Patients who transfer to RML Specialty Hospital often come directly from the ICU of a either a neighborhood acute care hospital or a downtown Chicago teaching hospital. Many of these patients receive nutritional support via feeding tubes due to having undergone tracheostomies, which subsequently leads to dysphagia (difficulty swallowing),” said Cindy Rohde, RD, LDN, a Nutrition Support Dietitian at RML. “Patients who are intubated with a breathing tube, have undergone trauma, or cannot use the oral route for nutrition often require a feeding tube.”
After following 500 patients by use of a specifically developed malnutrition protocol and subjective global assessment for RML patients, Rohde discovered that 74% of patients arriving from the ICU of acute care hospitals were moderately malnourished, and 15% were severely malnourished. “We realized a contributing cause was the patient not receiving full prescription of feeding in a day due to being off the feeding for a procedure, surgery, or other treatment.” explained Rohde.
“We switched patients to a volume-based feeding method, so they would receive the prescribed amount of nutrition each day, regardless of when they received it,” said Rohde. “If they were disconnected from their feeding tube during the day, the difference would be made up at night when they were less likely to have feeding interruptions and the formula could be run at a higher rate.”
After the switch, 95% of patients were found to have received their total prescribed nutrition on a regular basis, up from 82%. “This improvement is important, because a patient’s nutritional status is directly related to his or her ability to fight infection, heal wounds, be weaned off a ventilator, and work with physical and occupational therapists,” said Rohde. “Our focus on outcome-based results helps to improve each patient’s nutritional status, which in turn leads to a higher success rate for ventilator weaning, and a better chance of patients being able to perform daily activities after leaving RML.”