1. Tackling Malnutrition in … (insert your institution name here)
The purpose of this presentation is to help you elevate the conversation around malnutrition at your institution by providing you with content related to this serious yet often overlooked issue in Canada.
Since collaboration within your institution is an integral element in improving patient outcomes, organizing a meeting with some of your hospital key administrators and executives is an essential step in the process.
Note: Add your institution name as a means of customizing the presentation.

2. OUR Institution priorities
Optimize patient flow
Provide timely access to appropriate care
Ensure safe, high-quality, patient-centered care
Be cost-effective
You can use this slide to review your hospital priorities/concerns with your administrators and executives and highlight the negative impact of malnutrition on hospital priorities.
Note: This slide can be customized if needed.

3. Raise malnutrition awareness
Discuss available solutions
Agree on immediate actions
The next few slides are designed to help you:
Review some of the highlights from the Canadian Malnutrition Task Force (CMTF) Nutrition Care in Canadian Hospitals study (NCCH)
Present the current CMTF tools for the prevention and treatment of malnutrition
Stimulate discussions on the importance of concrete and immediate interventions to address the issue of malnutrition

4. Malnutrition predicts a lengthy and costly hospital stay
Hospital consequences
2-3
day longer stays in hospital1 1 2
OUT OF
Nearly
$2K
Average additional cost/patient2
Canadians admitted to hospital is malnourished1
The Canadian healthcare system is currently facing many challenges, including an increasing aging population admitted with multiple comorbitites while dealing with scarce resources.
Malnutrition creates an additional burden on the healthcare system
The Canadian Malnutrition Task Force (CMTF) conducted a cohort study from 2010 to 2013 in over 1000 patients from 18 hospitals across 8 provinces*, referred to as the Nutrition Care in Canadian Hospitals (NCCH) study. The authors reported that an astonishing 45% of patients (nearly 1 out of 2) are malnourished at hospital admission and that 1 in 4 of those entering the hospital malnourished are detected.
According to the CMTF study, each malnourished patient stays 2 to 3 days longer in the hospital than well-nourished patients, and this translates into about $2,000 more for each malnourished patient’s hospital stay, therefore dramatically increasing institutions’ costs.
Other research has shown that when malnourished patients are discharged, they are twice more likely to be readmitted in the healthcare system and 6 times more likely to die.
In summary, malnutrition is a widespread problem in Canadian hospitals that bears tremendous costs, both financially and in terms of patients’ quality of life.
In fact, the CMTF recently estimated the total annual burden of malnutrition in Canada to be approximately 2 billion dollars.
*Note: In preparation for your meeting, you may want to contact a colleague from a hospital site of your region that was involved in the NCCH study. Below are some of these sites:
NB: Campbellton Regional Hospital, Campbellton.
ON: University Health Network and St. Michael's Hospital, Toronto.
MB: St. Boniface General Hospital, Winnipeg.
AB: Royal Alexandra Hospital and Sturgeon Community Hospital, Edmonton.
QC: CHUM Notre-Dame Hospital, Montreal. x2
more likely to be readmitted3
Other research has indicated that malnourished patients are x6
more likely to die3
1. Allard JP et al.. JPEN 2015 Jan 26 [Epub ahead of print]. 2. Canadian 2015 Malnutrition Week poster. The Canadian Malnutrition Task Force. Accessed July 22, Lim SL et al. Clin Nutr 2012; 31: Canadian Malnutrition Week infographic.

5. Malnutrition negatively affects patients safety and performance indicators
- Risk of infection and pressure ulcers1
- Institution resources utilization and costs
- Patient flow2 and hospital access
Malnourished patients are at increased risk for developing pressure ulcers (also called pressure injuries) and infection (including hospital-acquired infections) which are both associated with the use of more resources. Resources can include treatment (e.g. medication), setting (e.g. more admissions to the ICU [intensive care unit]), healthcare provider time or medical equipment. This means higher costs for the institution.
In addition, malnutrition is associated with reduced patient flow - due to prolonged length of stay – and, consequently, decreased hospital access.
Finally, a recent patients’ survey derived from the NCCH study and led by Keller et al. reported that older, malnourished and sicker hospitalized patients had more eating difficulties and indicated an increased dissatisfaction with food quality (related to aspects such as taste, appearance, smell, portion size or temperature of food). Keller et al. mentioned that patient dissatisfaction with food service is associated with an increased length of stay and a low food intake; and that poor food intake during hospitalisation exacerbates malnutrition.
Clearly, malnutrition leads to many negative outcomes and can be perpetuated by hospital admission.
Note
Eating difficulties could mean any of the following barriers:
In an uncomfortable position to eat
Difficulty reaching food
Difficulty cutting up food
Difficultly opening packets/unwrapping food
Difficulty feeding self
Not enough time to eat all the food
Needed help to eat meals
- Patient satisfaction3
1. Lim SL et al. Clin Nutr 2012; 31: Keller H et al J Hum Nutr Diet Keller HH et al. J Hum Nutr Diet doi: /jhn

6. Malnutrition - What it means for us
Number of patients admitted each year: _________
Multiply by 45% = _________
Multiply by 2000 = ___________ $ annual cost of malnutrition
Performance indicators affected
(insert your institution key performance indicators here) …
More specifically, what does this means for our institution?
Note: Fill in the blanks with your hospital parameters prior to your meeting.
Considering that 45 % of your hospital admissions are malnourished patients, estimate the impact of these patients’ 2-3 days longer hospital stays which are known to each cost 2000$ more.

7. Malnutrition is preventable and can be tackled
Recognition & Treatment Tools and Algorithms
Canadian Nutrition Screening Tool (CNST)
Subjective Global Assessment (SGA)
Integrated Nutrition Pathway in Acute Care (INPAC)
My Meal Intake Tool (M-MIT)
Meal Audit Tool (MAT)
Education of healthcare team
Awareness raising
SGA training
nutritioncareincanada.ca
The CMTF has developed several easy-to-use resources to help identify ways to prevent and tackle malnutrition in your institution.
In addition, testimonials from other centers that have implemented strategies to improve nutrition care are also available on the CMTF website at nutritioncareincanada.ca.
This benchmarking can be helpful to improve the efficiency of interventions in your institution.

8. We need to take action - multidisciplinary Approach
Malnutrition awareness campaign
Steering committee to support nutrition care culture change
Champion(s) and stakeholders
Current practices improvements
Nutrition screening, assessment and prompt nutrition care (INPAC implementation)
Patients and families involvement
Healthcare professionals training
Being proactive within your institution is an integral element to take action towards the serious issue of malnutrition.
Next steps to advocate a multidisciplinary approach in your institution can include the following actions:
raising awareness on the importance of food for patient recovery i.e. missing a meal is like missing a medication or treatment;
creating a steering committee consisting of influencers across your institution who want to work collaboratively to develop the strategies, practices, and protocols to build a nutrition care culture in your hospital. Identifying a champion who will be in charge and involve stakeholders is a critical step to ensure success;
improving current practices by (1) endorsing and implementing nutrition screening for all medical and surgical patients at hospital admission to identify those at nutrition risk and to provide prompt and thorough nutrition assessment and care (INPAC); (2) ensuring patients and their families are part of the solution and are involved in nutrition care and (3) providing access to training for health care professionals who indicate their nutrition knowledge is not adequate.

9. Our institution next steps
(insert your next steps here) …
You can customize this slide to create a plan of action to be presented to your hospital key administrators and executives i.e. a discussion on what needs to be done to move the malnutrition agenda forward in your institution.
Examples: data collection at mealtime, development of a standardized screening process, budget for improving the quality/quantity of food provided, etc.
You can visit CMTF website at nutritioncareincanada.ca to learn more about implementing change in nutrition care processes.
Your goal is to have them agree on (a) specific item(s) to address the issue of malnutrition in your institution.