Nutritional Assessment

Related Product Information

Prealbumin is a simple blood test, as easy to perform as a glucose test. Prealbumin has a normal range of 17-40 mg/dL and a half-life of 1.9 days, compared to the traditional nutritional marker, Albumin, which has a half-life of 21 days. Monitoring with Prealbumin helps health care providers see a response to therapy much sooner.

Why Prealbumin ?

Speed. In the United States, the Joint Commission on Accreditation of Health Care Organizations (JCAHO) specifies that all patients must be nutritionally assessed soon after admission. Prealbumin is a quick, easy nutrition screening tool that can help meet this requirement. And physicians see results in 2 days, as opposed to 21 days with Albumin as the nutritional marker.

Reliability. Routine tests, such as serum Albumin, may be within the normal range, while Prealbumin indicates declining nutritional status. Prealbumin is also less affected by changes in hydration status and liver and renal function than other testing methods.

Results. Screening with Prealbumin can lead to early identification of patients at risk so health care providers can offer nutrition intervention. Also used to monitor the effectiveness of nutritional therapy, this biochemical marker is extremely sensitive to changes in nutritional status.

Simplify nutrition screening. Intervene early and see results. Incorporate Prealbumin from Beckman Coulter into your nutrition care process.

Financial Implications of Malnutrition: Larry H. Bernstein, MD, Thomas A. Shaw-Stiffel, MD, Mitchell Schorow, PhD, and Ronald Brouillette, MBA

Summary

Protein-energy malnutrition (PEM) or the possibility of developing PEM occurs in 30% to 50% of hospitalized patients; the frequency is determined by the criteria used in its assessment and the case mix of patients in the hospital population.

This condition exists independently of other medical conditions and results from preadmission or postadmission failure to meet nutrient requirements with associated loss of body weight and function, as well as impaired immunity. PEM also frequently arises in patients with a chronic condition and decreased functional reserve when a superimposed acute metabolic stress leads to accelerated nutrient depletion. Whether preexisting or not, PEM increases morbidity and mortality along with length of stay (LOS) and may be associated with complications such as pneumonia, sepsis, operative site infection, delayed wound healing, or decubitus ulcers. The cost of these complications and an extended LOS is a significant financial burden and a controllable medical liability for hospitals. Other costs include identifying patients at risk of PEM and providing nutrition support, not to mention treating any of its complications (mechanical, metabolic, and so forth). A proper analysis of the financial implications of late or untreated PEM versus nutrition support must therefore take into account not only the costs of complications or extended LOS due to the delay or failure to provide nutrition support, but also the costs associated with this intervention itself.

To receive the full text of this paper, in which the authors describe a model for examining the financial implications of malnutrition and nutritional therapy, contact us.

Integrating Prealbumin Testing into the Hospital's Nutritional Program

Form a Nutritional Support Team

Establish a Nutritional Support Team consisting of laboratorians, dietitians, pharmacists, nurses and physicians. This Nutritional Support Team determines criteria for acceptable nutritional support and meets regularly to ensure that the criteria are met. Top hospital officials should initially be involved in the establishment of the Team and continue to assess progress periodically.

Establish Testing Criteria

The Support Team should establish criteria that determine which patients are at risk and/or in need of nutritional testing. Criteria could include All newly-admitted patients, Patients over 65 years old, Patients with an inability to swallow or ingest food for five days prior to admission, Patients with a history of loss of over 20% of their weight, Patients with specific diseases, such as AIDS, Patients whose serum Albumin level is less than 3.2 mg/dL and Patients who are placed on TPN, PPN or enteral support

Develop a Nutritional Plan

A plan based on the estimated nutrient requirements of the patients identified as being malnourished needs to be developed. All patients need to be assessed by a dietitian within the first twenty-four hours of admission. Patients identified as malnourished should be monitored by the appropriate team members to insure that sufficient supplementation is provided.

Monitor Nutrition

Prealbumin should be measured 2-3 times per week and these results should be reviewed by the attending physician and consulting dietitian. Any necessary modification of diet should be brought to the attention of the attending physician.

Measure Impact of Implementation

Once Prealbumin testing is implemented, the actual effect on complications, hospital costs and hospital length of stay can be measured.