho
est to ide tif patie ts ho a e t ul at isk fo al-
ut itio , athe tha those ho a e at isk fo ski
eakdo i depe de t of al ut itio .
Side ar . H potheti al s e a io de o st ati g a
NST hi h ge e ates false positi e efe als.
Futu e Di e sio s i Cli i al Nut itio P a ti e
Deg ee of al ut itio ?
Nut itio diag osis
Pt ID = o e; = ild; =
assig ed?
ode ate; = se e e
Y Y
N N
Y Y
Ta le . Sa ple olle tio fo a d data fo a QAPI p oje t e aluati g a NST
ould eed to assess all patie ts i the hospital o
o spe ifi u si g u its to dete i e if the e
e e patie ts ho eeded a RDN efe al ut
e e ot ide tified th ough the NST. Most hospi-
tals do ot ha e suffi ie t RDN staffi g to o -
plete su h a stud ; the efo e, usi g a alidated
NST ith high se siti it , spe ifi it , a d i te -
ate elia ilit is p efe a le.
A fo al Qualit Assu a e / Pe fo a e I p o e-
e t QAPI p oje t a e used to e aluate the o
- alidated NST. Ta le p o ides suggested data
poi ts to olle t fo ea h patie t i o de to e aluate
the se siti it of the NST uestio , e aluatio of
false positi e ut itio s ee efe als . Ea h pa-
tie t efe ed to the RDN th ough the NST ould e
e o ded usi g p e-dete i ed patie t ide tifie s.
The RDN ould the o plete the ut itio assess-
e t a d o the t a ki g fo do u e t hethe a
ut itio diag osis is assig ed, the deg ee of p otei
- alo ie al ut itio ide tified if a , a d hethe
a ut itio i te e tio is p o ided. If the a s e to
all th ee of those i di ato s is o o o e , the
the efe al is a false positi e a d should e ide ti-
fied as su h i the app op iate olu . The o e all
pe e tage of false positi es a the e al ulated,
as lo g as all patie ts efe ed th ough the NST du -
i g that ti e pe iod a e t a ked.
No sta da d a epta le pe e tage of false positi e
efe als has ee esta lished i the lite atu e, ut a
e tai tole a e le el fo false positi e efe als
a e e ui ed i o de to li it the u e of false
egati es issed efe als . The tole a e le el
a also e i flue ed a aila ilit of RDNs to
o plete ut itio assess e ts fo patie ts ho
a ot ha e a ut itio diag osis o eed a ut i-
tio i te e tio . Ho e e , staffi g le els should
Wi te
Nut itio i te e - False Reaso uestio
tio o pleted? Positi e? t igge ed positi el
N BMI <
Che / s allo
Y
diffi ult
N Weight loss
ot di tate ualit of a e. If the NST esults i a
high u e of false positi es, ut the ut itio
tea feels that this le el of spe ifi it is e essa to
ai tai a le el of se siti it , the QAPI data should
e sha ed ith hospital leade ship to ad o ate fo
a i ease i li i al ut itio staffi g.
T a ki g hi h uestio s t igge false positi e efe -
als ill help to ide tif hi h uestio s a e du-
pli ati e see uestio a d thus a eed to e
ha ged o deleted f o the NST.
Other Prioritizatio Criteria I depe de t of the NST
If RDNs eed to e otified of patie ts ho a e ot
aptu ed the NST, p o esses a e uilt i to the
EHR sepa ate f o the ut itio s ee . This sepa a-
tio is i po ta t he usi g a alidated NST, e-
ause additio of othe ite ia o uestio s ill i -
alidate the tool.
Addi g uestio s to gathe i fo atio that a e
o tai ed usi g othe ethods, espe iall auto ated
ethods, is ou te -p odu ti e si e the goal is to
keep a ut itio s ee i g p o ess si ple a d
ui k fo u ses o othe o - ut itio p ofessio als
to o plete. Most EHRs a so t diet o de t pe
to ide tif patie ts o e te al ut itio EN a d
pha a a eate a list of patie ts e ei i g pa -
e te al ut itio PN . A auto ati ut itio efe -
al a e uilt i fo patie ts ad itted ith a diag-
osis of o gesti e hea t failu e if ut itio edu a-
tio is desi ed to help edu e the likelihood of ead-
issio ithi da s of dis ha ge. Dietitia s a
a ess the patie t lists of ou d-osto a e u ses
to ide tif patie ts ith p essu e i ju ies if eeded.
If the EHR is ot a le to ge e ate these lists, RDNs
should o k ith I fo atio Te h olog IT to e-
ate the i o de to a oid asted ti e i the ut i-
tio s ee i g a d p io itizatio p o ess.
Futu e Di e sio s i Cli i al Nut itio P a ti e
If additio al t igge s fo a ut itio efe al a e add-
ed, esides those i the i itial NST, it is i po ta t to
o side se e al fa to s elati g to the EHR.
. Do you a t the t igge to e assessed o ly o
ad it, o o ti uously du i g hospitalizatio ?
It is i po ta t to u de sta d he e the efe al is
ge e ated. If it is f o a spe ifi do u e tatio
ele e t o a li i al fo , is the fo o pleted
egula l , i.e. dail o e e shift? So e fo s a e
o l o pleted o ad issio , thus ould ot e a
sou e of efe als th oughout hospitalizatio , a d
ould the efo e iss patie ts ho de li e ut i-
tio all du i g thei sta .
. Do you a t the t igge to ge e ate a efe al fo
all patie ts, o just so e?
So e fo s o tools a e used o l o e tai
u its o patie ts populatio s, a d thus a e
used as a o e spe ifi efe al sou e. Ma
EHRs a ge e ate efe als ased o spe ifi o -
ditio s added to the patie t s diag osis list, o o
spe ifi p oto ols o o de sets.
. Do you a t the t igge to ge e ate a efe al o -
ly if o e has ot al eady ee e ei ed f o a y
sou e?
I so e i sta es dupli ate efe als a e ot e -
essa , i.e. if the i itial NST ide tifies the patie t
as at isk fo al ut itio , a additio al o sult
ased o a BMI < a ot e e essa . Ho -
e e , if this patie t is late put o EN, the RDN
ould a t to e ei e a se o d efe al.
. Do you a t the t igge to ge e ate a efe al o -
ly if o e has ot al eady ee e ei ed f o the
sa e sou e?
Although it has ot ee alidated as a NST ,
so e fa ilities a e ui e that RDNs o plete
ut itio assess e ts o patie ts ith a lo
B ade S ale s o e. I this ase, it ould e i -
po ta t to set B ade efe als to t igge o l
o e du i g hospitalizatio , othe ise the RDN
a e ei e a efe al e e ti e the s o e is do -
u e ted, i.e. e e , o hou s.
Wi te
. Ho ill the RDN e ei e the efe al?
Refe als a p i t out i the RDN offi e, sho up
as a task o the RDN s EHR task list, o appea i a
epo t ge e ated the EHR. Will epo ts e au-
to ati all ge e ated, o ill so eo e eed to
a uall u the epo t? Whe e e possi le, e-
po ts should ge e ate auto ati all to a oid hu-
a e o i u i g the epo t, o fo getti g it
altogethe .
It is u ial to u de sta d the EHRs p o esses a d
li itatio s i o de to eate a effe ti e ut itio
s ee i g a d p io itizatio p o ess, thus de elopi g
a good elatio ship ith the IT depa t e t is i -
po ta t.
Pote tial Barriers to I ple e ti g a Validated NST
Whe hoosi g a NST, it is esse tial to o tai i put
a d u -i f o u si g, ph si ia s, a d othe
stakeholde s, su h as the ou d a e tea o hospi-
tal ad i ist ato s fo used o disease ased p oto-
ols ith a ut itio o po e t. Nut itio depa t-
e t a d hospital ide P & P eed to e updated to
efle t the p oposed ha ges to the NST a d p io iti-
zatio p o ess, a d app o ed i the sa e a e as
ould a othe P & P. This usuall i ol es app o -
al at a o all of the follo i g o ittees: Nut i-
tio , Pha a a d The apeuti s, Nu si g Leade -
ship a d Medi al E e uti e.
Ba ie s a e e ou te ed he ha gi g the
NST fo ultiple easo s. Ma edi al dis ipli es,
su h as gast oe te olog , otola golog , o olog ,
a d a o e feel that thei patie ts a e at the
highest isk fo al ut itio a d the efo e the NST
a d p io itizatio p o ess should e oad e ough
to ide tif all of thei patie ts at ut itio isk. If
these a ie s a e e ou te ed, the e aluatio p o-
ess p ese ted i this a ti le a p o ide assu a e
that a s ste ati e aluatio of the NST has ee
o pleted a d ill e epeated pe iodi all su h as
a uall o ia uall . Ke stakeholde s a e i -
ited to o plete the e aluatio p o ess ith the
li i al ut itio tea to p o ide g eate u de -
sta di g a d o e ship of the su ess of the p o-
je t. Choosi g a alidated NST app op iate fo the
setti g a d patie t populatio ill help e pedite this
Futu e Di e sio s i Cli i al Nut itio P a ti e Wi te

p o ess as the e aluatio as al ead o pleted o u it esou es. Redu i g the u e of e-

he the tool as alidated.
A othe pote tial d a a k fo a NST is u si g
o plia e ith o pleti g the tool a u atel a d
tho oughl . The u si g staff a ot u de sta d
the easo fo the NST, o its i po ta e. Additio -
all , the total olu e of do u e tatio e ui ed o
ad issio a also i hi it o plia e.
IT a also state that the EHR a ot e ha ged to
efle t the e s ee i g p o ess o that the a -
ot eate the patie t lists e essa fo the addi-
tio al p io itizatio p o esses used i additio to the
NST. Othe hospitals usi g the sa e EHR a e
a le to sha e est p a ti es o ho to uild the p o-
esses eeded to eet the eeds of the li i al u-
t itio tea . Of ote, the NST should e uilt so
that efe als to the RDN a e auto ati all ge e at-
ed he the patie t t igge s positi el o the ut i-
tio s ee .
Ofte , RDNs the sel es esist edu i g the u e
of s ee i g uestio s o ha gi g to a alidated
NST, due to o e that the ill ot e otified of
patie ts ho eed ut itio the ap , o that the
ill e o e hel ed ith e efe als. E aluatio
of i di idual t igge s a e espe iall helpful i
de o st ati g that the a e pe haps ot e essa ,
thus eassu i g the RDNs that issi g high- isk pa-
tie ts ill e i i ized.
The CNM should also fa ilitate a dis ussio ith the
li i al tea to help the ide tif thei o e all goals
i p o idi g a e fo patie ts. Ulti atel , the ues-
tio o es do to this: hi h patie ts ould ost
e efit f o RDN i te e tio ? Most p a titio e s
ould ag ee the hospital is ot the ideal setti g fo
diet edu atio ; oth ph si al a d e tal st esses
li it the patie ts a ilit to u de sta d a d etai
i fo atio , a d a patie ts a e just ot ead o
i te ested i ha gi g thei eati g ha its. I stead of
i ludi g the diag osis of dia etes as a t igge fo a
ut itio o sult, it ould pe haps e o e effe ti e
to o k ith u si g to e su e that all patie ts ith
dia etes e ei e disease a age e t edu atio al
ate ials at dis ha ge, i ludi g asi diet i fo -
atio a d efe als to outpatie t li i s a d othe
fe als e ei ed fo patie ts that ould ot e efit
fo ut itio i te e tio f ees up additio al ti e
fo the RDN to spe d o patie ts that eall eed
thei help.
Future Dire tio s
Nut itio s ee i g i a ute a e hospitals a e-
ei e o e u i e sal fo us i the futu e. The A ade-
has p oposed to the Natio al Qualit Fo u that
fou ele t o i li i al ualit easu es eCQMs
elated to al ut itio e used i the Hospital I -
Patie t Qualit Repo ti g P og a . If these
easu es a e app o ed, hospitals a hoose o e o
all of the al ut itio - elated eCQMs to eet CMS s
e ui e e ts fo easu i g patie t a e th ough
the EHR fo Medi a e pa e t i e ti es. O e of
these eCQMs is the e ui e e t to o plete a u-
t itio s ee ithi hou s of ad issio , thus the
use of a sta da dized a d alidated NST ill e e
e efi ial i easu i g the i pa t of that eCQM, if
i ple e ted.
Co lusio
To su a ize, a NST should eet the follo i g
ite ia to the a i u e te t possi le:
Validated fo a si ila patie t populatio
ith high spe ifi it a d se siti it
High i te - ate elia ilit
Qui k a d eas to use
I teg ated ith tea o kflo
P o ides ea i gful li i al i fo atio
If a ie s e ist to i ple e ti g a alidated NST, the
e aluatio p o ess des i ed i this a ti le a help
add ess those o e s a d/o efi e the NST p o-
ess a d i g ti el , high- ualit a e to ou pa-
tie ts.
Refere es
. A e i a Dieteti Asso iatio . ADA s defi itio s
fo ut itio s ee i g a d ut itio assess e t.
J A Diet Asso . ; : - .
. Va Bokho ts-de a de S hue e MAE, Guaitoli
PR, Ja s a EP, et al. Nut itio s ee i g tools:
Does o e size fit all? A s ste ati e ie of
s ee i g tools fo the hospital setti g. Cli
Nut . ; : - .
Futu e Di e sio s i Cli i al Nut itio P a ti e Wi te

. Patel V, Co ki s MR, DiMa ia-Ghalili RA, et al. ; : - .

Nut itio s ee i g a d assess e t i hospital- . K le UG, Kosso sk MP, Ka sega d VL, et al.
ized patie ts: A su e of u e t p a ti es i Co pa iso of tools fo ut itio al assess e t
the U ited States. Nut Cli P a t. ; : - a d s ee i g at hospital ad issio : a popula-
. tio stud . Cli Nut . ; : - .
. Sha C, Fleu et C, Pi ka d JM, et al. Co pa iso . Baue JM, Vogl T, Wi klei S, et al. Co pa iso
of a o el, si ple ut itio s ee i g tool fo of the Mi i Nut itio al Assess e t, Su je ti e
adult o olog i patie ts a d the Mal ut itio Glo al Assess e t, a d Nut itio al Risk S ee -
S ee i g Tool agai st the Patie t-Ge e ated i g NRS fo ut itio al s ee i g a d as-
Su je ti e Glo al Assess e t. Suppo t Ca e sess e t i ge iat i hospital patie ts. Z Ge o -
Ca e . . DOI . /s - - - . tol Ge iat . ; : - .
. NSCR: Nut itio s ee i g tools - . . Skippe A, Fe guso M, Tho pso K, et al. Nut i-
E ide e A al sis Li a of the A ade of Nu- tio s ee i g tools: A a al sis of the e ide e.
t itio a d Dieteti s e site. http:// J Pa e te E te al Nut . ; : - .
.a deal.o g/topi . f ? . Be gst o N, B ade BJ, Laguzza A, et al. The
e u= & at= . A essed Ma h , B ade S ale fo p edi ti g p essu e so e
. isk. Nu si g Resea h. ; : - .
. Fe guso M, Cap a S, Baue J, et al. De elop- . M Caule S. Mal ut itio a e: P epa i g fo
e t of a alid a d elia le al ut itio s ee - the e t le el of ualit . J A ad Nut Diet.
i g tool fo adult a ute hospital patie ts. Nut i- ; : - .
tio . ; : - .
. Elia M. The MUST epo t. Nut itio al s ee i g We dy Phillips is a Di isio Di e to of Cli i al Sup-
of adults: a ultidis ipli a espo si ilit . Mal- po t fo Mo iso Health a es o po ate ut itio
ut itio Ad iso G oup MAG . Reddit h, tea . Je ife Doley is a Regio al Cli i al Nut itio
BAPEN. . Ma age a d Dieteti I te ship Di e to ith Mo i-
. Nu sal TZ, No a T, Atala BG, et al. Si ple t o- so Health a e at Ca o delet St. Ma ys Hospital i
pa t tool fo s ee i g of al ut itio . Nut itio . Tu so , AZ.

O e f ee CPEU a aila le to CNM DPG e e s!

. Read the a ti le titled Nut itio S ee i g i the A ute Ca e Setti g: Ho to Choose the Right Tool
We d Phillips, MS, RD, CNSC, CLE, FAND a d Je ife Dole , MBA, RD, CNSC, FAND.
. Log o to the CNM DPG e site at dpg.o g.
. Go to the e e s o l se tio a d li k o the li k fo the CPE E a .
. Take the e a ; ou CPE e tifi ate ill e e ailed to ou ithi o e eek.

This a ti le has ee app o ed fo CPE, Le el ; Lea i g Needs Codes , , , ; Pe -

fo a e I di ato s . , . , . . The test ill e ai a aila le fo th ee ea s afte the pu li atio
date of this editio of Futu e Di e sio s i Cli i al Nut itio P a ti e Fe ua , .

Future Di e sio s I Cli i al Nutritio Ma age e t

Vie poi ts a d state e ts i these ate ials do ot e essa il efle t poli ies a d/o offi ial positio s of the Cli i al
Nut itio Ma age e t Dieteti P a ti e G oup o the A ade of Nut itio a d Dieteti s. Cli i al Nut itio
Ma age e t Dieteti P a ti e G oup of the A ade of Nut itio a d Dieteti s. All ights ese ed.