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NUTRITION RISK SCREEN

RN Chart Audit | 18 October 2016

OVERVIEW/BACKGROUND
The Nutrition Risk Screen is a method for determining patients at risk of poor nutritional status. Nutrition risk
includes items such as low BMI, weight loss, decreased PO intake, and severe illness. A component of the screen is
the Nutrition Risk Screen Score, which rates the level of nutrition risk from 0-7. In EPIC, under Flowsheets, is the
Malnutrition Risk Screen. The value that must be completed regardless of a positive or negative nutrition risk screen,
is the Nutrition Initial Screening, for which the following options are offered and all that apply should be chosen:

Patient BMI <20.5

Patient has lost weight within the last 3 months
Patient had a reduced dietary intake in the last week
Patient is severely ill
None of the above
If the Nutrition Initial Screening choice is negative (i.e., none of the above) a patient does not need a score and the
screen is complete. However, if the Nutrition Initial Screening is positive (i.e., if any of the options other than none of
the above is/are chosen), other cells will appear which must be filled for the nutrition risk screen to be considered
complete. For a positive nutrition screen to be complete, the following must be included:

Nutrition initial screening (options as listed above). If 1 or more positive options are chosen, all the following must
also be filled:
Highest weight in last 3 months
Weight at admission and at 4 day LOS
Percent Weight Loss (automatically calculated with above 2)
Score for impaired nutritional status
Score for severity of Disease
Final Screening total score (shows at chart)
If a screen is listed without all these categories filled, it is incomplete. Nursing staff are instructed to complete this
score within the first 24 hours from admit, and again at 4 day LOS.

Purpose
The purpose of this chart audit is to determine how often the screen is being performed completely and to discover
specific reasons for incompletion.

Method
The following floors were reviewed in this chart audit: 3A, 3C, 4A, 5A, 6A, 7A, Cardiovascular Lab, D10N, D10S,
D6N, D6S, D7N, D7S, D8N, and D8S. For the majority of the floors, patients were selected by choosing every other
patient with greater than 24 hour LOS per floor, starting with the first patient on the list. This is indicated as Every
other patient >24 hr stay. Patients who had less than 1 day length of stay were skipped.

Joyce Moon, Sodexo Dietetic Intern

18 October 2016
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Floors 3C and Cardiovascular Lab did not have enough patients meeting this criteria, so all charts for all patients with
greater than 1 day length of stay were reviewed. This is indicated as All pts with >1 day LOS.

Results
A total of 194 charts were reviewed from the floors stated above. Of these charts, 117 (62.4%) Nutrition Risk Screens
were complete while 73 (37.6%) were incomplete and 37 (19%) incorrectly completed. Table 1 shows the breakdown
of these scores by floor and Figure 1 displays the total number of screens that were complete or incomplete. Figures
2 and 3 display the percentage of Nutrition Risk Screens that were complete and incomplete, separated by floor.
Figures 4 and 5 illustrate the different reasons why screens were considered incomplete; 72% of incomplete charts
involved missing the highest weight in 3 months cell. As seen in these tables and figures, the floors with the highest
percentage of screens completed were 3A and 4A, followed by D10 North. 3C is exempt from this discussion as the
sample was mostly infants and not applicable. The 1 appropriate nutrition risk screen, however, was fully completed.
Floors below 75% complete included Cardiovascular Lab, 5A, 7A, D8N, D8S, D6N, D6S, D10S, D7N, and D7S. Of
the incomplete charts, the majority were incomplete due to not filling out the highest weight in the last 3 months. Also
notable was for negative nutrition risk scores, though None of the Above was chosen initially, the majority of nurses
filled out the remaining cells though it was unnecessary to do so.

Table 1. Nutrition Risk Screen Score Audit

Joyce Moon, Sodexo Dietetic Intern

18 October 2016
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Total Number Nutrition Risk Screens

Complete versus Incomplete

# Complete
38%
# Incomplete

62%

Figure 1. Total Number of Nutrition Risk Screens Complete/Incomplete

Percent Nutrition Risk Screen Complete

120.0%
100.0%
80.0%
60.0%
40.0%
Percent Complete 20.0%
0.0%

Floor

Figure 2. Percent Nutrition Risk Screen Complete by Floor

Joyce Moon, Sodexo Dietetic Intern

18 October 2016
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Percent Nutrition Risk Screen Incomplete

80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
Percent Incomplete 20.0%
10.0%
0.0%

Floor

Figure 3. Percent Nutrition Risk Screen Incomplete by Floor

Joyce Moon, Sodexo Dietetic Intern

18 October 2016
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Reason for Incomplete Screens Breakdown

11%
Missing highest weight in 3
months
Missing Highest Weight and
1% 3% Score(s)
6% Missing Highest Weight and
1% Admit/4 LOS Weight
Missing Score(s) and Heighest
Weight
Missing Score(s) only
Missing Score(s) and Admit/4
15% LOS Weight
No Risk Screen Recorded
63%

Figure 4. Breakdown by Reason for Incomplete Screens (top-bottom legend corresponds clockwise to chart)

Nutrition Screens Missing "Highest Weight in 3 Months"

Missing Highest Weight

28% in 3 months

Other (missing scores, admit/4 LOS weight, or no risk screen recorded)

72%

Figure 5. Incomplete Screen breakdown: missing "Highest Weight in 3 Months" versus Other Reasons for Incomplete

Joyce Moon, Sodexo Dietetic Intern

18 October 2016
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CONCLUSION
In conclusion, less than 65% of patients whose charts were reviewed had a complete Nutrition Risk Screen. Ideally,
100% of patients would have a Nutrition Risk Screen fully completed within 24 hours of admit. Having these screens
completed is beneficial for properly identifying patients who may have poor nutrition status and could benefit from
nutrition care. This audit shows that the majority of incomplete screens were due to not filling out a patients highest
weight in 3 months. This information is important is for gauging how much and how quickly a patient has lost/is losing
weight, which not only is a criteria for diagnosing malnutrition, but is also useful knowledge for nutrition intervention.
Other reasons for not completing screens fully were not entering a score, not entering an admit weight or LOS day 4
weight, or not entering a choice at the initial screen at all. It was also found that after selecting a negative screen,
nurses often will enter more information than is required by choosing None of the Above but continuing to fill out
other cells; it will save nurses time to accurately fill out screens. It also saves time for Registered Dietitians who may
see patients who are not at risk when the screen is filled out incorrectly.

To promote the completion of correct and timely Nutrition Risk Scores, the Registered Dietitians should continue
attending nursing huddles on each floor to emphasize the importance of this screen, and explain the reason why
knowing the highest weight in 3 months is a valuable tool for assessing nutrition risk. Similarly, Nurse Leaders should
remind their staff regularly to ensure they are completing these screens. These screens promote proper health and
care of the patients here at Providence Hospital, and are a valuable component of Team Care.

Joyce Moon, Sodexo Dietetic Intern

18 October 2016