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                       JeffNEWS, September 13, 1994
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Jeff Nutrition Screening Program In Step With JCAHO Requirements
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By LINDA K. GALLAGHER, MA, RD
   Assistant Director, Patient Services, Department of 
   Nutrition and Dietetics

When members of the Joint Committee on Accreditation of Hospitals 
(JCAHO) next visit Jefferson, how well we screen, monitor and evaluate our 
inpatients for their nutrition needs is one care aspect they will review. 
JCAHO requires an interdisciplinary team approach to patient nutrition. 

Some years ago, Jefferson began to explore ways to screen and assess our 
patients' nutritional needs. With a full-fledged nutrition screening 
program in place since last January, this effort improves patients' care 
while they are in the hospital, and contributes to shorter lengths of stay. 
Both are key goals in the new era of health care.

To achieve these goals, dietetic technicians in the department of 
nutrition and dietetics screen patients for nutrition risk shortly after 
each patient's admission. Obtaining data at the bedside, they record the 
patient's height, weight, history of unintentional weight loss, and 
presence of persistent problems that adversely affect nutritional status. 
The number of nutrition risk factors determines the patient's level of 
nutrition risk.

The purpose of our screening program is to identify quickly patients who 
will benefit from comprehensive nutritional assessment and specialized 
nutritional care by the registered dietitian, and to provide nutritional 
support to those patients at nutrition risk. This means that every patient 
whose nutrition screening reveals either high or medium risk levels is 
evaluated by a dietitian.

Since many patients enter the hospital in poor nutritional state, some 
may become malnourished during hospitalization. This may occur because of 
the effects of chronic disease or acute illness. Patients may be unable to 
consume adequate nourishment or to benefit from the nutrients they do 
consume. In addition, often the patient's anxiety regarding hospitalization 
results in limited food intake. However it develops, malnutrition is 
clearly linked with poor outcomes, including increased patient 
complications and lengths of stay.

Integrating the nutritional assessment with other healthcare plans for 
the patient, the registered dietitian develops, implements and monitors the 
patient's nutritional care plan as prescribed by the physician.

With the advent of many new nutritional products and technologies, even 
the sickest patient can receive adequate nutritional support. Considering 
the patient's nutritional requirements, the dietitian will make 
recommendations for various forms of nutrition support including oral 
diets, tube feedings and parenteral nutrition. 

Identifying patients' need for nutrition education is a recent addition 
to the screening program. This helps prepare the patient for discharge and 
for making the transition back to daily life.

While an inpatient dietitian may begin nutrition education, in order for 
patients to be successful in making lifestyle changes in their eating 
habits, the dietitian will refer the patient for follow-up with a dietitan 
in Jefferson's Outpatient Nutrition Service. Since many outpatients return 
regularly, there can be more consistent and integrated follow-up. 
Outpatients can try out various nutritional approaches at home, for 
example. 

Consistent with JCAHO guidelines, our dietitians work with the other 
members of the patient care team, including physicians, nurses, 
pharmacists, speech therapists and others in both patient care and 
education. This collaboration enables a more comprehensive approach to 
patient care.

In summary, providing timely nutrition intervention for our patients 
results in improved patient care, fewer complications, improved outcomes, 
and contributes to shorter lengths of stay.


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Information provided by:  Editor, JeffNEWS
                          (215) 955-6204
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