© 2023 Canadian Malnutrition Task Force
Implementation of P-INPAC in your facility will require readiness, careful planning, adoption and monitoring/ reinforcing the change in the long term.
For implementation purposes, a Toolkit is in development which will provide the knowledge and tools needed to take practical steps and to fit the pathway into the nutrition care of your hospital. It is recommended that each hospital establishes an interdisciplinary team to promote the integrated approach that is required to treat malnutrition and to sustain the nutrition culture change required to implement P-INPAC.
The pediatric working group of CMTF is planning an implementation study on P-INPAC in the near future, so we can further improve it and assess how it will lead to improved outcomes of our pediatric patients.
The Canadian Paediatric Society, in collaboration with CMTF’s pediatric working group, has developed an online CPD module that explains how health care providers can use the Pediatric Integrated Nutrition Pathway for Acute Care (P-INPAC) to better identify and manage malnutrition in hospitalized children. This interactive module, titled Reducing the burden of paediatric malnutrition: Practical tools to guide care can be accessed HERE. Until January 31 2023, use coupon code CPSNUTRITION at checkout to receive free access to the module.
The Safer Healthcare Now! Initiative found at: https://www.patientsafetyinstitute.ca/en/toolsResources/ImprovementFramework/Documents/Improvement%20Frameworks%20GSK%20EN.PDF contains some helpful general resources to assist facilities and teams to make improvements in patient care.
Figure 1: Deming Circle for Continous Quality Improvement
Figure 1 depicts the process for continuous quality improvement (Deming circle or PDSA cycle) which can be useful for implementation1
Changes can be tested by planning the details including predictions and theories (PLAN), trying the idea out on a small scale and collecting data (DO), comparing the results of the test with plans and predictions (STUDY), and then transforming what was learned into action (ACT). Often, each cycle provides a basis for the next PDSA Cycle.
Implementing a Change
Teams are ready to implement changes when their degree of belief is high that the change is an improvement in their system. While testing involves trying and adapting different ideas for change, implementation means that a change now becomes a permanent and integral part of the day-to-day operation of the system. Implementation is similar to testing in the following ways:
- PDSA Cycles are used to build knowledge of the implementation process and translate that learning into action;
- Predictions are made;
- Data are collected;
- Unexpected and unplanned impacts are documented and studied;
- New knowledge is built into subsequent plans.
Several PDSA cycles will likely occur before implementation of a P-INPAC component is undertaken.
PDSA Cycles are used to build knowledge of the implementation process and translate that learning into action. For example:
PLAN: What are we trying to achieve?
- Have all patients been screened for malnutrition at admission?
- Start small with a couple nurses
DO: Test your plan
- Have 1 or 2 nurses screen a few patients
STUDY: What worked? What didn’t?
- What do the nurses think of the screening tool? Was it easy to use? Time consuming? What could be improved?
- Can you increase the number of patients screened? Do you need to replan your strategy?
1Huysentruyt K, De Schepper J, Bontems P, et al. Proposal for an algorithm for screening for undernutrition in hospitalized children. J Pediatr Gastro Nutr. 2016;63(5):e86-e91.
2Improvement Frameworks. Getting started Kit. Canadian Patient safety institute 2011 www.saferhealthcarenow.ca/EN/Interventions/Pages/default.aspx