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Nutrition Screening in NICU (4.8)

Nutrition Screening in NICU (4.8) - Policies, Clinical, UWHC Clinical, Department Specific, Clinical Nutrition, Pediatric Policies

4.8


Administrative Departmental Policy
This department-specific policy applies to the operations and staff of the Clinical Nutrition Department of
the University of Wisconsin Hospitals and Clinics Authority as integrated effective July 1, 2015.

Policy Title: Nutritional Care of the Infant in the Neonatal Intensive Care Unit
Policy Number: 4.8
Effective Date: May 13, 2014
Revision Date: March 20, 2017
I. PURPOSE

To establish guidelines for nutrition care in the Neonatal Intensive Care Unit (NICU) of
the American Family Children’s Hospital.

II. POLICY ELEMENTS

Nutrition care is a component of patient screening through assignment of nutrition acuity,
assessment, and reassessment during hospitalization. Nutrition assessments are
performed by a Registered Dietitian Nutritionist (RDN) who is registered with the
Commission on Dietetic Registration of the Academy of Nutrition and Dietetics (AND),
certified in the state of Wisconsin, and employed at UW Health. Clinical Nutrition
Service staff provides nutrition care to patients and functions as members of the
interdisciplinary health care team. Resources available to the RDN for medical nutrition
therapy and nutrition care planning include established policies and procedures, the AND
Pediatric Nutrition Care Manual, Clinical Practice Guidelines, and Delegation/Practice
Protocols. All patients receive nutrition care based on the specific needs of the individual
patient. Nutrition care includes the following: 1) nutrition screen, 2) nutrition
assessment, 3) development of a nutrition plan of care, 4) monitor the patient relative to
the nutrition care process, 5) reassess needs as appropriate, and 6) educate the patient’s
family on diet and nutrition as appropriate.

III. PROCEDURE
A. Patients at nutrition risk as identified by the physician admission history and physical
and/or RDN are assigned an acuity level of high, moderate or low within 72 hours of
admission. Criteria include, but are not limited to, gestational age, weight at birth,
medical diagnosis, and nutrition support needs.
B. Patients identified at nutrition risk by the nutrition acuity process will be assessed within
72 hours of admission. Consults or referrals by physicians or health care practitioners
initiate a nutrition assessment and documentation in the medical record.
C. The Nutrition Care Process is a systematic approach that provides a framework for the
RDN to individualize care, taking into account the patient's needs and values and using
the best evidence available to make decisions.
The Nutrition Care Process consists of the following steps:

a. Nutrition Assessment: The RDN collects and documents information such as
food or nutrition-related history; biochemical data, medical tests and procedures;
anthropometric measurements, nutrition-focused physical findings and client
history.
b. Diagnosis: Data collected during the nutrition assessment guides the RDN in
selection of the appropriate nutrition diagnosis (i.e., naming the specific problem).
c. Intervention: The RDN then selects the nutrition intervention that will be
directed to the root cause (or etiology) of the nutrition problem and aimed at
alleviating the signs and symptoms of the diagnosis.
d. Monitoring/Evaluation: The final step of the process is monitoring and
evaluation, which the RDN uses to determine if the patient/client has achieved, or
is making progress toward, the planned goals.
D. A summary of the nutrition assessment and plan of care will be documented in the
patient's medical record.
E. Nutritional care for the at risk patient is reassessed within 7-10 days but may be adjusted
on an individual basis when there is a change in the patient's medical condition that
requires modification, when patient transfers to a higher or lower level of care, and when
nutrition problems have resolved. Patients acutely hospitalized, screened and re-screened
at no or low nutrition risk, will be rescreened within 10 days. If no nutrition diagnosis is
identified at the time of the assessment, the patient may be re-screened low the following
week resulting in a re-screen every 10 days only if the patient remains at low risk. When
an infant is re-screened as low, the RDN will document this in the patient’s medical
record and include criteria used.
IV. REFERENCES
ξ UW Health Policy No. 8.47, Screening, Assessment and Reassessment of Patients:
https://uconnect.wisc.edu/policies/clinical/uw-health-clinical/med-records/patient-
assessment/352.policy.
ξ Joint Commission Standards for the Hospital, Lab and Home Care Surveys:
https://uconnect.wisc.edu/inside-uw-health/mission-watch/survey-readiness-
resources/joint-commission/.
ξ Centers for Medicare and Medicaid Services (CMS) Conditions of Participation:
https://uconnect.wisc.edu/inside-uw-health/mission-watch/survey-readiness-
resources/joint-commission/.
ξ Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual:
https://uconnect.wisc.edu/depts/uwhc/clinical-nutrition-services/.
ξ Academy of Nutrition and Dietetics. eNCPT, Nutrition Terminology Reference Manual,
Dietetics Based Language for Nutrition Care:
https://uconnect.wisc.edu/depts/uwhc/clinical-nutrition-services/.
ξ UW Health Clinical Practice Guidelines: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/.
ξ UW Health Delegation/Practice Protocols: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/.



V. COORDINATION

Sr. Management Sponsor: Chief Nursing Officer and Senior Vice President Patient Care Services
Director Clinical Nutrition Services

SIGNED BY:
Barbara Byrne, DNP, RN, PPCNP-BC
Vice President, AFCH Clinical Operations

Megan Waltz, MS, MBA, RDN
Director, Culinary Services and Clinical Nutrition

Revision Detail:

Previous revision: September 4, 2015
Next revision: March 20, 2019