at the University of Utah, and a team of doctors created a simple
checklist to screen for malnutrition.
The Strong for Surgery checklist asks patients 4 key questions to
determine if the patient is malnourished. Refer the patient to work
with a nutritionist or dietician in advance of surgery if the patient
answers yes to any of these questions:
• BMI less than 19;
• unintentional weight loss over 8 pounds in the last 3 months;
• poor appetite (eats less than half of meals or fewer than 2 meals per
day); and
• unable to take food orally.
As more facilities start to move to Enhanced Recovery After Surgery
(ERAS) protocols, pre-op nutrition will become even more important
for successful surgery, says Robyn Washington, MBA, BSN, RN,
CNOR, a clinical nurse III at Houston Methodist at the Texas Medical
Center. NPO after midnight has long been the standard, but ERAS
encourages patients to drink clear liquids up to 2 hours before surgery
and stop solid foods before midnight, says Ms. Washington. Houston
Methodist encourages patients to drink apple juice — preferably a
low-sugar brand — 2 hours before arriving at the facility.
It's been a slow process to get both surgeons and patients on board,
says Ms. Washington, but education has been a huge help. The hospi-
tal worked first with the surgeons' offices to get them up to speed on
ERAS and the role nutrition plays in patient outcomes. The hospital
supplies surgeons' offices with brochures that patients receive when
they schedule their surgery. Having doctors champion the cause —
especially the hospital's medical director, surgical director and mem-
bers of the anesthesia team — helped ease fears among hesitant doc-
tors.
"We have found that having other physicians discuss it with them
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