Simple Fixes to Administration of Nutritional Supplements Can Yield Big Results, Study Shows

Nearly half of all patients admitted to hospitals arrive malnourished, research shows. Many of these patients are prescribed nutritional supplements, but studies show an overwhelming number simply do not take them, leading to poor health outcomes and higher medical costs.

A University of Florida study has shown that changing the way hospitals document the distribution of nutritional supplements and better educating patients about the benefits of the medication can greatly improve patients’ health and cut waste.

“It’s relatively simple — if you eat, you get better faster,” said Sandra Citty, Ph.D., ARNP, UF College of Nursing clinical associate professor and lead study author. “We found that standardizing the ordering, administration and documentation of medical nutritional products tied to the electronic health record improved intake of products from 24 to 67 percent and decreased the return rate of prescribed supplements by 23 percent.”

The findings appeared in the BMJ Quality Improvements Journal.

Malnutrition is a major cause for hospital readmission, an increased risk for pressure ulcers and patient falls and added health care costs. Patients who use oral nutritional supplements have been found to have a shorter length of hospital stay, decreased medical episodes and reduced 30-day readmission rates.

Nutritional interventions are ‘‘low-hanging fruit’’ in the health care system — they are relatively easy to administer, fairly low cost and have few side effects. But studies have shown these supplements are often inconsistently offered and documented in hospitals, and many times large amounts go unconsumed.

Citty and her team conducted the study at UF Health hospitals in Gainesville and Jacksonville. Before the study began, Citty found that only 24 percent of nutritional supplements were potentially consumed by patients. Moreover, they found that in one day, more than 75 percent of products were returned unused to the formula room, noting a significant problem in administration and compliance as well as waste and costs.

Most hospitals do not effectively document nutritional supplement administration because it is not included in medication orders and there are fragmented methods to document administration by nurses. Citty’s team set out to improve this system.

First, they collaborated with a multidisciplinary nutrition improvement team to evaluate the processes and systems. They then developed a process improvement strategy to enhance the electronic health record to include nutritional supplements and products on the medication administration record. Before implementation, staffers — including nurses, patient support techs, nursing assistants, physicians, physician assistants, nurse practitioners, dietitians and pharmacists — were all trained in the new process.

The project took place from August 2014 to December 2015, with implementation of the new process beginning in July 2015.

After implementation, patients were educated about nutritional supplements. They reported this increased the likelihood they would take the prescribed nutritional supplements in the future. This new process improved nutritional supplement documentation to 100 percent and the return rate of unused prescribed nutritional supplements dropped by 23 percent.

Surveys revealed that hospital staff had a statistically significant increase in ease of administration and documentation of nutritional supplements, and 77 percent of staff reported the process change has had a positive effect on their practice. Also, 72 percent said they feel it has resulted in patients receiving more prescribed nutritional supplements.

The price of malnourishment can also be seen in the bottom line. According to studies, for every 1 percent increase in patients provided oral nutritional supplements, an average hospital can save $929,000. Citty’s project improved administration of these supplements by 16 percent, which could indicate a substantial cost savings for health care systems and patients.

“We are improving patient nutrition, reducing variations in care and reducing risks for our patients, which is our ultimate goal,” Citty said. “This study underscored the need for improved administration and documentation systems to enhance nutrition assessment and interventions.”