Project Overview

Malnutrition is common in medical acute care patients, many of whom are older adults (>65 yrs), affecting up to half of patients, and having significant consequences on their quality oflife, and use of the healthcare system. Malnutrition commonly occurs in individuals who are frail. The evidence informed knowledge product called the Integrated Nutrition Pathway for Acute Care (INPAC) outlines a process to improve nutrition care by 1) implementing nutrition screening at point of admission and introducing standardizedpreventative measures to promote food intake; 2) ensuring malnourished patients receive timely individualized assessment and treatment; 3) optimizing nutritional care in malnourished patients with liberal high energy and protein diets; and 4) standardizing the process of monitoring food intake early and systematically. The INPAC has been piloted in 5 hospitalsacross Canada (More2Eat Phase 1), and this next phase of work is to spread at minimum 3 main components of INPAC (screening, assessment, and use of oral nutritional supplements regularly, referred to as “medpass”) to new units in the existing hospitals, and start in five new hospitals. The overall goal of More2Eat Phase 2 is to build on results from Phase 1 to develop and evaluate a sustainable INPAC implementation model. Currently, nutrition care in hospitals is ad hoc and referral processes miss malnourished patients. Approximately 45% of medical patients are malnourished at admission, and 75% of these patients are not identified. They have a longer length of stay, and return to the community in a frailer state, with a high likelihood of readmission. Although the acute care admission is often short, it is a critical event that can help to establish better nutrition care for a patient post discharge. Furthermore, it is anticipated that earlier identification and treatment of malnutrition during hospitalization will lead to a shorter length of stay and improved quality of life. The INPAC is a feasible pathway that has been shown to be effective; a sustainable mode of implementation is needed so all hospitals can have what is needed to work towards implementing INPAC. More2Eat Phase 1 sites experienced success in implementation. Results include: reduced patientreported barriers to food intake, increased identification of malnutrition risk and diagnosis of malnutrition, and an average 1 day shorter length of stay. These outcomes have a  significant patient and healthcare impact. Necessary Phase 1 factors for implementation were: a dedicated champion and site implementation team; strategic use of quality improvement andchange management techniques; frequent INPAC audits completed by the site team to track implementation of care activities; researcher lead analysis and feedback of monthly audits to site teams; and a researcher driven community of practice that mentored champions. The primary knowledge product of Phase 1 was an internet based INPAC Implementation Toolkit, which will be used in Phase 2. For Phase 2, this three component model uses the created toolkit to provide the necessary knowledge and skills for making change, focusing on the development of a champion, site implementation team, and engagement of the broader team/management. Two furtherknowledge translation activities will include: 1) external facilitation, comentoring and coaching, achieved through a Google group and monthly teleconferences, and 2) a selfserve registry for INPAC audits and reports to support feedback to hospital teams. We hypothesize that Phase 2 hospitals will successfully implement nutrition screening, assessment using the subjective global assessment (+ handgrip strength to assess frailty), and medpass during an 18month period in one unit, while the original Phase 1 hospitals will spreadthe activities to two or more medical or surgical units.