Learning Collaborative
 
September 25, 2020
The Dish
The Dish provides a monthly update to participating sites enrolled in the MQii Learning Collaborative.
 
 
 
SPOTLIGHT: MALNUTRITION-RELATED EVENTS AT FNCE 2020

The Academy of Nutrition and Dietetics’ annual Food and Nutrition Conference and Expo (FNCE) will be held virtually from October 17–20, 2020, and will include various events focused on malnutrition. This year, there will be multiple presentations from MQii Learning Collaborative members and others who have used their nutrition expertise and leadership skills to improve the quality of malnutrition care for patients in their facilities. Below are details on some of these events:
 
COVID-19 CORNER

As the pandemic continues, the MQii Leadership Team is compiling resources about responding to COVID-19 for Learning Collaborative members. Here are a few resources and updates that may be of use to you during this time:
 
 
WHAT'S AROUND THE CORNER?
Please check the MQii Learning Collaborative Calendar to see a schedule of upcoming events with corresponding registration links.

Coffee Break: “Improving Malnutrition Care Through Company Transitions and Mergers” | Thursday, October 8, 2020, at 2:00 PM ET

This conversation will provide an opportunity for Learning Collaborative members to discuss how they can best continue and advance malnutrition quality improvement projects amid transitions in corporate leadership, including during the COVID-19 pandemic.

Please register for the session in advance here.  
For all of our expert webinars and Coffee Breaks, we encourage you to send any questions for the speakers in advance to [email protected].
In case you missed it:

If you missed previous MQii Learning Collaborative expert webinars, you can access webinar recordings and slides on the MQii Member Portal. You will also find other member-only content, including the calendar of upcoming events, pre-recorded educational webinars, and archived Dish newsletters, on this site. As a reminder, the login information is: Username: MQii Password: MQiiLC2018!
Malnutrition Awareness Events

We encourage you to explore 3 upcoming, annual malnutrition awareness events:
Consider opportunities to share your MQii project and findings!

The following table outlines conferences that may be of interest to Learning Collaborative members in the coming months. We encourage you to look at the event websites, review submission criteria, and consider sharing your research with various audiences. Please reach out with any questions or for assistance pulling submission materials together.
 
 
 
ADVANCED PRACTICE OPPORTUNITY

The Dietitians in Nutrition Support (DNS) Dietetic Practice Group (DPG) is now offering its Advanced Practice Residency in Nutrition Support for Adults to qualifying RDNs. This program provides an opportunity for RDNs to become experts in the management of nutrition support for adults through the application of evidence-based practice. The primarily online learning format will enable all enrolled residents to continue to work in their home facilities. This could be an excellent opportunity to enhance your skills and leadership in malnutrition-focused research and quality improvement. We encourage you to learn more about the program and consider applying by November 1 on the DNS DPG website.
MALNUTRITION RESEARCH

The MQii Leadership Team will share 2 posters during the clinical care poster session at FNCE on October 18, 2020. The first, titled “Improving Nutrition Care Processes and 30-day Readmissions Through Malnutrition Quality Improvement Initiatives,” highlights the collective impact of 27 hospitals participating in the MQii Learning Collaborative that have utilized the MQii Toolkit and 4 electronic clinical quality measures (eCQMs) to improve the identification of malnutrition and reduce 30-day readmission rates.

In the second, the authors of the poster titled, “Utilization of Nutrition Interventions in Malnourished Hospitalized Patients: Similarities and Differences in Care,” analyzed data from 4 systems participating in the MQii Learning Collaborative to assess how nutrition intervention approach and utilization varied by the method of documenting malnutrition risk. Among other findings, the authors concluded that only 46% of malnourished patients received a nutrition intervention (such as oral nutrition supplements and nutrition education) and that patients with a physician malnutrition diagnosis and dietitian assessment received nutrition support more often than those without a physician diagnosis. This further highlights the importance of interdisciplinary care coordination and of educating physicians about malnutrition and their role in diagnosing to ensure appropriate malnutrition diagnoses.

Additionally, Lima et al. recently published a paper titled, “Decline of nutritional status in the first week of hospitalization predicts longer length of stay and hospital readmission during six-month follow-up,” that emphasized the importance of monitoring nutritional status as an essential step of nutrition care from the very beginning of hospital admissions. The authors concluded that severe weight loss more often identified a decline in nutritional status than did a decline in category of the Subjective Global Assessment (SGA). They recommended that future research should focus on the most time-sensitive criteria to determine the best approach for identification and documentation of acute changes in nutritional status and to optimize outcomes. 
LEARNING COLLABORATIVE PARTICIPANT RESOURCES
NFPE “Tip of the Month” 

What are the physical signs that may indicate a deficiency in vitamin B-12?

When performing a nutrition focused physical exam (NFPE), look for abnormalities in the eyes, oral cavity, and skin, along with effects on functional status. These abnormalities may include:
  • Pale conjunctiva: paleness at eyelid
  • Pale tongue: pale, smooth, slick appearance
  • Glossitis: sore, swollen, red, smooth tongue
  • Pallor: pale face and skin (may have yellow tinge)
  • Peripheral neuropathy: paresthesia (tingling or “pins and needles”), muscle weakness, pain in affected area
  • Ataxia: poor coordination, unsteady walk, difficulty with fine motor skills, change in speech, involuntary back-and-forth eye movements, difficulty swallowing
  • Impaired cognitive function, disorientation, or dementia
  • Fatigue
Note that these abnormalities may also be present with other micronutrient deficiencies. Conditions that may increase risk for vitamin B-12 deficiency include: suboptimal intake; autoimmune diseases such as Crohn’s disease, Celiac disease, or type 1 diabetes; strict vegetarianism/veganism; malabsorptive surgical procedures such as gastric bypass surgery or sleeve gastrectomy; SBBO; terminal ileum disease; or consumption of medications such as proton pump inhibitors (PPIs) and H2 blockers. You can visit the Academy’s Eat Right Store to find the NFPE Pocket Guide for further guidance. 
NEXT STEPS
  • Visit the COVID-19 page on our website for more resources
  • Attend the MQii-led and malnutrition-focused sessions at FNCE (see Spotlight for more links)
  • Attend the upcoming October Coffee Break if you have questions regarding your malnutrition quality improvement efforts or want to discuss new or continuing malnutrition initiatives 
  • Share your progress or reach out with any questions to your MQii Point of Contact; please also let us know about any transitions in leadership, requested topics for future events, or additional events of interest to share with other members