A retrospective review of 230 inpatients assessed at nutritional risk revealed that 45% of the patients had no follow up to complete the care plan. The average length of stay (LOS) was 4.22 days. Traditional standards did not promote a timely nor a complete intervention to improve nutritional risk status. Solutions selected to improve this were: 1) to decrease time spent on electronic documentation; 2) to increase time available for patient intervention and 3) to develop a standard of care based on LOS.

Diagnoses with short LOS (5 days or less) and with high incidence of nutritional risk were identified first. The standard of care developed was a single intervention to include the assessment and the education to improve the most important nutritional risk factor. Medical record documentation requirements were streamlined. Computerized daily care records were revised to collect all routine assessment information. New educational materials were prepared to be brief and easy to review. We then reduced the total number of keystrokes by 40% for all our existing electronic documentation. After a trial of the revised documentation showed a reduction in total documentation time, the short stay standard of care was implemented. Prospective review of 70 patients managed using this new standard revealed that education can be completed with the assessment, thus completing the care plan in a single intervention.