A Nurse Driven Oral Nutritional Supplement Protocol developed from NDNQI Outcomes Data

Purpose:
Franciscan St. Francis conducts quarterly pressure ulcer prevalence studies to monitor effectiveness of our prevention program and occurrence of HAPU. NDNQI data is used to evaluate both frequency and effectiveness of preventative interventions, as well as appropriateness for at risk patients.

Significance:
Malnutrition, poor nutritional intake, and low body weight are significant influencers of pressure ulcer development and prolonged wound healing. 2010-2011 NDNQI data showed consistent performance below the top decile in providing appropriate nutritional support across all adult inpatient units.

Strategy and Implementation:
Following data review, we established a goal to outperform the median in providing nutritional support for at risk patients. Our approach was to develop a process that would enable systematic identification of patients at risk for nutritional deficits and to develop an evidence-based intervention aimed at preventing or lessening that risk. The first step in developing an oral nutritional supplement protocol was engaging primary stakeholders. The nurse driven Skin Action Team convened a subgroup to address evidence-based recommendations for a nutrition protocol. The subgroup was led by a CNS and included RN's from 4 adult units and a RD. We met with our nutrition representative to discuss how nutritional supplements could be used to meet the needs of our patients. Using the most current evidence-based literature and clinical practice guidelines we choose key etiologies for at risk patients and developed an algorithm to assist bedside nurses in selecting appropriate oral supplements.

Evaluation:
Following implementation of the nutrition protocol, evaluation metrics will consist of monitoring frequency and appropriateness of nutritional support for at risk patients during quarterly prevalence studies. Additional metrics will include monitoring overall prevalence and incidence rates.

Implications for Practice:
Implementation of an evidence-based nutrition protocol assists with the systematic identification of patients at risk for nutritional deficits and allows for targeted nutritional interventions. Thereby improving nutritional status and lessening the risk of pressure ulcer development.