Background: Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention, yet incompletion and error rates of 30%-90% have been reported for commonly used screening tools. The effect of a series of quality improvement initiatives in improving the referral process and the overall performance of the 3-Minute Nutrition Screening (3-MinNS) tool was assessed for patients at National University Hospital (Singapore) at risk for malnutrition.
Methods: Annual audits were carried out from 2008 through 2013 on 4,467 patients. Performance gaps were identified and addressed through interventions, including (1) implementing a nutrition screening protocol, (2) nutrition screening training, (3) nurse empowerment for online dietetics referral of at-risk cases, (4) a closed-loop feedback system, and (5) removing a component of 3-MinNS that caused the most errors without compromising its sensitivity and specificity.
Results: Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009, respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After the interventions, nonreferrals decreased to 7% (2010), 4% (2011), and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 +/- 1.8 days to 0.3 +/- 0.4 days (p < .001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012), and 5% (2013), and the percentage of blank or missing forms was reduced to and remained at 1%.
Conclusion: Quality improvement initiatives were effective in reducing the incompletion and error rates of nutrition screening and led to sustainable improvements in the referral process of patients at nutritional risk.