Success Stories


June 15, 2015 - Health Care Professional

Grey Bruce Health Services (GBHS) Implements Canadian Nutrition Screening Tool (CNST)

At Grey Bruce Health Services (GBHS) we have worked hard over the past year to implement the Canadian Nutrition Screening Tool (CNST) as a mandatory field in the electronic medical record for all adult patient admissions. Steps we took:

• July 2014 - Pre-implementation data was collected by a dietetic intern over a 3 week period. The results were similar data to CMTF data with only a third of patients screened to be at risk received a dietitian referral.

• August 2014 - GBHS data was then presented to the physician group and they responded asking for more information

• October 2014 - Dr. Heather Keller spoke at Grand Rounds explaining CMTF research initiatives

• January 2015 - Dietitians requested a medical directive whereby an automatic referral to a dietitian is generated when a patient screened at risk. Physicians were in unanimous agreement.

• January 2015 - Post-implementation data collected with paper screening tool improved dietitian referral rates to 2/3 of those screened at risk.

• May 2015 - Electronic documentation with the CNST as a mandatory field improved referrals for those screened at risk to 100%.

• Patients are triaged according to greatest need, with the patients at risk for malnutrition being considered a priority.

• Dietitians are assessing patients for malnutrition using subjective global assessment (SGA).

• Our medical directive allows dietitians to code malnutrition for physicians so it is properly recorded for a patient’s admission.

This initiative was supported by our entire team at GBHS and as a result we were awarded the 2015 Quality Award for the implementation of Malnutrition Screening. Other initiatives of note include our 2008 implementation of selective menus that offer patient choice at meal times in an effort to improve intake which was also recognized that year with a Quality Award.

What’s to come?
• Ready meals where hard to open packages are opened for patients on meal delivery to improve access to food.

• Protected meal times

• Formalizing a meal time assistance team where volunteers are trained in set up and feeding to help our patients reach adequate intake.

Written by: Nicole Ruff, RD Clinical Dietitian Medicine/Oncology and Professional Practice Leader Grey Bruce Health Services, Owen Sound, Ontario

© 2017 Canadian Malnutrition Task Force