Mobile Assessment of the Malnutrition Risk in Adult Patients: Case Tampere University Hospital

Ulla Siljamäki-Ojansuu and Noora Kinnunen

As many as over 50% of hospitalised patients do not receive adequate nutrition, as malnutrition or the risk of malnutrition cannot be identified. At the Tampere University Hospital (Tays), Medanets’ mobile solution helps address the risk of malnutrition according to the care guidelines.

Malnutrition is a common but very poorly recognised problem. Approximately 20–60% of hospitalised patients suffer from malnutrition or are at a risk of malnutrition, and, according to even the most conservative estimates, approximately half a million hospitalised patients in Finland experience problems with nutrition. Due to the lack of ability to properly identify these problems, the majority of patients do not receive adequate clinical nutrition, although recognising the risk of malnutrition and proper clinical nutrition are an important part of patient safety. [1.] Medanets’ mobile solution helps address the risk of malnutrition according to the care guidelines.

Malnutrition affects the patient and costs society

From the perspective of the patient, malnutrition slows down recovery from diseases and operations, increasing the likelihood of complications and even mortality rates. Recognition of the risk of malnutrition and the resulting enhanced clinical nutrition have been shown to improve the patient’s general condition, functional capacity and autonomy while boosting their appetite, mood and quality of life. Clinical nutrition also supports the effects of medications and prevents infections and the development of pressure ulcers. [2.]

Ultimately, the recognition of the risk of malnutrition and enhancing clinical nutrition improve the quality of treatment and patient safety.

 Ulla Siljamäki-Ojansuu, Authorised Nutritionist

If left untreated, malnutrition also costs society: In Finland, the costs related to malnutrition are more than EUR 600 million a year.  The majority of costs are generated by prolonged hospitalisations: malnutrition typically extends a period of hospitalisation by 3–8 days, and the incurred costs per hospitalisation increase by EUR 2,900–6,500. On the scale of Europe, the costs of malnutrition are larger than the costs related to obesity. [3.]

Screening methods that comply with care guidelines

In order to ensure proper clinical nutrition, it is key to identify the patients that suffer from malnutrition or are at a risk of malnutrition as early as possible. According to international recommendations and the 2010 clinical nutrition guidelines, each hospitalised patient’s risk of malnutrition must be assessed by the second day of admission. The risk of malnutrition of adult patients (including patients over 65) is assessed with the NRS-2002 method in the wards and outpatient clinics of hospitals and primary healthcare units. [2.]

Medanets’ solution allows for performing a mobile evidence-based NRS-2002 screening at the point of care. This makes the screening and result documentation integral parts of the care flow. The NRS-2002 screening feature of the mobile application is identical to the assessment performed on paper. The nurse asks the questions of the NRS-2002 screening from the patient and records their answers on a mobile device. The Medanets feature guides the nurse through the workflow step-by-step. When the questions have been answered, the feature provides the results and displays a summary.  In addition, the feature displays a verbal assessment of the situation, such as “moderate risk of malnutrition” or “severe risk of malnutrition”.   Brief instructions depending on the risk category are then displayed.  The results are immediately available in the application and the Electronic Health Record to everybody involved in the treatment process.

Proven benefits at Tampere University Hospital

The NRS-2002 screening method for the risk of malnutrition is available in the Medanets’ mobile application as part of the clinical forms feature. It was piloted at the Tampere University Hospital from October 2019 to January 2020. The pilot involved wards focused on internal medicine, rheumatic diseases, gastroenterology and musculoskeletal disorders.

The Tays nutrition unit launched an initiative to incorporate the screening for the risk of malnutrition as part of the Medanets application already in 2017. Screening for the risk of malnutrition with Medanets was thus a long-awaited feature. We wanted to include different types of wards in the pilot project.

Ulla Siljamäki-Ojansuu, Chief Nutritional Therapist at Tays, Head of Nutrition Unit

The number of NRS-2002 screenings performed before and after the mobile solution pilot project were analysed. In September 2019, before the introduction of the mobile solution, the wards that participated in the pilot project performed 31 malnutrition screenings. In October–January 2019–2020, after the implementation of the solution, there were more than 200 entries. This shows that the use of the mobile solution is purposeful, and it has improved the identification of high-risk patients.

As a result of the ability to assess the severity of the risk of malnutrition and the structured operating models, Tays has started providing individualised, customer-oriented clinical nutrition services such as custom diets, use of clinical nutrition preparations and nutrition counselling. The mobile solution also boosts the patients’ motivation and commitment to their treatment plan by letting the patient know their risk of malnutrition and providing them with individual, customer-oriented clinical nutrition appropriate for the risk category at the ward. 

Medanets’ mobile solution allows for targeting clinical nutrition efforts on high-risk patients, improving the effectivity and cost-efficiency of care. Enhanced clinical nutrition is an investment as it generates savings by reducing the likelihood of complications and making hospitalisations shorter.

Ulla Siljamäki-Ojansuu, Authorised Nutritionist

Improved information exchange also ensures the continuity of clinical nutrition

The mobile solution makes it easier to exchange information between the parties involved in the treatment process, improving the safety and continuity of treatment. The practical advantages of the mobile solution also include the fast speed of the malnutrition risk assessment compared with screenings performed on paper or in the Electronic Health Record. The result of the screening performed at the point of care is uploaded directly to the EHR without any steps in between, and the screening does not require the nurse to perform any calculations. This improves the quality of treatment and frees up the nurse’s time for other tasks.

Identifying the risk of malnutrition is part of the Say NO to Pressure Ulcers operating model implemented in early 2020 in the Pirkanmaa Hospital District. As a result, the mobile feature is used more extensively in the treatment of all patients, allowing more patients to receive proper clinical nutrition according to their risk category. The use of the mobile feature that stores information in the EHR indicates the total trend of malnutrition risk assessment results of different wards. This makes it possible to use the information in planning the patient’s clinical nutrition more effectively. In terms of the patient’s functional capacity, it is important that the clinical nutrition required by the patient continues when they are transferred from one unit or organisation to another.

Read more about the Say NO to Pressure Ulcers operating model, used in Pirkanmaa Hospital District, here.

The article was written by authorised nutritionist Ulla Siljamäki-Ojansuu and Medanets’ Marketing Coordinator Noora Kinnunen.

SOURCES:

[1] https://www.duodecimlehti.fi/duo11941

[2] National Nutrition Council. 2010.  Ravitsemushoito. Suositus sairaaloihin, terveyskeskuksiin, palvelu- ja hoitokoteihin sekä kuntoutuskeskuksiin. Helsinki: Edita Publishing Oy. https://www.ruokavirasto.fi/globalassets/teemat/terveytta-edistava-ruokavalio/ravitsemus–ja-ruokasuositukset/ravitsemushoito_netti_2.painos.pdf

[3] Alanne S, Siljamäki-Ojansuu U & Saarnio J. 2019. Vajaaravitsemuksen kustannukset. Suomen Lääkärilehti, 20, 1278−81.