(P30-014-24) Implementing Standardized Nutrition Screening and Assessment for Hospitalized Children: The P-INPAC Pilot Study Protocol

Objectives: The primary objectives are to assess current nutritional care practices related to screening and detection of malnutrition in hospitalized children, and to determine the feasibility of implementing a standardized nutrition care pathway (routine nutritional risk screening and assessment) in this population. The secondary objective is to assess practical aspects of pathway implementation to better anticipate challenges with broader implementation.

Methods: The Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) pilot study is a 3-phase, prospective, multicenter study across 3 Canadian pediatric, tertiary care hospitals (Toronto, Hamilton, and Montreal). It spans 32 weeks and involves 2 pediatric medicine and 1 surgical ward. It builds upon the success of the INPAC pathway for detecting, treating, and monitoring malnutrition in hospitalized adults in Canada.

The 3 phases are as follows:  

Health records of all eligible patients will be audited for current routine nutrition practices every other week (8 weeks). On alternating weeks, additional detailed nutrition screening and assessment of consenting patients will be performed by the study team using STRONGkids, PNST, SGNA, routine anthropometry, and patient mealtime and intake questionnaires.

Training and education about malnutrition, the P-INPAC pathway, and standardized nutritional risk screening and assessments, will be conducted by the research team for all impacted healthcare professionals (8 weeks).

Implementation of the first 2 steps of P-INPAC will be monitored and evaluated on the study wards, again through alternating audit and detailed assessments (16 weeks). Knowledge and practices questionnaires will be filled out by healthcare providers and compared to baseline.

Results: Recruitment for phase 1 is completed at 2 of 3 sites with 138 and 26 patients included in audit and detailed groups, respectively

Conclusions: Standardized nutrition risk screening and assessment of hospitalized children is uncommon, with recent studies suggesting suboptimal recognition of malnutrition by practitioners despite a high prevalence. This pilot study will assess the feasibility of implementing the P-INPAC pathway, which aims to improve prevention, detection, and treatment of malnutrition in acute care pediatric patients.

Funding Sources: Canadian Malnutrition Task Force