LEARNING OUTCOME: To examine an alternative multidisciplinary procedure for nutrition risk screening to achieve more efficiency of registered dietitian time and to expedite medical nutrition therapy to patients at risk.

Departmental quality assurance monitoring indicated gradual deviation in the dietitian's ability to perform the nutrition screen within established timeframes.

Contributing variables were: compression of staffing; reduced length of stay; higher turnover, increased admissions. As nursing completed initial patient interviews within 24 hours, some information collected by the dietitian was duplicated.

Given the association's definitions for screening and assessment, and JCAHO's efforts to effect multidisciplinary patient care, a proposal was accepted by nursing administration to consider transferring nutrition screening to the nursing staff— thereby prompting a referral to the R.D. to assess and intervene with patients at risk more promptly.

Criteria were established and a screening tool for nursing was developed for a six-week trial period on one unit Concurrent screening was performed by the R.D.

The trial validated the tool to identify patients at nutrition risk; 88 percent accuracy was achieved. Over 30 percent of the trial population did not need R.D. contact. Subsequently, the tool was piloted with the remaining population, confirming the validity of the tool and the hypothesis for the project. The degree of accuracy for risk identification was 81 percent.

The final stage of the project involves incorporating the nutrition screening criteria into the nursing interview form, with quality assurance monitoring by nutrition services for compliance and appropriateness of referrals.