1. More-2-Eat: Implementation of the the Integrated Nutrition Care Pathway for Acute Care (INPAC)

2. The Problem Prevalence of malnutrition in Canadian hospitals is 45% Nutritional status deteriorates in hospital for some Food intake < 50% and malnutrition are independent predictors of length of stay Malnutrition is an independent predictor of mortality A malnourished patient in hospital costs $2000 more than a well nourished patient

3. Prevalence of Malnutrition in Hospital Reported prevalence of malnutrition among hospitals in North America and Europe: 20% to 60%. The prevalence of malnutrition at admission is reported at 45% in acute care hospitals in Canada (Allard et al, 2015). Prevalence based on SGA (Based on Nutrition Care in Canadian Hospitals Study)

4. The Response: The Integrated Nutrition Pathway for Acute Care (INPAC) An evidence-based algorithm for the detection, treatment and monitoring of malnutrition amongst acute care medical and surgical patients. Developed through consensus from leading Canadian experts, clinicians and other stakeholders. This algorithm is a minimum standard and if a hospital or unit provides care above this minimum, they are encouraged to continue their high quality practice.

6. Taking Action: The ‘More-2-Eat’ Project Objectives: 1)To develop an implementation program for the INPAC 2)Test and evaluate implementation in 5 diverse hospitals in four provinces Funding: Technology Evaluation in the Elderly Network (2015-17)

7. Who is involved? A single medical unit has been selected to test INPAC. Everyone! – This is an ‘integrated’ pathway as it requires the involvement of the whole healthcare team, as well as the patient and their family in supporting nutrition care in and post hospitalization. A multidisciplinary site implementation team has been set up to support INPAC implementation. A M2E Research Associate will be hired to conduct data collection and support implementation processes. INPAC recommends key disciplines taking the lead with specific care activities, but this does not mean that other disciplines cannot take on these roles as well.

8. What is Involved? Development of a site implementation team Developing and trying various methods to implement INPAC in your hospital – E.g. how will screening for nutrition risk be done at admission Data collected from staff, patients/families to monitor the implementation process – collected by M2E Research Associate and the University of Waterloo Research Team

9. Timeline April-December 2015 – Getting Ready! (forming teams, hiring M2E Research Associate, baseline data collection, focus groups etc.) January – December 2016 – Implementing INPAC (data collection etc.) January – March 2017 – Monitoring: How are you following INPAC? (minor data collection, focus groups etc.)