Submitted by Jan Greer-Carney, MS, MBA, RD, LD
Like most dietitians working in this health care environment, I am keen to make sure providers and other support clinicians understand the value of nutrition and the dietitian. I was looking on the falls report at my hospital and wondered what, if any, nutrition issues patients who fell might have. We have an electronic health record (EHR), so I had my Clinical Applications Support Team run a query to look at nutrition as it related to falls and subsequently the prevention thereof.
My query included:
- Nutrition risk status as calculated by the EHR, using a validated screening tool
- Patients with:
- Diagnosed malnutrition
- Low or high body mass index (BMI)
- Recent unintended weight loss
- NPO diet order for more than 3 days
- Poor intake for more than 3 days
- Age greater than 65 years
- Alcohol withdrawal
- Receiving either parenteral or enteral nutrition
- Receiving nutritional supplements
This was not a formal study, but a retrospective view of the current state. My query supported the role of nutrition in the prevention of falls. Obviously not all falls had a nutrition component, but enough did that nutrition parameters are now included in our Falls Risk Screening Tool.
Of those patients who had fallen, patients with diagnosed malnutrition, unintended weight loss, poor intake, or NPO for more than 3 days fell more frequently than well-nourished patients. That coupled with advanced age resulted in a higher frequency. More falls occurred in patients with either a low or a high BMI than in those with a BMI in the normal or overweight ranges.
My query also demonstrated that the dietitians and diet technicians were doing a good job of capturing patients in need of nutritional supplementation. All patients with poor intake or unintended weight loss who had a diet order other than NPO were getting supplemental nutrition of some sort. That was good to demonstrate to administration that the Nutrition Department was doing its part!
It gave me pause to realize how fortunate we are to live in the age where computers can help us accomplish this. Can you imagine the manual spreadsheet for this exercise? Now, I can add to my data every month and perhaps begin to see some kind of trend, thanks to nutrition informatics.