Malnutrition Management in a Canadian Hospital with the Integrated Nutrition Pathway for Acute Care (INPAC)

Purpose: Malnutrition is an underdiagnosed and undertreated medical condition among hospitalized patients. Validated nutritional care algorithms guide dietitians in identifying malnutrition and elaborating appropriate nutritional care plans for malnourished patients. This study describes how malnutrition was managed in a Canadian hospital that implemented the Integrated Nutrition Pathway for Acute Care (INPAC) algorithm. Methods: Retrospective chart audits were conducted using electronic medical records of all malnourished hospitalized patients admitted to nine acute care units in 2017 and 2019 to describe nutritional care plans during their hospitalization and at discharge. Results: A total of 158 and 122 patients were identified as malnourished in 2017 and 2019, respectively. All malnourished patients (100%) in 2017 and 2019 were provided with a nutritional care plan by a dietitian during their hospitalization. Nutritional discharge planning was more frequent in 2019 (n = 53, 43%), compared to 2017 (n = 46, 29%). The use of oral nutritional supplements (ONS) at mealtime remained the most commonly used nutritional intervention during hospitalization in 2017 (n = 106, 67.1%) and 2019 (n = 81, 66.4%). However, the assistance of a dietetic technician had become as frequently used as ONS at mealtime in 2019 (n = 81, 66.4%). Referring patients to an outpatient clinic represented the most frequently used nutritional intervention during discharge planning in both years (n = 20, 43.5% in 2017 and n = 35, 66.0% in 2019). Conclusions: All malnourished patients received a nutritional care plan during their hospitalization, but only half were provided with a nutrition care plan at discharge. Future studies are needed to assess the impact of nutritional interventions on malnourished patients during hospitalization and at discharge and to clarify the optimal number and types of interventions required to treat malnutrition.